Prevalence and Risk Factors of CKD in South Kivu, Democratic Republic of Congo: A Large-Scale Population Study

BACKGROUND: The prevalence of chronic kidney disease (CKD) in African American individuals is high but whether this applies to native populations in sub-Saharan Africa is unclear. METHODS: In a cross-sectional study, we assessed the prevalence and risk factors of CKD in rural and urban adults in South Kivu, Democratic Republic of Congo. Glomerular filtration rate (GFR) was estimated using the CKD–Epidemiology Collaboration (CKD-EPI) equations based on serum creatinine (eGFRcr), cystatin C (eGFRcys), or both markers (eGFRcr-cys), without ethnic correction factor. CKD was defined as an eGFR <60 ml/min per 1.73 m(2) and/or albuminuria (albumin-to-creatinine ratio ≥30 mg/g). RESULTS: A total of 1317 participants aged 41.1 ± 17.1 years (730 rural, 587 urban) were enrolled. The prevalence of hypertension (20.2%; 95% confidence interval [CI], 18–22.3), diabetes mellitus (4.3%; 95% CI, 3.2–5.4) and obesity (8.9%; 95% CI, 7.4–10.5) was higher in urban than rural participants (all P < 0.05). HIV infection prevalence was 0.41% (95% CI, 0.05–0.78). The prevalence of eGFRcr <60 ml/min per 1.73 m(2) was 5.4% (95% CI, 4.2–6.7). The prevalence of albuminuria was 6.6% (95 % CI, 5.1–8.1). The overall prevalence of CKD was 12.2% (95% CI, 10.2–14.2) according to CKD-EPIcr. Factors independently associated with CKD-EPIcr were older age (adjusted odds ratio [aOR], 1.05 [1.04–1.07]), urban residence (aOR 1.86 [1.18–2.95]), female sex (aOR 1.66 [1.04–2.66]), hypertension (aOR 1.90 [1.15–3.12]), diabetes (aOR 2.03 [1.02–4.06]), and HIV infection (10.21 [2.75–37.85]). The results based on eGFRcys or eGFRcr-cys were largely consistent with the preceding. CONCLUSION: Overall, the burden of CKD is substantial (>11%), predominantly in the urban area, and largely driven by classic risk factors (gender, aging, HIV, hypertension, and diabetes).