尼日利亚中北部地区慢性肾脏病的患病率及其危险因素：一项基于人群的调查。
Prevalence of chronic kidney disease and risk factors in North-Central Nigeria: a population-based survey.
机构信息
Division of Nephrology, Department of Medicine, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
出版信息
BMC Nephrol. 2020 Nov 10;21(1):467. doi: 10.1186/s12882-020-02126-8.
BACKGROUND
Chronic kidney disease (CKD) is a growing challenge in low- and middle-income countries, particularly in sub-Saharan Africa. There is insufficient population-based data on CKD in Nigeria that is required to estimate its true burden, and to design prevention and management strategies. The study aims to determine the prevalence of CKD and its risk factors in Nigeria.
METHODS
We studied 8 urban communities in Kwara State, North-Central zone of Nigeria. Blood pressure, fasting blood sugar, urinalysis, weight, height, waist circumference and hip circumference were obtained. Albuminuria and kidney length were measured by ultrasound while estimated glomerular filtration rate (eGFR) was derived from serum creatinine, using chronic disease epidemiology collaboration (CKD-EPI) equation. Associations of risk factors with CKD were determined by multivariate logistic regression and expressed as adjusted odds ratio (aOR) with corresponding 95% confidence intervals.
RESULTS
One thousand three hundred and fifty-three adults ≥18 years (44% males) with mean age of 44.3 ± 14.4 years, were screened. Mean kidney lengths were: right, 93.5 ± 7.0 cm and left, 93.4 ± 7.5 cm. The age-adjusted prevalence of hypertension was 24%; diabetes 4%; obesity 8.7%; albuminuria of > 30 mg/L 7%; and dipstick proteinuria 13%. The age-adjusted prevalence of CKD by estimated GFR < 60 ml/min/1.73m and/or Proteinuria was 12%. Diabetes (aOR 6.41, 95%CI = 3.50-11.73, P = 0.001), obesity (aOR 1.50, 95%CI = 1.10-2.05, P = 0.011), proteinuria (aOR 2.07, 95%CI = 1.05-4.08, P = 0.035); female sex (aOR 1.67, 95%CI = 1.47-1.89, P = 0.001); and age (aOR 1.89, 95%CI = 1.13-3.17, P = 0.015) were the identified predictors of CKD.
CONCLUSIONS
CKD and its risk factors are prevalent among middle-aged urban populations in North-Central Nigeria. It is common among women, fueled by diabetes, ageing, obesity, and albuminuria. These data add to existing regional studies of burden of CKD that may serve as template for a national prevention framework for CKD in Nigeria. One of the limitations of the study is that the participants were voluntary community dwellers and as such not representative for the community. The sample may thus have been subjected to selection bias possibly resulting in overestimation of CKD risk factors.
背景
慢性肾脏病（CKD）是中低收入国家日益严重的挑战，尤其是在撒哈拉以南非洲。尼日利亚缺乏基于人群的 CKD 数据，无法准确估计其实际负担，也无法制定预防和管理策略。本研究旨在确定尼日利亚 CKD 的患病率及其危险因素。
方法
我们研究了尼日利亚中北部夸拉州的 8 个城市社区。测量了血压、空腹血糖、尿分析、体重、身高、腰围和臀围。通过超声测量白蛋白尿和肾脏长度，通过血清肌酐使用慢性肾脏病流行病学合作（CKD-EPI）方程计算估算肾小球滤过率（eGFR）。使用多元逻辑回归确定危险因素与 CKD 的相关性，并以相应的 95%置信区间表示调整后的优势比（aOR）。
结果
共筛查了 1353 名年龄≥18 岁的成年人（44%为男性），平均年龄为 44.3±14.4 岁。右肾长度为 93.5±7.0cm，左肾长度为 93.4±7.5cm。年龄调整后的高血压患病率为 24%；糖尿病 4%；肥胖症 8.7%；白蛋白尿>30mg/L 为 7%；尿蛋白试纸检测为 13%。年龄调整后的估算肾小球滤过率<60ml/min/1.73m 和/或蛋白尿的 CKD 患病率为 12%。糖尿病（aOR 6.41，95%CI=3.50-11.73，P=0.001）、肥胖症（aOR 1.50，95%CI=1.10-2.05，P=0.011）、蛋白尿（aOR 2.07，95%CI=1.05-4.08，P=0.035）、女性（aOR 1.67，95%CI=1.47-1.89，P=0.001）和年龄（aOR 1.89，95%CI=1.13-3.17，P=0.015）是 CKD 的识别预测因子。
结论
CKD 及其危险因素在尼日利亚中北部的中年城市人群中普遍存在。它在女性中更为常见，由糖尿病、衰老、肥胖症和白蛋白尿驱动。这些数据增加了现有的 CKD 负担区域研究，可为尼日利亚的 CKD 国家预防框架提供模板。该研究的局限性之一是参与者是自愿的社区居民，因此不能代表社区。因此，样本可能受到选择偏差的影响，这可能导致 CKD 危险因素的高估。
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