Prevalence, concordance and associations of chronic kidney disease by five estimators in South Africa

Nasheeta Peer,Jaya George,Krisela Steyn,Carl Lombard,Andre-Pascal Kengne,Naomi Levitt

doi:10.1186/s12882-020-02018-x

Abstract

BackgroundTo determine the prevalence, distribution, concordance and associations of chronic kidney disease (CKD) determined by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town.MethodsData collection in this cross-sectional study included interviews, clinical measurements and biochemical analyses, including serum creatinine and cystatin C levels. GFR was based on the CKD Epidemiology Collaboration (CKD-EPI) equations (CKD-EPI creatinine (CKD-EPIcr), CKD-EPI cystatin C (CKD-EPIcys), CKD-EPI creatinine-cystatins (CKD-EPIcr-cys)), Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault formula (CGF). GFR < 60 mL/min/1.73 m2 defined CKD.ResultsAmong 392 men and 700 women, mean GFR, was between 114.0 (CKD-EPIcr) and 135.4 mL/min/1.73 m2 (CGF) in men, and between 107.5 (CKD-EPIcr-cys) and 173.4 mL/min/1.73 m2 (CGF) in women. CKD prevalence ranged from 2.3% (CKD-EPIcr and MDRD) to 5.1% (CKD-EPIcys) in men and 1.6% (CGF) to 6.7% (CKD-EPIcr-cys) in women. The kappa statistic was high between CKD-EPIcr and MDRD (0.934), and CKD-EPIcys and CKD-EPIcr-cys (0.815), but fair-to-moderate between the other eqs. (0.353–0.565). In the basic regressions, older age and body mass index ≥30 kg/m2, but not gender, were significantly associated with CKD-EPIcr-defined CKD. In the presence of these three variables, hypertension, heart rate ≥ 90 beats/minute, diabetes and low-density lipoprotein cholesterol were significant predictors of prevalent CKD.ConclusionsVarying CKD prevalence estimates, because of different GFR equations used, underscores the need to improve accuracy of CKD diagnoses. Furthermore, screening for CKD should be incorporated into the routine assessment of high-risk patients such as those with hypertension or diabetes.

Highlights

To determine the prevalence, distribution, concordance and associations of chronic kidney disease (CKD) determined by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town
Of the 1116 participants examined in this study, 24 were excluded because they did not have creatinine and cystatin C results to determine estimated GFR (eGFR)
The mean eGFR was between 114 mL/min/1.73 m2 (CKD-EPIcr) and 135 mL/min/1.73 m2 (CGF) in men, and 108 mL/min/1.73 m2 (CKD-EPIcr-cys) and 173 mL/min/ 1.73 m2 (CGF) in women (Fig. 1)

Summary

Introduction

Distribution, concordance and associations of chronic kidney disease (CKD) determined by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town. Contributing to the rise in CKD is the worldwide increase in prevalence of hypertension, diabetes, obesity and the metabolic syndrome. A few wealthy countries and individuals with access to private health insurance can meet the demands imposed by the late stages of CKD [1]. These options are frequently not available to the poor due to high costs nor in developing nations with limited resources and where renal transplantation may not even be available [3]. This leads almost inevitably to premature mortality and impacts hugely on families, both emotionally and economically with loss of income from breadwinners who are usually of working-age

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