Performance of creatinine- or cystatin C–based equations to estimate glomerular filtration rate in sub-Saharan African populations

Bukabau, Justine Busanga; Yayo, Eric; Gnionsahé, Appolinaire; Monnet, Dagui; Pottel, Hans; Cavalier, Étienne; Nkodila, Aliocha; Makulo, J.R.; Mokoli, Vieux Momeme; Lepira, François Bompeka; Nseka, Nazaire Mangani; Krzesinski, Jean Marie; Sumaili, Ernest Kiswaya

doi:10.1016/j.kint.2018.11.045

Cited by 82 publications

(94 citation statements)

References 48 publications

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“…The authors also evaluated the Full Age Spectrum (FAS) equation and found it to be as accurate as CKD-EPI for GFR ≥60 mL/min/1.73m 2 but better for those with creatinine based GFR < 60 mL/min/1.73m 2 . Addition of cystatin C did not improve performance of the equations among this study group [25].…”

Section: Introductioncontrasting

confidence: 53%

“…Its advantages include low cost, excellent safety profile, low protein binding, low levels of toxicity at the dose used for measuring GFR, stability at room temperature (20 to 25°C), and being able to provide an accurate measure of glomerular filtration [20,23]. Previous studies using iohexol to measure GFR in sub-Saharan Africa have included few people with CKD [13,24,25]. The largest study to date conducted in the Democratic Republic of Congo and Ivory Coast used plasma iohexol to measure GFR in 494 participants.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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 subgroups , 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.

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Section: Introductioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…After processing, serum samples were then transferred to a central laboratory in each of the three study regions (eastern Uganda, southwestern Uganda and western Kenya) where serum creatinine was measured by the Jaffe method, traceable to isotope dilution mass spectrometry (IDMS) reference on the Cobas Integra 400 Plus (Roche Diagnostics, South San Francisco, CA, USA) and DRI-CHEM NX500i (Fujifilm, Tokyo, Japan) platforms in Uganda and Kenya, respectively. The resultant standardized serum creatinine values were used to estimate glomerular filtration rate (eGFR) using the CKD-EPI equation [20], without the black race coefficient given concerns that this may misclassify Africans [21][22][23].…”

Section: Kidney Function Assessmentsmentioning

confidence: 99%

The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study

et al. 2020

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Background Chronic kidney disease (CKD) may be common among individuals living in sub-Saharan Africa due to the confluence of CKD risk factors and genetic predisposition. Methods We ascertained the prevalence of CKD and its risk factors among a sample of 3,686 participants of a population-based HIV trial in rural Uganda and Kenya. Prevalent CKD was defined as a serum creatinine-based estimated glomerular filtration rate <60 mL/min/1.73m 2 or proteinuria (urine dipstick �1+). We used inverse-weighting to estimate the population prevalence of CKD, and multivariable log-link Poisson models to assess the associations of potential risk factors with CKD. Results The estimated CKD prevalence was 6.8% (95% CI 5.7-8.1%) overall and varied by region, being 12.5% (10.1-15.4%) in eastern Uganda, 3.9% (2.2-6.8%) in southwestern Uganda and 3.7% (2.7-5.1%) in western Kenya. Risk factors associated with greater CKD prevalence included age �60 years (adjusted prevalence ratio [aPR] 3.5 [95% CI 1.9-6.5] compared with age 18-29 years), HIV infection (aPR 1.6 [1.1-2.2]), and residence in eastern Uganda (aPR 3.9 [2.6-5.9]). However, two-thirds of individuals with CKD did not have HIV, diabetes, or hypertension as risk factors. Furthermore, we noted many individuals who did not have proteinuria had dipstick positive leukocyturia or hematuria.

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“…Recent evidence indeed suggests that it is more appropriate not to use the African American correction factor in SSA populations. 21,22 CKD was classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, using the combination of eGFR and albuminuria. A low eGFR was defined as eGFR <60 ml/min per 1.73 m 2 based on serum creatinine, cystatin C, or both.…”

Section: Assessment Of Ckdmentioning

confidence: 99%

Prevalence and Risk Factors of CKD in South Kivu, Democratic Republic of Congo: A Large-Scale Population Study

Masimango

Sumaili

Wallemacq

et al. 2020

Kidney International Reports

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Background: The prevalence of chronic kidney disease (CKD) in African American individuals is high but whether this applies to native populations in sub-Saharan Africa is unclear. Methods: In a cross-sectional study, we assessed the prevalence and risk factors of CKD in rural and urban adults in South Kivu, Democratic Republic of Congo. Glomerular filtration rate (GFR) was estimated using the CKD-Epidemiology Collaboration (CKD-EPI) equations based on serum creatinine (eGFRcr), cystatin C (eGFRcys), or both markers (eGFRcr-cys), without ethnic correction factor. CKD was defined as an eGFR <60 ml/min per 1.73 m 2 and/or albuminuria (albumin-to-creatinine ratio $30 mg/g). Results: A total of 1317 participants aged 41.1 AE 17.1 years (730 rural, 587 urban) were enrolled. The prevalence of hypertension (20.2%; 95% confidence interval [CI], 18-22.3), diabetes mellitus (4.3%; 95% CI, 3.2-5.4) and obesity (8.9%; 95% CI, 7.4-10.5) was higher in urban than rural participants (all P < 0.05). HIV infection prevalence was 0.41% (95% CI, 0.05-0.78). The prevalence of eGFRcr <60 ml/min per 1.73 m 2 was 5.4% (95% CI, 4.2-6.7). The prevalence of albuminuria was 6.6% (95 % CI, 5.1-8.1). The overall prevalence of CKD was 12.2% (95% CI, 10.2-14.2) according to CKD-EPIcr. Factors independently associated with CKD-EPIcr were older age (adjusted odds ratio [aOR], 1.05 [1.04-1.07]), urban residence (aOR 1.86 [1.18-2.95]), female sex (aOR 1.66 [1.04-2.66]), hypertension (aOR 1.90 [1.15-3.12]), diabetes (aOR 2.03 [1.02-4.06]), and HIV infection (10.21 [2.75-37.85]). The results based on eGFRcys or eGFRcr-cys were largely consistent with the preceding. Conclusion: Overall, the burden of CKD is substantial (>11%), predominantly in the urban area, and largely driven by classic risk factors (gender, aging, HIV, hypertension, and diabetes).

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Performance of creatinine- or cystatin C–based equations to estimate glomerular filtration rate in sub-Saharan African populations

Cited by 82 publications

References 48 publications

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

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

The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study

Prevalence and Risk Factors of CKD in South Kivu, Democratic Republic of Congo: A Large-Scale Population Study

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