Abstract
BackgroundNon-communicable diseases (NCDs) are a growing burden which affects every part of the world, including developing countries. Chronic kidney disease (CKD) has varied etiology which can result from or complicate other NCDs such as diabetes and cardiovascular diseases. The growing prevalence of NCDs coupled with the increasing age in most developing countries, has seen a marked increase of CKD in these settings. CKD has been described as “the most neglected NCD” and greatly affects the quality of life of patients. It also places a huge economic burden on societies. However, few epidemiological data exist, particularly in sub-Saharan Africa. Assessment of the prevalence of albuminuria as a marker of kidney damage and CKD progression and its main risk factors was thus needed in Rwanda.MethodsThis study analyzed data collected during the first STEPwise approach to NCD risk factor Surveillance (STEPS) survey in Rwanda, conducted from 2012 to 2013, to assess the prevalence of albuminuria. A multistage cluster sampling allowed to select a representative sample of the general population. Furthermore, descriptive, as well as univariable analyses and multiple logistic regression were performed to respond to the research question.ResultsThis survey brought a representative sample of 6,998 participants, among which 4,384 (62.65%) were female. Median age was 33 years (interquartile range, IQR 26-44), and over three quarters (78.45%) lived in rural areas. The albuminuria prevalence was 105.9 per 1,000 population. Overall, semi-urban and urban residency were associated with lower odds of CKD (odds ratio, OR 0.36, CI 0.23-0.56, p<0.001 and OR 0.34, CI 0.23-0.50, p<0.001, respectively) than rural status. Being married or living with a partner had higher odds (OR 1.44 (CI 1.03-2.02, p=0.031) and OR 1.62 (CI 1.06-2.48, p=0.026), respectively) of CKD than being single. Odds of positive albuminuria were also greater among participants living with human immunodeficiency virus (HIV) (OR 1.64, CI 1.09- 2.47, p=0.018). Gender, age group, smoking status and vegetable consumption, body mass index (BMI) and hypertension were not associated with albuminuria.ConclusionThe albuminuria prevalence was estimated at 105.9 per 1,000 in Rwanda. Rural residence, partnered status and HIV positivity were identified as main risk factors for albuminuria. Increased early screening of albuminuria to prevent CKD among high-risk groups, especially HIV patients, is therefore recommended.
Highlights
Chronic kidney disease (CKD) affects approximately 10 to 15% of the global population [1], and has been described as the most neglected Non-communicable diseases (NCDs) [2]
The required sample size was estimated at n=6549 to detect an odds ratio of at least 1.5, or n=6350 to detect an odds ratio lower or equal to 0.6, for any factor with an estimated prevalence of 10%, 95% confidence level, 90% precision and with a 1:10 ratio of people with albuminuria to those without albuminuria
Albuminuria prevalence among study participants Overall, 741 out of 6,998 (10.59%) of participants were found positive for albuminuria, which corresponds to a prevalence of 105.9 per 1,000 population
Summary
Chronic kidney disease (CKD) affects approximately 10 to 15% of the global population [1], and has been described as the most neglected NCD [2]. Major complications of CKD include hypertension, anemia, bone and electrolytes disorders and volume retention [9, 10]. All of these greatly affect the quality of life of patients, and are linked to high mortality levels [12]. CKD has been described as “the most neglected NCD” and greatly affects the quality of life of patients It places a huge economic burden on societies.
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