Burden of chronic kidney disease on the African continent: a systematic review and meta-analysis

Abstract

Background: Accurate contemporary data on the burden of Chronic Kidney Disease (CKD) on the African continent are lacking. We determined the prevalence of CKD in adult populations living in Africa, and variations by stage, gender, estimated Glomerular Filtration Rate (eGFR) equation, and residence.

Methods: For this systematic review, we searched multiple electronic databases for original studies on CKD prevalence reported from January 1, 2000 to December 31, 2016. Two reviewers independently undertook quality assessment and data extraction. We stabilized the variance of study-specific estimates with the Freeman-Turkey single arcsine transformation and pooled the data using a random effects meta-analysis models.

Results: A total of 98 studies involving 98,432 individuals were included in the final meta-analysis. The overall prevalence was 15.8% (95% CI 12.1-19.9) for CKD stages 1-5 and 4.6% (3.3-6.1) for CKD stages 3-5 in the general population. Equivalent figures were greater at 32.3% (23.4-41.8) and 13.3% (10.7-16.0) in high-risk populations (people with hypertension, diabetes, HIV). CKD prevalence was higher in studies based on the Cockcroft-Gault formula than MDRD or CKD-EPI equations; and in studies from sub-Saharan Africa compared with those from North Africa (17.7, 95% CI 13.7-22.1 vs 6.1, 95% CI 3.6-9.3, p < 0.001). There was substantial heterogeneity across studies (all I² > 90%) and no evidence of publication bias in main analyses.

Conclusion: CKD is highly prevalent across Africa, inviting efforts into prevention, early detection and control of CKD in adults living on the African continent which is particularly important in a resource limited environment.

Trial registration: Prospero Registration ID: CRD42017054445 .

Keywords: Africa; Chronic kidney disease; Meta-analysis; Prevalence; Systematic review.

Fig. 1

Selection of articles for inclusion in the systematic review

Fig. 2

Prevalence of CKD in general populations of adults living on the African continent by region

Fig. 3

Prevalence of CKD in general populations of adults living in Africa. Black boxes represent the effect estimates (prevalence) and the horizontal bars are for the 95% confidence intervals (CIs). The diamond is for the pooled effect estimate and 95% CI and the dotted vertical line centered on the diamond has been added to assist visual interpretation

Fig. 4

Prevalence of CKD stages 3 to 5 in general populations of adults living in Africa. Black boxes represent the effect estimates (prevalence) and the horizontal bars are for the 95% confidence intervals (CIs). The diamond is for the pooled effect estimate and 95% CI and the dotted vertical line centered on the diamond has been added to assist visual interpretation

Fig. 5

Prevalence of CKD in high-risk populations of adults living in Africa. Black boxes represent the effect estimates (prevalence) and the horizontal bars are for the 95% confidence intervals (CIs). The diamond is for the pooled effect estimate and 95% CI and the dotted vertical line centered on the diamond has been added to assist visual interpretation

Fig. 6

Prevalence of CKD stages 3 to 5 in high-risk populations of adults living in Africa. Black boxes represent the effect estimates (prevalence) and the horizontal bars are for the 95% confidence intervals (CIs). The diamond is for the pooled effect estimate and 95% CI and the dotted vertical line centered on the diamond has been added to assist visual interpretation