Prevalence, concordance and associations of chronic kidney disease by five estimators in South Africa
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RESEARCH ARTICLE
Open Access
Prevalence, concordance and associations of chronic kidney disease by five estimators in South Africa Nasheeta Peer1,2* , Jaya George3, Carl Lombard4, Krisela Steyn5ˆ, Naomi Levitt2,5 and Andre-Pascal Kengne1,2
Abstract Background: To determine the prevalence, distribution, concordance and associations of chronic kidney disease (CKD) determined by five glomerular filtration rate (GFR) formulae in urban black residents of Cape Town. Methods: Data collection in this cross-sectional study included interviews, clinical measurements and biochemical analyses, including serum creatinine and cystatin C levels. GFR was based on the CKD Epidemiology Collaboration (CKD-EPI) equations (CKD-EPI creatinine (CKD-EPIcr), CKD-EPI cystatin C (CKD-EPIcys), CKD-EPI creatinine-cystatins (CKD-EPIcr-cys)), Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault formula (CGF). GFR < 60 mL/min/ 1.73 m2 defined CKD. Results: Among 392 men and 700 women, mean GFR, was between 114.0 (CKD-EPIcr) and 135.4 mL/min/1.73 m2 (CGF) in men, and between 107.5 (CKD-EPIcr-cys) and 173.4 mL/min/1.73 m2 (CGF) in women. CKD prevalence ranged from 2.3% (CKD-EPIcr and MDRD) to 5.1% (CKD-EPIcys) in men and 1.6% (CGF) to 6.7% (CKD-EPIcr-cys) in women. The kappa statistic was high between CKD-EPIcr and MDRD (0.934), and CKD-EPIcys and CKD-EPIcr-cys (0.815), but fair-to-moderate between the other eqs. (0.353–0.565). In the basic regressions, older age and body mass index ≥30 kg/m2, but not gender, were significantly associated with CKD-EPIcr-defined CKD. In the presence of these three variables, hypertension, heart rate ≥ 90 beats/minute, diabetes and low-density lipoprotein cholesterol were significant predictors of prevalent CKD. Conclusions: Varying CKD prevalence estimates, because of different GFR equations used, underscores the need to improve accuracy of CKD diagnoses. Furthermore, screening for CKD should be incorporated into the routine assessment of high-risk patients such as those with hypertension or diabetes. Keywords: Chronic kidney disease, CKD-EPI, Cockcroft-Gault, Cystatin C, MDRD, South Africa
* Correspondence: [email protected] ˆKrisela Steyn is deceased. 1 Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa 2 Department of Medicine, University of Cape Town, Cape Town, South Africa Full list of author information is available at the end of the article
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