Data Set : Prevalence, characterization and response to chronic kidney disease in an urban and rural setting in South Africa
Date
2016-11-18
Authors
Naicker, Saraladevi
Fabian, June
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Globally, chronic kidney disease (CKD) is an emerging public health challenge but accurate data on its true prevalence are scarce, particularly in poorly resourced regions such as sub-Saharan Africa (SSA). Limited funding for population-based studies, poor laboratory infrastructure and the absence of a validated estimating equation for kidney function in Africans are contributing factors. Consequently, most available studies used to estimate population prevalence are hospital-based, with small samples of participants who are at high risk for kidney disease. While serum creatinine is most commonly used to estimate glomerular filtration, there is considerable potential bias in the measurement of creatinine that might lead to inaccurate estimates of kidney disease at individual and population level. To address this, the Laboratory Working Group of the National Kidney Disease Education Program published recommendations in 2006 to standardize the laboratory measurement of creatinine. The primary objective of this review was to appraise implementation of these recommendations in studies conducted in SSA after 2006. Secondary objectives were to assess bias relating to choice of estimating equations for assessing glomerular function in Africans and to evaluate use of recommended diagnostic criteria for CKD. This study was registered with Prospero (CRD42017068151), and using PubMed, African Journals Online and Web of Science, 5845 abstracts were reviewed and 252 full-text articles included for narrative analysis. Overall, two-thirds of studies did not report laboratory methods for creatinine measurement and just over 80% did not report whether their creatinine measurement was isotope dilution mass spectroscopy (IDMS) traceable. For those reporting a method, Jaffe was the most common (93%). The four-variable Modification of Diet in Renal Disease (4-v MDRD) equation was most frequently used (42%), followed by the CKD Epidemiology Collaboration (CKD-EPI) equation for creatinine (26%). For the 4-v MDRD equation and CKD-EPI equations, respectively, one-third to one half of studies clarified use of the coefficient for African-American (AA) ethnicity. When reporting CKD prevalence, <15% of studies fulfilled Kidney Disease: Improving Global Outcomes criteria and even fewer used a population-based sample. Six studies compared performance of estimating equations to measured glomerular filtration rate (GFR) demonstrating that coefficients for AA ethnicity used in the 4-v MDRD and the CKD-EPI equations overestimated GFR in Africans. To improve on reporting in future studies, we propose an 'easy to use' checklist that will standardize reporting of kidney function and improve the quality of studies in the region. This research contributes some understanding of the factors requiring attention to ensure accurate assessment of the burden of kidney disease in SSA. Many of these factors are difficult to address and extend beyond individual researchers to health systems and governmental policy, but understanding the burden of kidney disease is a critical first step to informing an integrated public health response that would provide appropriate screening, prevention and management of kidney disease in countries from SSA. This is particularly relevant as CKD is a common pathway in both infectious and non-communicable diseases, and multimorbidity is now commonplace, and even more so when those living with severe kidney disease have limited or no access to renal replacement therapy.
Description
This narrative systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42017068151) and completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) together with the revised quality assessment of diagnostic accuracy studies (QUADAS-2) guidelines [18–20]. The period selected for review included all original research studies published from 31 January 2008 to 31 December 2018. This was based on the assumption that after the NKDEP guidelines were published in 2006, this would set the standard for the widespread implementation of IDMS-traceable creatinine assays in diagnostic laboratories by 2008—and we would see a similar trend in studies from SSA [5]. For studies that determined the prevalence of CKD, the recommended criteria for diagnosis of CKD were first published in 2002 and subsequently updated in 2012 [3, 4]. Likewise, we anticipated that these guidelines would inform the choice of criteria for clinical studies.
The online databases for PubMed, African Journals Online and Web of Science were searched using the relevant medical subject headings (Supplementary data, Appendix S1). Based on the title and abstract, all studies from the SSA region that assessed kidney function in adults were evaluated according to inclusion and exclusion criteria agreed upon by the team conducting the systematic review (Supplementary data, Appendix S1). Only those abstracts with studies with full-text articles, available in English, were selected for the final analysis.
Keywords
Citation
June Fabian et al. on behalf of the African Research in Kidney Disease (ARK) Working Group. Methods and reporting of kidney function: a systematic review of studies from sub-Saharan Africa. Clinical Kidney Journal. 2019. sfz089, https://doi.org/10.1093/ckj/sfz089