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Multicenter Study
. 2020 Jan 15;21(1):20.
doi: 10.1186/s12882-020-1688-0.

How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study

Robert Kalyesubula  1   2   3 , June Fabian  4   5 , Wisdom Nakanga  6 , Robert Newton  7 , Billy Ssebunnya  7 , Josephine Prynn  6 , Jaya George  8 , Alisha N Wade  5 , Janet Seeley  7   9 , Dorothea Nitsch  9 , Christian Hansen  7   9 , Moffat Nyirenda  7   9   6 , Liam Smeeth  9 , Saraladevi Naicker  10 , Amelia C Crampin  9   6 , Laurie A Tomlinson  9
Affiliations
Multicenter Study

How to estimate glomerular filtration rate in sub-Saharan Africa: design and methods of the African Research into Kidney Diseases (ARK) study

Robert Kalyesubula et al. BMC Nephrol. .

Abstract

Background: Chronic kidney disease (CKD) is a substantial cause of morbidity and mortality worldwide with disproportionate effects in sub-Saharan Africa (SSA). The optimal methods to estimate glomerular filtration rate (GFR) and therefore to determine the presence of CKD in SSA are uncertain. We plan to measure iohexol excretion to accurately determine GFR in Malawi, South Africa and Uganda. We will then assess the performance of existing equations to estimate GFR and determine whether a modified equation can better improve estimation of GFR in sub-Saharan Africa.

Methods: The African Research on Kidney Disease (ARK) study is a three-country study embedded within existing cohorts. We seek to enrol 3000 adults > 18 years based on baseline serum creatinine. Study procedures include questionnaires on socio-demographics and established risk factors for kidney disease along with anthropometry, body composition, blood pressure, blood chemistry and urine microscopy and albuminuria. We will measure GFR (mGFR) by plasma clearance of iohexol at 120, 180 and 240 min. We will compare eGFR determined by established equations with mGFR using Bland-Altman plots. We will use regression methods to estimate GFR and compare the newly derived model with existing equations.

Discussion: Through the ARK study, we aim to establish the optimal approach to estimate GFR in SSA. The study has the advantage of drawing participants from three countries, which will increase the applicability of the findings across the region. It is also embedded within established cohorts that have longitudinal information and serial measures that can be used to characterize kidney disease over a period of time. This will help to overcome the limitations of previous research, including small numbers, selected population sub-groups, and lack of data on proteinuria. The ARK collaboration provides an opportunity for close working partnerships across different centres, using standardized protocols and measurements, and shared bio-repositories. We plan to build on the collaboration for this study for future work on kidney disease in sub-Saharan Africa, and welcome additional partners from across the continent.

Keywords: Chronic kidney disease; Glomerular filtration rate; Measurement; Sub-Saharan Africa.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Map of Africa showing the ARK centres from Malawi, South Africa and Uganda. The general population cohort is run by the Medical Research Council-Uganda virus Institute and the London School of Hygiene and tropical Medicine (MRC-UVRI-LSHTM, Uganda). The Malawi Epidemiology and Intervention Research Unit (MEIRU) runs the MEIRU cohort in Malawi and the Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit runs the Agincourt Unit in South Africa. Map proposed by Robert Kalyesubula and illustrated by Helmut Kraus
Fig. 2
Fig. 2
Recruitment flowchart for ARK. ABPM- Ambulatory Blood Pressure Monitor; ACR- Albumin: creatinine Ratio; ASOT- Antistreptococcal antibody titres; BIA- Bioimpedance Analysis; BP-Blood Pressure; CBC- Cell blood count; GFR- glomerular filtration rate; CKD- Chronic kidney disease; HB-Haemoglobin; NCD-Non-communicable diseases; SA-South Africa. Credit for the ARK study map and copyright go to Helmut Kraus
See this image and copyright information in PMC

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