Objectives While increasing attention is paid to the rising prevalence of chronic diseases in Africa, there is little focus on chronic kidney disease (CKD). This systematic review assesses CKD burden among the general population and high-risk groups on the entire African continent. Design, setting and participants We searched Medline and PubMed databases for articles published between 1 January 1995 and 7 April 2017 by sensitive search strategies focusing on CKD surveys at the community level and high-risk groups. In total, 7918 references were evaluated, of which 7766 articles were excluded because they did not meet the inclusion criteria. Thus, 152 studies were included in the final analysis. Outcome measurement The prevalence of CKD in each study group was expressed as a range and pooled prevalence rate of CKD was calculated as a point estimate and 95% CI. No meta-analysis was done. Data were presented for different populations. Results In the community-level studies, based on available medium-quality and high-quality studies, the prevalence of CKD ranged from 2% to 41% (pooled prevalence: 10.1%; 95% CI 9.8% to 10.5%). The prevalence of CKD in the high-risk groups ranged from 1% to 46% (pooled prevalence: 5.6%; 95% CI 5.4% to 5.8%) in patients with HIV (based on available medium-quality and high-quality studies), 11%–90% (pooled prevalence: 24.7%; 95% CI 23.6% to 25.7%) in patients with diabetes (based on all available studies which are of low quality except four of medium quality) and 13%–51% (pooled prevalence: 34.5%; 95 % CI 34.04% to 36%) in patients with hypertension (based on all available studies which are of low quality except two of medium quality). Conclusion In Africa, CKD is a public health problem, mainly attributed to high-risk conditions as hypertension and diabetes. The poor data quality restricts the validity of the findings and draws the attention to the importance of designing future robust studies.

https://bmjopen.bmj.com/content/bmjopen/8/1/e015069.full.pdf

Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review

Introduction 
The widespread use of antiretroviral therapies (ART) has increased life expectancy in HIV patients, predisposing them to chronic non-communicable diseases including Chronic Kidney Disease (CKD). We performed a systematic review and meta-analysis (PROSPERO registration number CRD42016036246) to determine the global and regional prevalence of CKD in HIV patients.


Methods 
We searched PubMed, Web of Science, EBSCO and AJOL for articles published between January 1982 and May 2016. CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min using the MDRD, Cockcroft-Gault or CKD-EPI equations. Random effects model was used to combine prevalence estimates from across studies after variance stabilization via Freeman–Tukey transformation.


Result 
Sixty-one eligible articles (n = 209,078 HIV patients) in 60 countries were selected. The overall CKD prevalence was 6.4% (95%CI 5.2–7.7%) with MDRD, 4.8% (95%CI 2.9–7.1%) with CKD-EPI and 12.3% (95%CI 8.4–16.7%) with Cockcroft–Gault; p = 0.003 for difference across estimators. Sub-group analysis identified differences in prevalence by WHO region with Africa having the highest MDRD-based prevalence at 7.9% (95%CI 5.2–11.1%). Within Africa, the pooled MDRD-based prevalence was highest in West Africa [14.6% (95%CI 9.9–20.0%)] and lowest in Southern Africa (3.2%, 95%CI 3.0–3.4%). The heterogeneity observed could be explained by WHO region, comorbid hypertension and diabetes mellitus, but not by gender, hepatitis B or C coinfection, CD4 count or antiretroviral status.


Conclusion 
CKD is common in HIV-infected people, particularly in Africa. HIV treatment programs need to intensify screening for CKD with added need to introduce global guidelines for CKD identification and treatment in HIV positive patients.

/pdf/chronic-kidney-disease-in-the-global-adult-hiv-infected-1pbe0qyn06.pdf

Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis.

Global case studies for chronic kidney disease/end-stage kidney disease care

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Introduction 
Antiretroviral therapy (ART) has changed the course of HIV/AIDs by enabling patients to live longer, raising concern of the co- existence of HIV with other chronic illnesses, notably non-communicable diseases (NCDs). NCDs are on the rise in developing countries and evidence shows higher occurrence among people living with HIV (PLHIV). In Uganda, the burden of NCDs among PLHIV remains largely unquantified.


Objective 
To determine the prevalence of hypertension, osteoporosis, diabetes mellitus, renal impairment, asthma, cardiomyopathy and multi-morbidity among HIV positive patients, receiving Anti-Retroviral Therapy at Joint Clinical Research Centre, Lubowa, Uganda.


Methods 
This was a cross-sectional study conducted among 387 systematically sampled patients, receiving ART at the Joint Clinical Research Centre, Lubowa, between March and April 2017. The study used data extracted from routine care patient files to identify individuals with non-communicable diseases. Prevalence of the NCDs was estimated and reported with 95% confidence intervals. Prevalence was also reported at various levels of socio- demographic, behavioural and clinical factors.


Results 
The overall prevalence of having at least one NCD was 20.7% (95% CI: 16.7–24.5). The prevalence of hypertension was 12.4% (95% CI: 9.1–15.7), osteoporosis 6.5% (95% CI: 4.0–8.9), diabetes mellitus 4.7% (95% CI: 2.6–6.8), renal impairment 1.6% (95% CI: 0.3–2.8), asthma 1.6% (95% CI: 0.3–2.8), and cardiomyopathy 1.3% (95% CI: 0.2–2.4). Prevalence of multi-morbidity was 4.7% (95% CI: 2.6–6.8). Prevalence was significantly higher among older participants, widowed participants and individuals with an opportunistic infection.


Conclusion 
Non-communicable diseases are common among people living with HIV. There is need to encourage early diagnosis and treatment of non-communicable diseases in PLHIV in Uganda.

/pdf/prevalence-of-non-communicable-diseases-among-hiv-positive-1rjimk3tzx.pdf

Prevalence of non-communicable diseases among HIV positive patients on antiretroviral therapy at joint clinical research centre, Lubowa, Uganda

We determined the prevalence of renal impairment and possible HIV-associated nephropathy (HIVAN) in adults with World Health Organization (WHO) stages I or II HIV, presenting to the antiretroviral therapy (ART) clinic in a central hospital in Malawi. We enrolled 526 ART-naive subjects, 67% women, median age 34 (17–73) years and mean CD4 count 305 (3–993) cells/μL. Blood pressure, weight, urine dipstick and microscopy, CD4 cell count and serum creatinine were measured. Creatinine clearance (CrCL) was estimated using the Cockcroft–Gault equation. Possible HIVAN was diagnosed based on levels of proteinuria and CrCl. In all, 23.3% had proteinuria (≥1+). 57.4% had reduced CrCl (<90 mL/minute): 18.8% had moderate (CrCl 30–59 mL/minute) and 2.2% severe (CrCl <30 mL/minute) renal dysfunction. Extrapolating from renal biopsy studies that confirmed HIVAN, the proportion of patients with HIVAN in our clinic ranges from 1.8–21.2%. We conclude that renal impairment was common, though rarely severe, among HIV-infected ...

The prevalence of renal impairment among adults with early HIV disease in Blantyre, Malawi.

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The prevalence of renal impairment among adults with early HIV disease in Blantyre, Malawi.