Prevalence of impaired renal function among rural and urban populations: findings of a cross-sectional study in Malawi

Nakanga, W. P., Prynn, J. E., Banda, L., Kalyesubula, R., Tomlinson, L. A., Nyirenda, M. and Crampin, A. C. (2019) Prevalence of impaired renal function among rural and urban populations: findings of a cross-sectional study in Malawi. Wellcome Open Research, 4, 92. (doi: 10.12688/wellcomeopenres.15255.1)

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Abstract

Background: Sub-Saharan Africa faces region-specific risk factors for chronic kidney disease (CKD), such as nephrotoxic herbal medicines, antiretroviral therapy and infections, in addition to hypertension and diabetes. However, large epidemiological studies from this area are scarce. Methods: In a cross-sectional survey of non-communicable diseases, we conducted a prevalence sub-study of CKD in two Malawian populations. Study participants (N=5264) of 18 years of age and above were recruited and data on demographics and CKD risk factors were collected. Glomerular filtration rate was estimated (eGFR) using the CKD-EPI equation. Results: The prevalence of eGFR<60ml/min/1.73m2 was 1.4% (95% CI 1.1 – 1.7%) and eGFR<90ml/min/1.73m2 was 20.6% (95% CI 19.5 – 21.7%). The rural area had higher age-standardized prevalence of both eGFR<60ml/min/1.73m2, at 1.8% (95% CI 1.4 – 2.3) and eGFR <90 ml/min/1.73m², at 21.1% (95% CI 19.9 – 22.3), than urban location, which had a prevalence of 1.5%, (95% CI 1.0 – 2.2) and 19.4% (95% CI 18.0 – 20.8), respectively, with overlapping confidence intervals. The prevalence of CKD was lower in females than in males in both rural and urban areas. Older age (p < 0.001), a higher level of education (p = 0.03) and hypertension (p < 0.001) were associated with a higher adjusted odds ratio (aOR) of low eGFR. Diabetes was associated with a reduced aOR of eGFR<90ml/min/1.73m2 of 0.69 (95% CI 0.49–0.96; p=0.03). Of participants with eGFR<60ml/min/1.73m2, 14 (19.4%) had no history of hypertension, diabetes or HIV, while 36 (50%) had a single risk factor of being hypertensive. Conclusions: Impaired renal function is prevalent, but lower than expected, in rural and urban Malawi. Further research is needed to increase understanding of CKD incidence, survival and validation of eGFR calculations in this population.

Item Type:Articles
Additional Information:The baseline survey was funded by the Wellcome Trust through a Strategic Award (098610/Z/12/Z and 098610/B/12/A) awarded to Prof Moffat Nyirenda. The creatinine testing was supported by a project grant from the GSK Africa Non Communicable Disease Open Lab (Project number:8111) as part of a broader multicenter collaborative study between South Africa, Uganda, Malawi and the London School of Hygiene and Tropical Medicine, which is collectively identified as the African Research in Kidney Disease (ARK) Network. We acknowledge GSK Open Lab and Wellcome Trust for their financial support during the different stages of this research.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Crampin, Professor Mia
Authors: Nakanga, W. P., Prynn, J. E., Banda, L., Kalyesubula, R., Tomlinson, L. A., Nyirenda, M., and Crampin, A. C.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:Wellcome Open Research
Publisher:F1000Research
ISSN:2398-502X
ISSN (Online):2398-502X
Copyright Holders:Copyright © 2019 Nakanga WP et al.
First Published:First published in Wellcome Open Research 4:92
Publisher Policy:Reproduced under a Creative Commons License
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