FP376THE BURDEN OF CKD IN HIGH RISK CONDITIONS IN THE AFRICAN CONTINENT: A SYSTEMATIC REVIEW

Abstract

Introduction and Aims: The prevalence of chronic kidney disease (CKD) is growing in Africa and the disproportionately high risk for CKD in some African countries may depend on the high risk heath profile within the same communities. While Africa now faces a double challenge of infectious illnesses and chronic diseases, the problem of CKD is still under estimated. This systematic review aims at assessing the burden of CKD among high risk groups in the whole African continent. Methods: MEDLINE and PUBMED databases were searched for articles published between January 1995 to October 2014 without language restriction by sensitive search strategies focusing on CKD in high risk groups in African countries. Articles were independently assessed by two reviewers and were included if they were based on the assessment of the CKD burden among patients with HIV, diabetes, hypertension and Lupus. Studies including patients affected by acute kidney injury, renal carcinoma, end stage renal disease and surveys on the African general population were excluded Results: 5363 references were initially retrieved. 5305 articles were excluded because they did not meet the inclusion and exclusion criteria. Thus, 56 studies were included in the final analysis. The diagnosis of CKD was based on KDOQI guidelines (eGFR<60/ ml/ min /1.73m2) in 53% of the studies, while the remaining studies (47%) depended on the assessment of proteinuria (either dipstick or 24 hours proteinuria). Twenty-six studies focused on HIV patients, seventeen on diabetics, seven on lupus patients and six among hypertensive patients. The pooled prevalence of these diseases and the corresponding prevalence of CKD among these high risk groups in African countries is reported in the Table. Chronic diseases like hypertension and diabetes are now responsible for the largest attributable risk of CKD in the African continent. However, the share of CKD associated with infectious diseases like HIV ( prevalence of HIV in African countries ranges from 0.5% in Senegal to 26.5% in Swaziland) remains substantial in Africa. Conclusions: In Africa the burden of CKD attributable to high risk conditions like hypertension and diabetes is of the same order or greater than that in economically developed western countries. HIV is a main cause of CKD in countries with a high prevalence of this disease like Swaziland. (Table Presented).