Abstract P031: Prevalence And Severity Of Chronic Kidney Disease In Haiti: Findings From A Population-based Cohort

Abstract

Despite the increasing role of chronic kidney disease (CKD) as a major cause of global morbidity and mortality, there is limited understanding of its prevalence and risk factors in low-income countries, including Haiti. We hypothesized the prevalence of CKD is high in urban Haiti due to high rates of uncontrolled risk factors, primarily hypertension (HTN). We evaluated the prevalence and risk factors for CKD in a population-based cohort from Haiti. Among 2426 participants ≥18 years, serum creatinine and urinary albumin and creatinine were measured at time of study enrollment. Estimated glomerular filtration rate (eGFR) was dichotomized at <60 mL/min/1.73m 2 . Albuminuria was defined as an albumin to creatinine ratio (ACR) ≥30 mg/g. CKD was defined as reduced eGFR and/or albuminuria. HTN was defined as a systolic blood pressure (BP) ≥140 mmHg, diastolic BP ≥90 mmHg, or use of antihypertensive medication. Factors associated with CKD were assessed with logistic regression. National Health and Nutrition Examination Survey (NHANES) 2015-2018 data was used for cohort comparison. Median age was 41 years (IQR 28-55), 57% of participants were female, and 69% earned <1 USD per day. All participants identified as Black Haitian. The prevalence of HTN and diabetes were 34% (814/2426) and 6% (139/2426), respectively. Age -standardized CKD prevalence was 13.5%. More participants had albuminuria (283; 11.7%) than a reduced eGFR (70; 2.9%). Of those with HTN, 25.4% (207/814) had CKD. One participant had ESRD and required dialysis. Diabetes (adjusted odds ratio (aOR) 4.1, 95% Confidence Interval (CI): 2.7 to 6.2) and HTN (aOR 2.9, CI: 2.1 to 4.2) were significantly associated with CKD after adjusting for age, sex, education, and poverty. Compared to similarly aged non-Hispanic Black adults in NHANES, Haitians had a 14-fold lower prevalence of ESRD (0.04% vs. 0.59%). In conclusion, the prevalence of CKD is high in Port-au-Prince and HTN and diabetes were the greatest associated risk factors. The prevalence of ESRD was lower than in non-Hispanic Black Americans, likely due to low dialysis capacity in Haiti. With limited treatment options for severe CKD, early community-based identification and intervention of CKD coupled with better management of HTN and diabetes is critical.