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LETTER TO THE EDITOR
Year : 2012  |  Volume : 11  |  Issue : 2  |  Page : 119-120  

Chronic kidney disease in sub-Saharan Africa: Hypothesis for research demand


Department of Health and Environmental Science, School of Medicine, Kyoto University, Japan

Date of Web Publication6-Mar-2012

Correspondence Address:
Biruck D Yirsaw
Department of Health and Environmental Science, School of Medicine, Kyoto University
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.93537

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How to cite this article:
Yirsaw BD. Chronic kidney disease in sub-Saharan Africa: Hypothesis for research demand. Ann Afr Med 2012;11:119-20

How to cite this URL:
Yirsaw BD. Chronic kidney disease in sub-Saharan Africa: Hypothesis for research demand. Ann Afr Med [serial online] 2012 [cited 2019 Jun 26];11:119-20. Available from: http://www.annalsafrmed.org/text.asp?2012/11/2/119/93537

Dear Sir,

The world's disease profile is changing and chronic diseases are now considerably the leading cause of morbidity and mortality in the world, accounts for 60% of all deaths. One of the chronic diseases of a worldwide public health problem is chronic kidney disease (CKD), which recently has an increased prevalence in sub-Saharan Africa. Epidemiological and clinical evidences have shown an increased risk for CKD among individuals with diabetes, hypertension, obesity and infections and low economic situations. Owing to limited published reports available so far on the prevalence of CKD patients in the region, this review suggested a research need for CKD screening.

The world's disease profile is changing and chronic diseases are now considerably the leading cause of morbidity and mortality in the world, accounts for 60% of all deaths. [1],[2] This imperceptible epidemic is an underrated cause of poverty and hampers the economic growth of many countries. Contrary to the common perception, 80% of chronic disease deaths occur in low- and middle-income countries. [2],[3]

One of the chronic disease of a worldwide public health problem is chronic kidney disease (CKD), [4] which recently has an increased prevalence in sub-Saharan Africa. [5] CKD is defined according to the presence or absence of kidney damage and level of kidney function-irrespective of the type of kidney disease (diagnosis) [6]

Disease distribution

The disease is now recognized as a global public health problem. While the disease magnitude has been better characterized in developed countries; increasing evidence shows developing countries to receive even the greater burden. CKD and, to a greater extent, end-stage renal disease (ESRD), contribute substantially to the disparate burden of illness, disability and premature death across sex, age, race/ethnicity, socioeconomic status, and geographic boundaries. [7]

Epidemiological and clinical evidences have shown an increased risk for CKD among individuals with certain clinical and socio-demographic characteristics. [6] Cohort studies identified hypertension, diabetes, hyperlipidemia, obesity, and smoking as risk factors or markers in the general population for the development of CKD. [8],[9] However, in some places in Sri Lanka and Nicaragua, the conventional risk factors were not associated with the disease prevalence. [10],[11]

According to an extensive review made by Barsoum 2006, [12] chronic glomerulonephritis and interstitial nephritis are currently the principal causes of CKD in developing countries, reflecting the high prevalence of bacterial, viral, and parasitic infections that affect the kidneys. [13]

Diabetic nephropathy is estimated to be prevalent in South Africa (14.5-16.7%), Zambia (23.8%), Egypt (12.4%), Sudan (8.9-9.2%), and Ethiopia (6.1%). [14] In addition, it was estimated that by the year 2030, more than 70% of patients with ESRD will be residents of developing countries demanding organizational and financial resources for the prevention and early detection of CKD. [13]

This substantial burden on healthcare resources is as a result of the progressive nature of CKD and the ensuing ESRD. A research identifying the feature of this rapidly increasing disease in a particular geography has fundamental academic, clinical and epidemiological importance, which helps in the recognition of specific risk factors and subsequent planning for adequate prevention. [8],[12]

Basis for research intervention

Prevalence of CKD particularly ESRD patient population is on rise worldwide. It remains under-diagnosed and under-treated since in its early stages the disease is often asymptomatic, making individuals with the disease and also their health-care providers unaware of its silence yet threatening presence. [15]

The disease epidemiology in sub-Saharan Africa is markedly different from other regions. Although middle-aged and elderly populations are predominantly affected in developed countries; in sub-Saharan Africa, CKD mainly affects economically productive young society between the ages of 20 and 50 years with HTN, diabetes and infections. [5],[16]

According to a research done in Congo by Sumaili et al., the prevalence of CKD among the study subjects was 36%. [17] Similarly a study in Nigeria indicated the high prevalence of the disease. [18] A retrospective study in Dakar showed that 243 in-patients of chronic renal failure were managed in Dakar University Hospital Internal Medicine Department during a three-year period where the majorities were young and about a third was in ESRD. [5] Several associations have been made to explain the causal associations between CKD and environmental factors. [19]

Is CKD prevalent in most sub-Saharan African countries due to low economic and environmental condition? [6],[18] Does the gradual increase in prevalence of diabetes, [20] HTN, [21] and infections in sub-Saharan Africa put the people at higher risk for CKD? [8],[9] Understanding the pattern of CKD incidence is important for designing preventive strategies in most cost effective ways to slow down the progression of the disease; [6] however, limited published reports are available so far on the prevalence of CKD patients in the region.

 
   References Top

1.Beaglehole R, Yach D. Globalization and the prevention and control of non-communicable disease: The neglected chronic diseases of adults. Lancet 2003;362:903-8.   Back to cited text no. 1
    
2.WHO. The World Health Report 2003. Shaping the future. Geneva: World Health Organization; 2003.  Back to cited text no. 2
    
3.Atkins RC. The changing patterns of chronic kidney disease: the need to develop strategies for prevention relevant to different regions and countries. Kidney Int Suppl 2005;98:S83-5.  Back to cited text no. 3
    
4.K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, stratification. Part IV: Definition and classification of stages of chronic kidney disease. Am J Kidney Dis 2002;39:S46-75.  Back to cited text no. 4
    
5.Arogundade FA, Barsoum RS. CKD prevention in Sub-Saharan Africa: a call for governmental, nongovernmental, and community support. Am J Kidney Dis 2008;51:515-23.   Back to cited text no. 5
    
6.National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Executive summary 2002. New York: National Kidney Foundation; 2002.   Back to cited text no. 6
    
7.Pugsley D, Norris KC, Garcia-Garcia G, Agodoa L. Global Aprroaches for Understanding the disproportionate burden of chronic kidney disease. Ethn Dis 2009;19 Suppl 1:S1-1-2.  Back to cited text no. 7
    
8.Meguid El Nahas A, Bello AK. Chronic kidney disease: the global challenge. Lancet 2005;365:331-40.   Back to cited text no. 8
    
9.Míguez-Burbano MJ, Wyatt C, Lewis JE, Rodríguez A, Duncan R. Ignoring the obvious missing piece of chronic kidney disease in HIV: cigarette smoking. J Assoc Nurses AIDS Care 2010;21:16-24.   Back to cited text no. 9
    
10.Gooneratne IK, Ranaweera AK, Liyanarachchi NP, Gunawardane N, Lanerolle RD. Epidemiology of chronic kidney disease in a Sri Lankan population. Int J Diabetes Dev Ctries 2008;28:60-4.  Back to cited text no. 10
    
11.Torres C, Aragón A, González M, López I, Jakobsson K, Elinder CG, et al. Decreased Kidney Function of Unknown Cause in Nicaragua: A community based survey. Am J Kidney Dis 2010;55:485-96. Available from: http://www.sciencedirect.com. [Last accessed on 2010 Feb16].  Back to cited text no. 11
    
12.Barsoum RS, Francis MR. Spectrum of glomerulonephritis in Egypt. Saudi J Kidney Dis Transpl 2000;11:421-9.   Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.Barsoum RS. Chronic kidney disease in the developing world. N Engl J Med 2009;354:997-9.   Back to cited text no. 13
    
14.Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med 1997;14 Suppl 5:S1-85.  Back to cited text no. 14
    
15.Shyam C, Ashish K, Dugga AK, Sunder S. Chronic Kidney Disease: A Perspective. J Indian Acad Clin Med 2007;8:150-63.   Back to cited text no. 15
    
16.Krzesinski1 JM, Sumaili KE, Cohen E. How to tackle the avalanche of chronic kidney disease in sub-Saharan Africa: the situation in the Democratic Republic of Congo as an example. Nephrol Dial Transplant 2007;22:332-5.  Back to cited text no. 16
    
17.Sumaili K, Cohen EP, Zinga CV, Krzesinski JM, Pakasa NM, and Nseka NM. High prevalence of undiagnosed chronic kidney disease among at-risk population in Kinshasa, Central Africa: The Democratic Republic of Congo. BioMed Central Nephrology 2009; 10(1, article18).  Back to cited text no. 17
    
18.Afolabi MO, Abioye-Kuteyi EA, Arogundade FA, Bello IS. Prevalence of chronic kidney disease in a Nigerian family practice population. SA Fam Pract 2009;51:132-7.  Back to cited text no. 18
    
19.Soderland P, Lovekar S, Weiner DE, Brooks DR, Kaufman JS. Chronic kidney disease associated with environmental toxins and exposures. Adv Chronic Kidney Dis 2010;17:254-64.  Back to cited text no. 19
    
20.Bello AK, Peters J, Rigby J, Rahman AA, El Nahas M. Socioeconomic status and chronic kidney disease at presentation to a renal service in the United Kingdom. Clin J Am Soc Nephrol 2008;3:1316-23.  Back to cited text no. 20
    
21.Addo J, Smeeth L, Leon DA. Hypertension in Sub-Saharan Africa: A Systematic Review in Avialable from: http://hyper.ahajournals.org/cgi/reprint/HYPERTENSIONAHA.107.093336v1. [Last accessed 2010 May 9].  Back to cited text no. 21
    



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