Kidney dysfunction: prevalence and associated risk factors in a community-based study from the North West Province of South Africa

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Abstract Background Chronic kidney disease (CKD) is in the top 10 leading causes of mortality globally. In South Africa where non-communicable diseases are the main cause of mortality the true prevalence of CKD is unknown, and its associated risk factors remain understudied in the general population. In this study we investigate the prevalence and identify the main risk factors involved in kidney dysfunction that will be helpful in guiding health care professionals in the planning of intervention studies. Methods This cross-sectional study included 1999 participants older than 30 years. Kidney dysfunction was defined as (i) estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73m2, or (ii) urine albuminuria-to-creatinine ration (uACR) ≥ 3.0 mg/mmol, or a combination (i and ii). The risk factors included are age, sex, locality, body mass index (BMI), blood pressure (BP), Lipids, hemoglobin A1c (HbA1C), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), tobacco use and human immunodeficiency virus (HIV). Results The mean age of all participants was 48.0 (42.0;56.0) years, and 656/1999 (33%) had kidney dysfunction. Those with kidney dysfunction were older, majority women, had higher measures of adiposity, systolic, diastolic, and mean arterial BP, higher lipids as well as higher CRP (all p ≤ 0.024). In multiple regression analyses, eGFR was associated with systolic BP (β = 0.11) and HIV (β=-0.09), while albuminuria was associated with elevated CRP (β = 0.12) and HIV infection (β = 0.11) (all p < 0.026). In both groups (individuals with and without kidney dysfunction) eGFR associated with age (β=-0.29, β=-0.49, respectively), male sex (β = 0.35, β0.28, respectively), body mass index (BMI) (β=-0.12, β=-0.09, respectively), low density lipoprotein cholesterol/ high density lipoprotein cholesterol ratio (β=-0.17, β=-0.09, respectively) and CRP (β = 0.10, β = 0.09, respectively) (all p < 0.005); while uACR associated with female sex (β = 0.10, β=-0.14, respectively), urban locality (β=-0.11, β=-0.08, respectively), BMI (β=-0.11, β-0.11, respectively), and systolic BP (β = 0.27, β = 0.14) (all p < 0.017). Conclusions In this relatively young population kidney dysfunction prevalence is high. When compared to individuals without kidney dysfunction intervention strategies should be focussed on controlling blood pressure, inflammation, and HIV.

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