Prevalence and Severity of Chronic Kidney Disease in Haiti

Abstract

Background: CKD is a major cause of morbidity and mortality in lower-income countries. However, population-based studies characterizing the epidemiology of CKD in these settings are lacking. The study objective was to describe the epidemiology of CKD in a population-based cohort in urban Haiti, including estimates of the prevalence by CKD stage, the magnitude of associated factors with CKD, and the proportion on guideline-recommended treatment.

Methods: We assessed the prevalence of CKD and associated risk factors in the population-based Haiti Cardiovascular Disease Cohort. We analyzed cross-sectional data from 2424 adults who completed a clinical examination, risk factor surveys, and laboratory measurements for serum creatinine, urinary albumin, and urinary creatinine. We compared our results with US estimates from the National Health and Nutrition Examination Survey. CKD was defined as either a reduced eGFR <60 ml/min per 1.73 m 2 or urinary albumin-to-creatinine ratio ≥30 mg/g according to the Kidney Disease Improving Global Outcomes guidelines. Multivariable logistic regression identified associated factors with CKD.

Results: The mean age was 42 years, 57% of participants were female, and 69% lived in extreme poverty on ≤1 US dollar per day. The age-standardized prevalence of CKD was 14% (95% confidence interval [CI], 12% to 15%). The age-standardized prevalence of reduced eGFR and elevated urinary albumin-to-creatinine ratio was 3% (95% CI, 2% to 4%) and 11% (95% CI, 10% to 13%), respectively. Diabetes (adjusted odds ratio, 4.1; 95% CI, 2.7 to 6.2) and hypertension (adjusted odds ratio, 2.9; 95% CI, 2.0 to 4.2) were significantly associated with CKD. Only 12% of participants with CKD and albuminuria were on guideline-recommended agents, such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.

Conclusions: In a large population-based cohort of Haitian adults, CKD was highly associated with both diabetes and hypertension. The proportion of participants with CKD on treatment was low, underscoring the need for strengthening clinical management and nephrology care health infrastructure in Haiti.

Clinical trial registry name and registration number: A Longitudinal Cohort Study to Evaluate Cardiovascular Risk Factors and Disease in Haiti, NCT03892265 .

Graphical abstract

Figure 1

Prevalence by Kidney Disease Improving Global Outcomes CKD stage on the basis of eGFR and albumin-to-creatinine ratio values. Prevalence of CKD by eGFR and albuminuria categories, overall and stratified by hypertension and diabetes. CKD-related risk were defined as green, low risk (if no other markers of kidney disease, no CKD); yellow, moderately high risk; orange, high risk; and red, very high risk. eGFR was calculated with the Chronic Kidney Disease Epidemiology Collaboration equation 2021. Risk levels were defined as G1, normal or high (≥90 ml/min per 1.73 m²); G2, mildly decreased (60–89 ml/min per 1.73 m²); G3a, mildly to moderately decreased (45–59 ml/min per 1.73 m²); G3b, moderately to severely decreased (30–44 ml/min per 1.73 m²); G4, severely decreased (15–29 ml/min per 1.73 m²); and G5, kidney failure. A1, UACR 0–30 mg/g; A2, UACR 30–300 mg/g; A3, UACR 300+ mg/g. UACR, urinary albumin-to-creatinine ratio.

Figure 2

Prevalence of CKD over age by KDIGO risk, eGFR, and albumin-to-creatinine ratio strata. Stages of CKD according to (A) KDIGO risk category by age, (B) eGFR strata, and (C) UACR strata. KDIGO, Kidney Disease Improving Global Outcomes.