How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study

Kalyesubula, R. et al. (2020) How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study. BMC Nephrology, 21(1), 20. (doi: 10.1186/s12882-020-1688-0) (PMID:31941441) (PMCID:PMC6964098)

Abstract

Background: Chronic kidney disease (CKD) is a substantial cause of morbidity and mortality worldwide with disproportionate effects in sub-Saharan Africa (SSA). The optimal methods to estimate glomerular filtration rate (GFR) and therefore to determine the presence of CKD in SSA are uncertain. We plan to measure iohexol excretion to accurately determine GFR in Malawi, South Africa and Uganda. We will then assess the performance of existing equations to estimate GFR and determine whether a modified equation can better improve estimation of GFR in sub-Saharan Africa. Methods: The African Research on Kidney Disease (ARK) study is a three-country study embedded within existing cohorts. We seek to enrol 3000 adults > 18 years based on baseline serum creatinine. Study procedures include questionnaires on socio-demographics and established risk factors for kidney disease along with anthropometry, body composition, blood pressure, blood chemistry and urine microscopy and albuminuria. We will measure GFR (mGFR) by plasma clearance of iohexol at 120, 180 and 240 min. We will compare eGFR determined by established equations with mGFR using Bland-Altman plots. We will use regression methods to estimate GFR and compare the newly derived model with existing equations. Discussion: Through the ARK study, we aim to establish the optimal approach to estimate GFR in SSA. The study has the advantage of drawing participants from three countries, which will increase the applicability of the findings across the region. It is also embedded within established cohorts that have longitudinal information and serial measures that can be used to characterize kidney disease over a period of time. This will help to overcome the limitations of previous research, including small numbers, selected population sub-groups, and lack of data on proteinuria. The ARK collaboration provides an opportunity for close working partnerships across different centres, using standardized protocols and measurements, and shared bio-repositories. We plan to build on the collaboration for this study for future work on kidney disease in sub-Saharan Africa, and welcome additional partners from across the continent.

• Item Type: Articles
• Additional Information: The study in Uganda and Malawi (RK) is funded by the GlaxoSmithKline Africa Non-Communicable Disease (NCD) Open Lab (Project Number: 8111). The study in South Africa (SN) is funded by the South African Medical Research Council, MRC UK (via the Newton Fund) and the GlaxoSmithKline Africa NCD Open Lab (Project Number: 074). LAT is funded by a Wellcome Trust Intermediate Clinical Fellowship (101143/Z/13/Z). The original cohort studies at MEIRU, Malawi were funded by the Wellcome Trust. ANW is supported by the Fogarty International Centre (NIH) under Award Number K43TW010698.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Crampin, Professor Mia
• Authors: Kalyesubula, R., Fabian, J., Nakanga, W., Newton, R., Ssebunnya, B., Prynn, J., George, J., Wade, A. N., Seeley, J., Nitsch, D., Hansen, C., Nyirenda, M., Smeeth, L., Naicker, S., Crampin, A. C., and Tomlinson, L. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: BMC Nephrology
• Publisher: BioMed Central
• ISSN: 1471-2369
• ISSN (Online): 1471-2369
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in BMC Nephrology 21(1):20
• Publisher Policy: Reproduced under a Creative Commons License