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Chronic Kidney Disease Prevalence, Progression, and Associated Risk Factors Based on Serum Creatinine Levels Among South African Patients in Public Sector Health Care Facilities

18 Pages Posted: 17 Oct 2023

See all articles by Alana T. Brennan

Alana T. Brennan

Boston University - Department of Global Health

Emma M. Kileel

Boston University - School of Public Health

Siyabonga Khoza

National Health Laboratory Services (NHLS) - Department of Chemical Pathology

Nigel Crowther

National Health Laboratory Services (NHLS) - Department of Chemical Pathology

Jacob Bor

Boston University - Department of Global Health

Matthew P. Fox

Boston University - Department of Global Health

Sydney Rosen

Boston University - Department of Global Health

Patricia Hibberd

Boston University - Department of Global Health

Frederick Raal

University of the Witwatersrand - Faculty of Health Sciences

Kamy Chetty

National Health Laboratory Services (NHLS)

Koleka Mlisana

National Health Laboratory Services (NHLS)

Jaya George

National Health Laboratory Services (NHLS) - Department of Chemical Pathology

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Abstract

Background: Chronic kidney disease (CKD) has emerged as a substantial global health challenge, with a marked rise in associated mortality. However, it often goes undetected until advanced stages, particularly in low- and middle-income countries like South Africa. We investigated the prevalence and progression of CKD in South Africa, utilizing data from the National Health Laboratory Services (NHLS) Multi-morbidity Cohort. 

Methods: We enrolled adult patients aged 18-85 years who underwent initial creatinine laboratory testing at government hospitals and clinics from January 2012-January 2016. CKD was assessed using the CKD-EPI equation, excluding the race factor, with a cutoff of CKD-EPI <60 mL/min/1.73 m2. Lab-diagnosed CKD was defined as two eGFR (estimated glomerular filtration rate) measurements <60 mL/min/1.73 m2 at least 90 days apart, following the Kidney Disease Improvement Global Outcomes guidelines. Cox regression and Kaplan-Meier survival curves were used to estimate rates of progression and hazard ratios. 

Results: Among 6,106,521 adults tested between 2012-2016, 1.4% (95%CI:1.4-1.5%) were diagnosed with CKD, with the majority in stage 3. Over follow-up (median:2 years, IQR:0.8-3.6 years), 59.5% (95%CI: 59.2-60) of stage 3 patients remained in stage 3, while 13.9% (95%CI:13.6-14.1) progressed to stage 4, and 9.9% (95% CI: 9.7-10.2) to stage 5. For stage 4 patients, 34.9% (95%CI:34.1-35.7) progressed to stage 5, 68% (95%CI:67.1-68.9) of stage 5 patients remained in stage 5. We estimated a 48% higher adjusted hazard of CKD progression for individuals with diabetes (aHR: 1.48, 95%CI:1.40-1.56) compared to those without. Advancing age also increased the risk, particularly for those aged >50 years. 

Interpretation: This study underscores the urgency for early detection and management of CKD in South Africa, particularly for high-risk individuals. Strengthening primary healthcare systems and raising CKD awareness are vital for improved patient outcomes and to alleviate the burden on healthcare resources. Early intervention can delay CKD progression, thus reducing the need for costly treatments like dialysis and transplantation.

Funding: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 1K01DK116929-01A1.

Declaration of Interest: Authors declare no competing interests.

Ethical Approval: Approval for analysis of de-identified NHLS data was granted by Boston University’s Institutional Review Board (protocol no. H-41152), Human Research Ethics Committee of the University of the Witwatersrand (protocol no. M200851) and NHLS Academic Affairs and Research Management System (protocol no. PR2232386).

Keywords: chronic kidney disease, renal insufficiency, HIV, tuberculosis, South Africa, low-and middle-income country

Suggested Citation

Brennan, Alana T. and Kileel, Emma M. and Khoza, Siyabonga and Crowther, Nigel and Bor, Jacob and Fox, Matthew P. and Rosen, Sydney and Hibberd, Patricia and Raal, Frederick and Chetty, Kamy and Mlisana, Koleka and George, Jaya, Chronic Kidney Disease Prevalence, Progression, and Associated Risk Factors Based on Serum Creatinine Levels Among South African Patients in Public Sector Health Care Facilities. Available at SSRN: https://ssrn.com/abstract=4603261 or http://dx.doi.org/10.2139/ssrn.4603261

Alana T. Brennan (Contact Author)

Boston University - Department of Global Health ( email )

Emma M. Kileel

Boston University - School of Public Health ( email )

Boston, MA
United States

Siyabonga Khoza

National Health Laboratory Services (NHLS) - Department of Chemical Pathology ( email )

Nigel Crowther

National Health Laboratory Services (NHLS) - Department of Chemical Pathology ( email )

Jacob Bor

Boston University - Department of Global Health ( email )

Matthew P. Fox

Boston University - Department of Global Health ( email )

Sydney Rosen

Boston University - Department of Global Health ( email )

Patricia Hibberd

Boston University - Department of Global Health ( email )

Frederick Raal

University of the Witwatersrand - Faculty of Health Sciences ( email )

Kamy Chetty

National Health Laboratory Services (NHLS) ( email )

Modderfontein Road
Sandringham, Johannesburg
South Africa

Koleka Mlisana

National Health Laboratory Services (NHLS) ( email )

Modderfontein Road
Sandringham, Johannesburg
South Africa

Jaya George

National Health Laboratory Services (NHLS) - Department of Chemical Pathology ( email )