Measurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study

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dc.contributor.authorJune Fabian
dc.contributor.authorRobert Kalyesubula
dc.contributor.authorJoseph Mkandawire
dc.contributor.authorChristian Holm Hansen
dc.contributor.authorDorothea Nitsch
dc.contributor.authorEustasius Musenge
dc.contributor.authorWisdom P Nakanga
dc.contributor.authorJosephine E Prynn
dc.contributor.authorGavin Dreyer
dc.contributor.authorTracy Snyman
dc.contributor.authorBilly Ssebunnya
dc.contributor.authorMichele Ramsay
dc.contributor.authorLiam Smeeth
dc.contributor.authorStephen Tollman
dc.contributor.authorSaraladevi Naicker
dc.contributor.authorAmelia Crampin
dc.contributor.authorRobert Newton
dc.contributor.authorJaya A George
dc.contributor.authorLaurie Tomlinson
dc.date.accessioned2024-03-25T08:53:53Z
dc.date.available2024-03-25T08:53:53Z
dc.date.issued2022
dc.description.abstractBackground The burden of kidney disease in many African countries is unknown. Equations used to estimate kidney function from serum creatinine have limited regional validation. We sought to determine the most accurate way to measure kidney function and thus estimate the prevalence of impaired kidney function in African populations. Methods We measured serum creatinine, cystatin C, and glomerular filtration rate (GFR) using the slope-intercept method for iohexol plasma clearance (mGFR) in population cohorts from Malawi, Uganda, and South Africa. We compared performance of creatinine and cystatin C-based estimating equations to mGFR, modelled and validated a new creatinine-based equation, and developed a multiple imputation model trained on the mGFR sample using age, sex, and creatinine as the variables to predict the population prevalence of impaired kidney function in west, east, and southern Africa. Findings Of 3025 people who underwent measured GFR testing (Malawi n=1020, South Africa n=986, and Uganda n=1019), we analysed data for 2578 participants who had complete data and adequate quality measurements. Among 2578 included participants, creatinine-based equations overestimated kidney function compared with mGFR, worsened by use of ethnicity coefficients. The greatest bias occurred at low kidney function, such that the proportion with GFR of less than 60 mL/min per 1·73 m² either directly measured or estimated by cystatin C was more than double that estimated from creatinine. A new creatinine-based equation did not outperform existing equations, and no equation, including the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 race-neutral equation, estimated GFR within plus or minus 30% of mGFR for 75% or more of the participants. Using a model to impute kidney function based on mGFR, the estimated prevalence of impaired kidney function was more than two-times higher than creatinine-based estimates in populations across six countries in Africa. Interpretation Estimating GFR using serum creatinine substantially underestimates the individual and populationlevel burden of impaired kidney function in Africa with implications for understanding disease progression and complications, clinical care, and service provision. Scalable and affordable ways to accurately identify impaired kidney function in Africa are urgently needed.
dc.description.librarianPM2023
dc.facultyFaculty of Health Sciences
dc.identifier.urihttps://hdl.handle.net/10539/38200
dc.language.isoen
dc.schoolPublic Health
dc.titleMeasurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study
dc.typeArticle
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