RENAL DATA FROM ASIA - AFRICA
|Year : 2017 | Volume
| Issue : 6 | Page : 1389-1396
|Prevalence and risk factors of chronic kidney disease in an african semi-urban area: Results from a cross-sectional survey in Gueoul, Senegal
Maria Faye1, Ahmed Tall Lemrabott1, Mouhamadou Moustapha Cissé1, Khodia Fall1, Younoussa Keita2, Alioune A Ngaide3, Alassane Mbaye3, El Hadji Fary Ka1, Abdou Niang1, Abdoul Kane3, Boucar Diouf1
1 Department of Nephrology, Aristide Le Dantec Universitary Hospital, Dakar, Senegal
2 Department of Pediatrics, Aristide Le Dantec Universitary Hospital, Dakar, Senegal
3 Department of Cardiology, Grand-Yoff General Hospital, Dakar, Senegal
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|Date of Web Publication||18-Dec-2017|
| Abstract|| |
Chronic kidney disease (CKD) is a public health priority worldwide; however, its prevalence and incidence are difficult to assess. In Africa, few studies have been conducted on the prevalence of CKD. This study sought to describe the epidemiological characteristics and profile of CKD, as well as the related risk factors in Guéoul, a semi-urban zone in Senegal. An observational, cross-sectional, and descriptive study was conducted in Guéoul city in Senegal from November 1, 2012, to December 10, 2012, according to the WHO STEPS approach. People older than 35 years living in Guéoul city were included in the study. Cardiovascular and renal disease risk factor screening was conducted for this population. Data were analyzed using the 3.5.1 version of Epi Info software. The significance level was a P <0.05. One thousand four hundred and eleven participants with a mean age of 48 ± 12.68 years and a sex ratio of 0.34 were included in the study (359 men/1052 women). The prevalence of renal disease was 36.5%. Sixty-eight people showed proteinuria greater than two cross with urinary dipsticks. Two hundred and six people had a glomerular filtration rate <60 mL/min, and among them, 201 were in stage III, two in stage IV, and three in stage V according to the modification of diet in renal disease formula. Ninety-eight participants had morphological abnormalities. Cardiovascular risk factors found among participants with renal disease were obesity (25.2%), hypertension (55.5%), diabetes (2.3%), and renal and metabolic syndrome (32.43%). Those that statistically significantly correlated with renal disease were obesity (P = 0.0001), hypertension (P = 0.0001), and diabetes (P = 0.021). This study assessed the extent of renal disease in the population of Guéoul city. Being aware of the prevalence of CKD in the general population of Senegal is mandatory for defining appropriate strategies for the management of these risk factors and progression of renal diseases.
|How to cite this article:|
Faye M, Lemrabott AT, Cissé MM, Fall K, Keita Y, Ngaide AA, Mbaye A, Fary Ka E, Niang A, Kane A, Diouf B. Prevalence and risk factors of chronic kidney disease in an african semi-urban area: Results from a cross-sectional survey in Gueoul, Senegal. Saudi J Kidney Dis Transpl 2017;28:1389-96
|How to cite this URL:|
Faye M, Lemrabott AT, Cissé MM, Fall K, Keita Y, Ngaide AA, Mbaye A, Fary Ka E, Niang A, Kane A, Diouf B. Prevalence and risk factors of chronic kidney disease in an african semi-urban area: Results from a cross-sectional survey in Gueoul, Senegal. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Dec 13];28:1389-96. Available from: http://www.sjkdt.org/text.asp?2017/28/6/1389/220878
| Introduction|| |
The incidence and prevalence of chronic kidney disease (CKD) are difficult to assess with precision because renal impairment is usually asymptomatic. Many major surveys have been based on records of routine medical care and are biased. Renal disease fits in the context of noncommunicable diseases (NCDs), in the same way as diabetes and cardiovascular disease. These NCDs are major causes of morbidity and mortality in the world. The out-break of these NCDs and, in particular, cardiovascular diseases, diabetes, or CKD is due to the development of risk factors that are often common. The identification of these risk factors is essential to develop prevention strategies. Primary prevention is very important because of the high cost associated with these diseases and their complications. Thus, this study in the commune of Guéoul was conducted to measure the prevalence of CKD, to assess the profile of CKD and cardiovascular risk factors in relation to kidney disease in an attempt to plan prevention strategies.
| Materials and Methods|| |
This was an observational, transversal, and descriptive study conducted in Guéoul city. All people aged 35 or older, residents for at least six months, or more in the town of Guéoul were included in the study. Information was collected through a survey designed by the World Health Organization for the purpose of obtaining core data on established risk factors that determine risk burden. The STEPS instrument designed by the World Health Organization is divided into three main subsections:
Step 1- Questionnaire-based assessment: This includes:
- Social and demographic data
- Habits and lifestyle: Smoking and physical activity
- Medical history: Collecting information about hypertension, diabetes, dyslipidemia, healthy lifestyles, and family history;
Step 2- Simple physical measurements:
- Blood pressure
- Waist circumference.
Step 3- Biochemical and clinical measurements including:
- Urine examination
- Fasting glucose, creatinine, total cholesterol, HDL-cholesterol, and triglyceride measurement
- Morphological examination (height, corticomedullary differentiation, contours, and cysts) of the kidneys.
The data were collected at the interviewee's home by medical and paramedical personnel trained to use the STEPS instruments. People were recruited after signed the consent form. An electronic sphygmomanometer type was used to measure blood pressure. For each participant, two values of blood pressures spaced at least 10 min apart were systematically taken. After taking systolic and diastolic blood pressures on both arms, the highest numbers were selected. The weight of participant was taken with a scale placed on a stable and plane surface. To measure the participant's height, wearing a portable measuring rod was used neither shoes nor hat. The height was measured in centimeter. A standard tape meter, applied directly to the skin, was using to measure waist circumference. The urine examination used a MULTISTIX® brand dipstick which was immersed for 5 s in a fresh urine sample collected in an unused disposable cup. The reading was taken after 1 min. Creatinine was measured with kinetic creatinine. The analysis of laboratory data (glucose, creatinine, total cholesterol, HDL-cholesterol, and triglycerides) was done using a spectrophotometer. LDL was calculated using Friedewald's formula. Fasting blood sugar was performed for those who presented a blood sugar >1.26 g/L in the first assay. Morphological examination (height, corticomedullary differentiation, contours, and cysts) of the kidneys was done using a portable SonoSite® brand ultrasound equipped with a 2.5 MHz probe device.
Operational definitions used in this study were:
- CKD was defined as a creatinine clearance <60 mL/min and/or proteinuria (>2+) and/or pyuria and/or hematuria and/or morphological abnormalities of the kidneys (reduction in size <80 cm, long or poor corticomedullary differentiation, or presence of at least 2 cysts in each kidney). The creatinine clearance was calculated using the modification of diet in renal disease (MDRD) formula. The staging of CKD was based on KDOQI 2003 classification. Further evaluation of the participants presenting hematuria and pyuria in urine dipstick analysis was not possible due to the lack of microscopic urinalysis and urine sediment test. Those cases were not included as chronic renal diseases in the study
- Hypertension: People known with high blood pressure or with systolic blood pressure ≥140 or diastolic blood pressure ≥90 mm Hg
- Diabetes mellitus: People with diabetes or fasting blood sugar higher than 1.26 g/L (finded at two times)
- Dyslipidemia: People known with dyslipidemia or with one or more of the following abnormalities:
- Dyslipidemia type I: Hypertriglyceridemia (>1.5 g/L)
- Dyslipidemia type II: Hypo-HDL (<0.4 g/L in women and <0.35 g/L in men)
- Dyslipidemia type III: Total hypercholesterolemia (>2 g/L)
- Dyslipidemia type IV: Hyper-LDL >1 g/L.
- BMI: the ratio of weight (kg) to the square of height (m) was used to calculate BMI.
- Lean if BMI <18 kg/m2.
- Normal if BMI≥18 and <25 kg/m2.
- Overweight between 25 and 29.9 kg/m2 BMI.
- Obese if BMI ≥30 kg/m2.
- Abdominal obesity was defined using definition of the International Diabetes Federation (IDF).
- People with <150 min of physical activity per week was considered as low physical activity.
- Metabolic syndrome was defined using the IDF criteria in 2005.
All individuals signed written consent. The data were collected with full privacy considerations. All participants with health issues who need medical attention were referred to hospital
| Statistical Analysis|| |
The data were collected through an electronic questionnaire analyzed with Epi Info version 3.5.1 (CDC, Atlanta Georgia). Data were analyzed as follows:
- The descriptive study was carried out by calculating for each category, the proportions of the variables, and for quantitative variables, the positional and dispersion parameters
- A bivariate analysis used Chi-square test for comparisons of proportions, Student's test for comparison of means, and logistic regression. The difference was statistically significant if P value was inferior to 0.05. Correlation between risk factor and CKD was considered if prevalence was higher in the CKD group compared to the group without CKD, with a difference statistically significant.
| Results|| |
Description of Study Population
Among 1500 people who presented for the study, 1411 were selected and 89 were excluded because of incompleted parameters. The sex ratio was 0.34. The mean age was 48 ± 12.68 years (range 35–95 years). The most representative occupation was independent workers (52%). The prevalence of obesity and overweight was 13% (n = 183) and 25.4% (n = 358), respectively. Obesity was more prevalent among female patients (15.9%) than among males (4.5%) (P<0.001). The prevalence of alcohol and smokers was 0.6% (n = 9) and 2.5% (n = 35), respectively [Table 1]. The prevalence of physical inactivity in our cohort was 64% (n = 907). The prevalence of hypertension was 46.4% (n = 654). The prevalence of diabetes was 7.2% (n = 102). The prevalence of dyslipidemia in the overall study population was 61% (n = 862). The prevalence of metabolic syndrome was 19.8% (n = 279) according to IDF and 13.1% (185) according to NCEP.
Epidemiological profile of chronic kidney disease in the population of Guéoul
Five hundred and fifteen had kidney disease, a prevalence of 36.5%. The mean age of people with kidney disease was 48.78 ± 12.68 years (range: 35–95). Ages 50–60 and ≥70 years were the most representative (22% and 22.2%). Among people with chronic kidney disease, women comprised 73.3% compared to 26.7% of men with a sex ratio of 0.35. Independent workers, homemakers, and retired people represented 50%, 25%, and 12% of the people with kidney disease, respectively.
Renal disease parameters
Sixty-eight people or 15% of patients with CKD had proteinuria greater than two pluses with urinary dipsticks. According to the MDRD formula, 206 people (206/515) had a glomerular filtration rate (GFR) <60 mL/min [Table 2] and [Table 3]. Ninety-eight participants had morphological abnormalities including 81 with reduced kidney size and poor corticomedullary differentiation and 17 people showed polycystic kidneys.
Kidney disease and risk factors
The prevalence of smoking and alcoholism in patients with renal diseases was 2.5% and 1.2%, respectively. One hundred and thirty people (25.2%) were obese. The prevalence of diabetes and hypertension in people with renal disease was 2.3% and 55.5%. The prevalence of dyslipidemia was 44% and the metabolic syndrome occurred in 32.4% of people with renal disease [Table 4].
| Discussion|| |
The prevalence of chronic renal disease in the population of Guéoul city was 36.5%. This prevalence was far higher than that found in several other countries,, [Table 5]. The high prevalence found in the surveyed population could be explained partly by the fact that the study was conducted in a semi-urban area where access to care is very difficult in addition high prevalence of obesity and hypertension in this cohort. The majority of the population in Senegal use herbal and traditional treatments in which their nephrotoxicity is suspected but not yet proven. However, this prevalence cannot be applied to the Senegalese general population.
In our study, the mean age of the people with renal disease was 48.78 years. This relatively young age was also found in Seck's study (47.9) and other developing countries such as Congo (53.9 years) and India (45.22 years). However, in China, the mean age of the people with kidney disease was higher (63.6 years). In our series, the prevalence of CKD was higher in participants aged over 50 years. This contrasts with the results of the KEEP and NHANES studies where the peaks were in individuals aged over 60. Young patients in our study and in most developing countries could be explained mainly by the young character of the population in these countries but also the weakness of prevention strategies.
The prevalence of proteinuria greater than 2 pluses measured with dipstick was 15% in our study. This was correlated with a high level of proteinuria and could be equivalent to a weight exceeding 500 mg/24 h assay. Our results were similar to those found in the literature where high levels of proteinuria were found either by measurement of microalbuminuria (>300 mg/24 h) or urine dipsticks (>2+) or the ratio of albumin to creatinine in urine (>300 mg/g) [Table 6].
According to the MDRD formula, which was used in most studies to estimate GFR, 14.7% of the population in our study had renal failure. This was relatively close to that observed in most studies in the world. About 14.4% of our study population was in stage III of renal failure. This prevalence was similar to those of the KEEP study (14.8%), Nigeria (10.4%), and Japan (10.6%). However, it was higher than that of China (5.2%), the United Kingdom (4.9%), and Italy (3.3%). Renal failure stages IV and V combined were found in 0.3% of the population. These results were similar to those of NHANES, KEEP, and SEEK which were, respectively, 0.5%, 0.8%, and 0.8% of participants with severe renal impairment or end-stage renal disease (ESRD).,,
The prevalence of smoking in patients with kidney diseases was 2.5%. For participants with no other risk factors of CKD, the risk of impaired GFR is higher in smokers than in nonsmokers. In diabetics, smoking increases the risk of developing nephropathy and it is more serious when the number of cigarettes increases.
The frequency of obesity in renal patients was 25.2%. In our study as evidenced by data from the literature, obesity is a risk factor for onset of renal disease (P = 0.017) [Table 7]. Indeed, obesity increases the prevalence of CKD. Several epidemiological data have shown that increased body mass index is mainly associated with the development of glomerular diseases (GAO glomerular diseases associated with obesity).
The prevalence of hypertension in people with kidney disease in our study was 55.5% and it was significantly correlated with the occurrence of renal disease in the population (P = 0.0001). This result was higher than that found in an earlier study done in Saint Louis, where 39% of the people with renal failure had height blood pressure.
As reported in several studies worldwide, in our study, hypertension is a powerful predictor of renal impairment [Table 7].
The prevalence of diabetes in patients with kidney disease in our study population was 2.3%. A strong correlation between renal failure and diabetes mellitus has been shown in several studies around the world [Table 7]. It has even been reported that diabetes has become the leading cause of ESRD in developed countries.
The prevalence of dyslipidemia in people with renal diseases was 44%. This prevalence was also high (63%) in the study done in Saint-Louis, Senegal. Dyslipidemia is considered to be an initiation and progression factor of renal diseases.
| Conclusion|| |
This study enabled us to estimate the frequency of CKDs in the population of Guéoul city. However, these results cannot be generalized to the whole population of Senegal. It is therefore necessary and urgent to assess the prevalence of kidney diseases and cardiovascular risk factors in the general population of Senegal to plan preventive and therapeutic strategies. In the developing countries like Senegal, these strategies must be essentially based on primary prevention, keeping in mind the elevated cost of therapeutic measures which are not easily accessible to the whole population in these countries.
Conflict of interest: None declared.
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Department of Nephrology, Aristide Le Dantec University Hospital, Dakar
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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