Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.
Nephrol Dial Transplant. 2018 Oct 1;33(10):1812-1822. doi: 10.1093/ndt/gfx347.
BACKGROUND: Chronic kidney disease (CKD) is a major burden among sub-Saharan African (SSA) populations. However, differences in CKD prevalence between rural and urban settings in Africa, and upon migration to Europe are unknown. We therefore assessed the differences in CKD prevalence among homogenous SSA population (Ghanaians) residing in rural and urban Ghana and in three European cities, and whether conventional risk factors of CKD explained the observed differences. Furthermore, we assessed whether the prevalence of CKD varied among individuals with hypertension and diabetes compared with individuals without these conditions. METHODS: For this analysis, data from Research on Obesity & Diabetes among African Migrants (RODAM), a multi-centre cross-sectional study, were used. The study included a random sample of 5607 adult Ghanaians living in Europe (1465 Amsterdam, 577 Berlin, 1041 London) and Ghana (1445 urban and 1079 rural) aged 25-70 years. CKD status was defined according to severity of kidney disease using the combination of glomerular filtration rate (G1-G5) and albuminuria (A1-A3) levels as defined by the 2012 Kidney Disease: Improving Global Outcomes severity classification. Comparisons among sites were made using logistic regression analysis. RESULTS: CKD prevalence was lower in Ghanaians living in Europe (10.1%) compared with their compatriots living in Ghana (13.3%) even after adjustment for age, sex and conventional risk factors of CKD [adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.56-0.88, P = 0.002]. CKD prevalence was markedly lower among Ghanaian migrants with hypertension (adjusted OR = 0.54, 0.44-0.76, P = 0.001) and diabetes (adjusted OR = 0.37, 0.22-0.62, P = 0.001) compared with non-migrant Ghanaians with hypertension and diabetes. No significant differences in CKD prevalence was observed among non-migrant Ghanaians and migrant Ghanaians with no hypertension and diabetes. Among Ghanaian residents in Europe, the odds of CKD were lower in Amsterdam than in Berlin, while among Ghanaian residents in Ghana, the odds of CKD were lower in rural Ghana (adjusted OR = 0.68, 95% CI 0.53-0.88, P = 0.004) than in urban Ghana, but these difference were explained by conventional risk factors. CONCLUSION: Our study shows important differences in CKD prevalence among Ghanaians living in Europe compared with those living in Ghana, independent of conventional risk factors, with marked differences among those with hypertension and diabetes. Further research is needed to identify factors that might explain the observed difference across sites to implement interventions to reduce the high burden of CKD, especially in rural and urban Ghana.
背景：慢性肾脏病（CKD）是撒哈拉以南非洲（SSA）人群的主要负担。然而，非洲农村和城市环境之间以及移民到欧洲后的 CKD 患病率差异尚不清楚。因此，我们评估了居住在加纳农村和城市以及欧洲三个城市的同质 SSA 人群（加纳人）之间 CKD 患病率的差异，以及传统的 CKD 危险因素是否可以解释观察到的差异。此外，我们评估了高血压和糖尿病患者的 CKD 患病率是否与无这些疾病的患者有所不同。
方法：本分析使用了肥胖与糖尿病研究中非洲移民（RODAM）的多中心横断面研究的数据。该研究纳入了欧洲（阿姆斯特丹 1465 人、柏林 577 人、伦敦 1041 人）和加纳（城市 1445 人、农村 1079 人）的 5607 名年龄在 25-70 岁之间的成年加纳人。根据肾小球滤过率（G1-G5）和蛋白尿（A1-A3）水平的严重程度，使用 2012 年肾脏病：改善全球预后严重程度分类来定义 CKD 状态。使用逻辑回归分析比较各研究点之间的差异。
结果：与居住在加纳的同胞相比，居住在欧洲的加纳人 CKD 患病率较低（欧洲 10.1%，加纳 13.3%），即使在调整了年龄、性别和 CKD 的传统危险因素后，这种差异仍然存在[调整后的优势比（OR）=0.70，95%置信区间（CI）0.56-0.88，P=0.002]。与加纳非移民高血压（调整 OR=0.54，0.44-0.76，P=0.001）和糖尿病（调整 OR=0.37，0.22-0.62，P=0.001）患者相比，加纳移民高血压和糖尿病患者的 CKD 患病率明显较低。加纳非移民高血压和糖尿病患者与加纳移民非高血压和糖尿病患者之间的 CKD 患病率没有显著差异。在欧洲的加纳居民中，与柏林相比，阿姆斯特丹的 CKD 几率较低，而在加纳的加纳居民中，与城市加纳相比，农村加纳的 CKD 几率较低（调整 OR=0.68，95%CI 0.53-0.88，P=0.004），但这些差异可通过传统危险因素来解释。
结论：我们的研究表明，居住在欧洲的加纳人与居住在加纳的加纳人之间 CKD 患病率存在重要差异，独立于传统危险因素，而高血压和糖尿病患者之间的差异更为明显。需要进一步研究以确定可能解释各研究点之间观察到的差异的因素，以便实施干预措施来降低加纳农村和城市地区 CKD 的高负担。
BMC Health Serv Res. 2023-10-27
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