Craik,AlisonMayindi,NokthulaChipungu,ShingiraiKhoza,BongekileGómez-Olivé, Xavier FTomlinson, Laurie Alexandra2022-12-092022-12-092022-12-11https://hdl.handle.net/10539/33712https://doi.org/10.54223/uniwitwatersrand-10539-33712https://creativecommons.org/licenses/by/4.0/Background: Urinary schistosomiasis caused by infection with Schistosoma haematobium (S. haematobium) remains endemic in Africa and is associated with haematuria and albuminuria/proteinuria. Kidney Disease Improving Global Outcomes clinical practice guidelines recommend evaluating proteinuria/albuminuria and glomerular filtration rate for chronic kidney disease (CKD) diagnosis. The guidelines are informed by population data outside of Africa but have been adopted in many African countries with little validation. Our study aimed to characterise the burden of urinary schistosomiasis in rural South Africa and evaluate its relationship with markers of kidney dysfunction with implications for CKD screening. Methods: In this baseline population-based cohort study, we recruited 2021 adults aged 20-79 years in the Mpumalanga Province, South Africa. Sociodemographic and anthropometric data were recorded, urinalysis performed, and serum creatinine and urine albumin and creatinine measured. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 and/or urine albumin-creatinine ratio >3.0mg/mmol. S. haematobium infection was determined by urine microscopy. Multivariable analyses were performed to determine relationships between S. haematobium and markers of kidney dysfunction. Results: Data were available for 1226 of 2021 participants. 717 (58.5%) were female and median age was 35 years (IQR 27 – 47). Prevalence of kidney dysfunction was 20.2% and prevalence of S. haematobium infection was 5.1%. S. haematobium infection was strongly associated with kidney dysfunction (OR 8.66; 95% CI 4.10 – 18.3) and related to albuminuria alone (OR 8.69; 95% CI 4.11 – 18.9), with no evidence of an association with eGFR <90ml/min/1.73m2 (OR 0.43; 95% CI 0.05 – 3.59). Discussion: The strong association between urinary schistosomiasis and albuminuria requires careful consideration when screening for CKD. Screening for, and treatment of, schistosomiasis should be a routine part of initial work-up for CKD in S. haematobium endemic areas. Urinary schistosomiasis, a neglected tropical disease, remains a public health concern in the Mpumulanga province of South Africa.Study information The African Research on Kidney Disease (ARK) Study aimed to determine chronic kidney disease (CKD) prevalence and identify associated risk factors in rural South Africa. The study took place from November 2017 to September 2018 and included a population-based sample (N=2759) of adults aged 20-79 years from the Agincourt Health and Socio-Demographic Surveillance System (HDSS) site in rural Bushbuckridge, Mpumalanga Province. Institutional review board approval was obtained from the University of Witwatersrand (clearance number M170583) Written informed consent was obtained from individual participants prior to enrolment. This is a secondary data analysis nested within the ARK study. In this population-based cohort study, we aimed to characterise the burden of urinary schistosomiasis in rural South Africa and evaluate its relationship with markers of kidney dysfunction with implications for CKD screening. We recruited 2021 adults aged 20-79 years in the Mpumalanga Province, South Africa. Sociodemographic and anthropometric data were recorded, urinalysis performed, and serum and urine samples collected. We measured serum creatinine and urine albumin/creatinine. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 and/or urine albumin-creatinine ratio >3.0mg/mmol. S.haematobium infection was determined by urine microscopy. Multivariable analyses were performed to determine relationships between S.haematobium and kidney dysfunction. The methodology for this sub-study is dependent on the larger ARK study processes. Data quality and ethics processes have previously been validated by the ARK consortium . Institutional review board approval was obtained from the University of Witwatersrand (clearance number M170583) Written informed consent was obtained from individual participants prior to enrolment. Additional approval for this sub-study from the London School of Hygiene and Tropical Medicine (reference number 22152). Kalyesubula R, Fabian J, Nakanga W, Newton R, Ssebunnya B, Prynn J, et al. How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study. BMC Nephrol. 2020 Jan 15;21(1):20.Attribution 4.0 International (CC BY 4.0) This is a human-readable summary of (and not a substitute for) the license. Disclaimer. You are free to: Share — copy and redistribute the material in any medium or format Adapt — remix, transform, and build upon the material for any purpose, even commercially. This license is acceptable for Free Cultural Works. The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. Notices: You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation. No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.enThis work is presented on behalf of the African Research on Kidney Disease (ARK) Consortium The ARK-SA study was jointly funded by the South African MRC, MRC UK (via the Newton Fund), and GSK Africa Non-Communicable Disease Open Lab (via a supporting grant Project Number: 074). Authors retained control of the final content of the publicationResearch Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Kidney diseasesKidneySchistosomiasis haematobiaUrinary Tract InfectionsProteinuriaCohort StudiesDatasethttps://doi.org/10.54223/uniwitwatersrand-10539-33712