High prevalence of undiagnosed chronic kidney disease among at-risk population in Kinshasa, the Democratic Republic of Congo

Ernest K Sumaili,Eric P Cohen,Nazaire M Nseka,Chantal V Zinga,Jean-Marie Krzesinski,Nestor M Pakasa

doi:10.1186/1471-2369-10-18

Ernest K Sumaili, Eric P Cohen + Show 4 more

Open Access

https://doi.org/10.1186/1471-2369-10-18

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Abstract

BackgroundThere is limited knowledge of Chronic Kidney Disease (CKD) among high risk populations, especially in the developing countries. We report our study of testing for CKD in at-risk subjects.MethodsIn a cross-sectional study, 527 people from primary and secondary health care areas in the city of Kinshasa were studied from a random sample of at-risk out-patients with hypertension, diabetes, obesity, or HIV+. We measured blood pressure (BP), blood glucose level, proteinuria, body mass index, and estimated glomerular filtration rate (eGFR by MDRD equation) using calibrated creatinine levels based on one random measurement. The associations between health characteristics, indicators of kidney damage (proteinuria) and kidney function (<60 ml/min/1.73 m2) were also examined.ResultsThe prevalence of CKD in this study was 36%, but only 12% were aware of their condition. 4% of patients had stage 1 CKD, 6% stage 2, 18% stage 3, 2% stage 4, and 6% had stage 5. 24 hour quantitative proteinuria (>300 mg/day) was found in 19%. In those with the at-risk conditions, the % of CKD was: 44% in patients with hypertension, 39% in those with diabetes; 16% in the obese and 12% in those who were HIV+. 82% of those with a history of diabetes had elevated serum glucose levels at screening (≥ 126 mg/dl). Only 6% of individuals with hypertension having CKD had reduced BP to lower than 130/80 mmHg. In multivariate analysis, diabetes, proteinuria and hypertension were the strongest determinants of CKD 3+.ConclusionIt appears that one out of three people in this at-risk population has undiagnosed CKD and poorly controlled CKD risk factors. This growing problem poses clear challenges to this developing country. Therefore, CKD should be addressed through the development of multidisciplinary teams and improved communication between traditional health care givers and nephrology services. Attention to CKD risk factors must become a priority.

Highlights

There is limited knowledge of Chronic Kidney Disease (CKD) among high risk populations, especially in the developing countries
Our findings show the effectiveness of community based targeted health screening program, in identifying significant numbers of persons with CKD previously undiagnosed, and in finding those with inadequate risk-factor control
This study suggests that there is a great potential for decreasing CKD as well as end stage renal disease (ESRD) incidence and cardiovascular morbidity or mortality by optimizing modifiable risk factors in this high-risk population

Summary

Introduction

There is limited knowledge of Chronic Kidney Disease (CKD) among high risk populations, especially in the developing countries. Major contributory factors for this ominous picture include late referral to hospital, limited renal replacement therapy (RRT), limited capacity of health workers for CKD detection and prevention, and poor awareness of kidney disease in the community [3,5,6]. This situation prompted the International Society of Nephrology Commission for the Global Advancement of Nephrology (ISN COMGAN) to make the fight against CKD one of its priorities, by promoting awareness, early detection, and effective treatment [7]

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