Search

Use of race adjustment in estimating glomerular filtration rate (eGFR) has been challenged given concerns that it may negatively impact the clinical care of Black patients, as it results in Black patients being systematically assigned higher eGFR values than non-Black patients. We conducted a systematic review to assess how well eGFR, with and without race adjustment, estimates measured GFR (mGFR) in Black adults globally. A search across multiple databases for articles published from 1999 to May 2021 that compared eGFR to mGFR and reported outcomes by Black race was performed. We included studies that assessed eGFR using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr) creatinine equations. Risk of study bias and applicability were assessed with the QUality Assessment of Diagnostic Accuracy Studies-2. Of 13,167 citations identified, 12 met the data synthesis criteria (unique patient cohorts in which eGFR was compared to mGFR with and without race adjustment). The studies included patients with and without kidney disease from Africa (n = 6), the United States (n = 3), Europe (n = 2), and Brazil (n = 1). Of 11 CKD-EPI equation studies, all assessed bias, 8 assessed accuracy, 6 assessed precision, and 5 assessed correlation/concordance. Of 7 MDRD equation studies, all assessed bias, 6 assessed accuracy, 5 assessed precision, and 3 assessed correlation/concordance. The majority of studies found that removal of race adjustment improved bias, accuracy, and precision of eGFR equations for Black adults. Risk of study bias was often unclear, but applicability concerns were low. Our systematic review supports the need for future studies to be conducted in diverse populations to assess the possibility of alternative approaches for estimating GFR. This study additionally provides systematic-level evidence for the American Society of Nephrology—National Kidney Foundation Task Force efforts to pursue other options for GFR estimation. [ABSTRACT FROM AUTHOR]

Individuals, societies, and the environment are affected by neglected and emerging diseases. These diseases result in a variety of severe outcomes, including permanent disabilities, chronic diseases such as chronic kidney disease, and even mortality. Consequences include high health care expenditures, loss of means of support, social stigma, and social exclusion. The burden of these diseases is exacerbated in low- and middle-income countries owing to poverty, inadequate fundamental infrastructure, and the absence of health and social protection systems. The World Health Organization is committed to promoting the following public health strategies to prevent and control neglected tropical diseases: preventive chemotherapy; intensive case management; vector control; provision of safe drinkable water, sanitation, and hygiene; and veterinary public health. In addition, it promotes a One Health strategy, which is a collaborative, multisectoral, and interdisciplinary approach to achieving the greatest health outcomes by recognizing the interdependence of human beings, animals, plants, and their shared environment. This article provides knowledge and strategies for the prevention and treatment of neglected and emerging diseases, with a particular concentration on kidney diseases, as part of a comprehensive approach to One Health. [ABSTRACT FROM AUTHOR]

Summary: The burden of chronic kidney disease (CKD) has increased exponentially worldwide but more so in low- and middle-income countries. Specific risk factors in these regions expose their populations to an increased risk of CKD, such as genetic risk with APOL1 among populations of West African heritage or farmers with CKD of unknown etiology that spans various countries across several continents to immigrant/indigenous populations in both low- and high-income countries. Low- and middle-income economies also have the double burden of communicable and noncommunicable diseases, both contributing to the high prevalence of CKD. The economies are characterized by low health expenditure, sparse or nonexistent health insurance and welfare programs, and predominant out-of-pocket spending for medical care. This review highlights the challenges in populations with CKD from low-resource settings globally and explores how health systems can help ameliorate the CKD burden. [Display omitted] [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a global problem with increasing prevalence. End-stage renal disease (ESRD) accounts for 8% of all medical admissions and 42% of renal admissions in Nigeria. Screening for CKD facilitates early detection, evaluation, and treatment of CKD. There is a dearth of community-based data on the magnitude of CKD in Nigeria. This was an epidemiological study to define CKD and its risk factors in rural and semiurban communities in Southeast Nigeria. Obesity was defined as body mass index (BMI) >30 kg/m2. The metabolic syndrome was evaluated using the National Cholesterol Evaluation Programme Adult Treatment Panel III definition; hypertension was defined as systolic blood pressure (SBP) 140 mm Hg and/or diastolic blood pressure (DBP) 90 mm Hg. Diabetes mellitus (DM) was defined as fasting plasma glucose 7.0 mmol/l or 2-h plasma glucose 11.1 mmol/l. Proteinuria was regarded as significant if 1+ and above, and hematuria was considered present if positive using urine strips. The glomerular filtration rate (GFR) was estimated using the CKD-EPI formula. A total of 2182 respondents aged 25-64 years were screened; 1941 with mean age of 43.7 ±13.2 years were analyzed. Of this number, 26.1% had hypertension, 5.9% had DM, 10.4% had the metabolic syndrome, 14.9% were obese and 19% had proteinuria and/or hematuria. The prevalence of CKD was 11.4%. This study documented high prevalence of CKD and its risk factors. Routine screening of patients for risk factors for CKD at each contact with the doctor will help to identify early CKD patients who may benefit from preventive measures. [ABSTRACT FROM AUTHOR]

Background. The magnitude of the problem of chronic kidney disease (CKD) is enormous, and the prevalence keeps rising. To highlight the burden of CKD in developing countries, the authors looked at end-stage renal disease (ESRD) patients seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria. Method. ESRD patients seen from 01/05/1990 to 31/12/2003 were recruited. Records from A&E Department, medical-out-patients, wards and dialysis unit were used. Results. A total of 1001 male versus 537 female patients were reviewed. About 593 male versus 315 female patients had haemodialysis. The mean age was 42.55 ± 15.43 years and 86.5% were <60 years. Primary renal disease could not be determined in 51.6% while hypertension and glomerulonephritis accounted for -17.2% and 14.6%, respectively. Death from renal causes constituted 22.03% of medical deaths. Conclusion. The prognosis for CKD patients in Nigeria is abysmal. Only few patients had renal-replacement-therapy (RRT). The prohibitive cost precludes many patients. This underscores the need for preventive measures to reduce the impact of CKD in the society. [ABSTRACT FROM AUTHOR]

Objective: Chronic kidney disease (CKD) is a major cause of cardiovascular morbidity and mortality all over the world. The combined effect of volume and pressure overload seen in patients with CKD is the primary cause of left ventricular hypertrophy (LVH). Though it accounts for a significant proportion of patients dying in hospitals in Nigeria, information on CKD in African Blacks is lacking. This study evaluates the prevalence of LVH and factors affecting it in pre-dialysis patients by using echocardiography. Design, Setting and Patients: One hundred consecutive patients with CKD who were attending the medical outpatient and renal clinics of University of Nigeria Teaching Hospital, Enugu, who satisfied the inclusion criteria were screened for the study. Eighty-eight patients completed the study. Forty-five age- and sex-matched subjects were selected as controls. Clinical and laboratory parameters and echocardiographic indices were measured. Results: Left ventricular hypertrophy (LVH), defined in absolute terms as left ventricular mass index >134 g/m2 in men and >110 g/m2 in women was present in 95.5% of patients and 6.7% of controls. The most prevalent type of LVH was eccentric hypertrophy, which was found in 54.6%, while concentric was seen in 40.9%. Hypertension was present in 85.2% of the patients. The predominant causes of CKD were chronic glomerulonephritis (43.2%), hypertension (25%), and diabetes mellitus (14.8%). All the patients studied had advanced CKD, either stage 4 or 5 of the Kidney Disease Outcome Quality Initiative classification of CKD. Stepwise method of multiple linear regressions identified mean arterial pressure (32%), hemoglobin concentration (22%), male sex (17%), and creatinine clearance (24%) as predictors of LVH in CKD. Conclusion: This study showed a strong association between CKD and LVH in patients in developing countries at the time of first evaluation by a nephrologist. It demonstrated a high prevalence of LVH in patients at first evaluation. The patients were often anemic and had severe hypertension even at first presentation. Early detection and treatment of causes of CKD should be pursued aggressively at the primary prevention level, as has been advocated by the International Society of Nephrology to reduce the effects of CKD and its attendant complications in the society. [ABSTRACT FROM AUTHOR]