Abstract
ObjectivesData on renal dysfunction in sub‐Saharan Africa, comparing urban and rural areas, have not yet been reported. Therefore, we aimed to determine the distribution of low estimated glomerular filtration rates (eGFRs) in urban and rural Tanzania, to describe factors associated with low eGFR and to quantify fractions attributable to common risk factors.MethodsWe conducted a community‐based survey of 1095 randomly selected Tanzanian adults (≥18 years). A structured questionnaire and examinations were used to document sociodemographic characteristics, diet, physical activity, anthropomorphic measurements and blood pressure. Blood tests were performed for HIV infection, diabetes mellitus and creatinine. eGFR was calculated using two equations recommended for African adults.ResultsSerum creatinine was available for 1043 participants: 170 in Mwanza city, 326 in district towns and 547 in rural areas. Mean age was 35.5 years and 54% were females. The prevalence of eGFR < 60 ml/min/1.73 m2 in these 3 strata was 2.3% (95% CI = 0.8–6.6%), 7.5% (4.7–11.8%) and 7.4% (5.1–10.6%), respectively. When age standardised to the WHO world population, prevalences were 3.8%, 10.1% and 8.1%. Factors associated with low eGFR included district town residence, older age, greater wealth, less physical activity and hypertension. Only 21% of cases with eGFR < 60 ml/min/1.73 m2 were attributable to HIV, hypertension or diabetes.ConclusionsDecreased renal function is common in Tanzania, particularly in district towns, and unique risk factors for kidney disease may exist in this population. Population‐specific strategies for prevention, early diagnosis and treatment of kidney disease are needed for Africa.
Highlights
Despite the rising tide of non-communicable disease (NCD) in sub-Saharan Africa (SSA), few studies have assessed the burden of kidney disease in this region [1]
Health facility data indicate that kidney disease is common, including our own study from western Tanzania, which demonstrated that kidney disease was the 6th leading cause of hospital deaths [2]
According to a recent meta-analysis, only three high-quality epidemiological surveys had been conducted in SSA, and none had compared the prevalence of kidney disease in urban and rural settings [1]
Summary
Despite the rising tide of non-communicable disease (NCD) in sub-Saharan Africa (SSA), few studies have assessed the burden of kidney disease in this region [1]. Risk factors for kidney disease in SSA are poorly described and may differ from those in the United States and Europe [3,4], and between urban and rural areas [3,5]. Infectious risk factors for kidney disease remain common in SSA, in rural areas [5]. Noninfectious risk factors such as diabetes, hypertension and obesity are becoming increasingly prevalent, in urban areas [6]. Better understanding of risk factors for kidney disease in sub-Saharan Africa is critical for planning clinical trials and improving services [3,4,5]
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