World Health Organization, Country Office for Rwanda, Kigali, Rwanda.
World Health Organization, Inter Country Support Team, Eastern and Southern Africa, Harare, Zimbabwe.
BMC Nephrol. 2021 Nov 1;22(1):361. doi: 10.1186/s12882-021-02574-w.
Non-communicable diseases (NCDs) are a growing burden which affects every part of the world, including developing countries. Chronic kidney disease (CKD) has varied etiology which can result from or complicate other NCDs such as diabetes and cardiovascular diseases. The growing prevalence of NCDs coupled with the increasing age in most developing countries, has seen a marked increase of CKD in these settings. CKD has been described as "the most neglected NCD" and greatly affects the quality of life of patients. It also places a huge economic burden on societies. However, few epidemiological data exist, particularly in sub-Saharan Africa. Assessment of the prevalence of albuminuria as a marker of kidney damage and CKD progression and its main risk factors was thus needed in Rwanda.
This study analyzed data collected during the first STEPwise approach to NCD risk factor Surveillance (STEPS) survey in Rwanda, conducted from 2012 to 2013, to assess the prevalence of albuminuria. A multistage cluster sampling allowed to select a representative sample of the general population. Furthermore, descriptive, as well as univariable analyses and multiple logistic regression were performed to respond to the research question.
This survey brought a representative sample of 6,998 participants, among which 4,384 (62.65%) were female. Median age was 33 years (interquartile range, IQR 26-44), and over three quarters (78.45%) lived in rural areas. The albuminuria prevalence was 105.9 per 1,000 population. Overall, semi-urban and urban residency were associated with lower odds of CKD (odds ratio, OR 0.36, CI 0.23-0.56, p<0.001 and OR 0.34, CI 0.23-0.50, p<0.001, respectively) than rural status. Being married or living with a partner had higher odds (OR 1.44 (CI 1.03-2.02, p=0.031) and OR 1.62 (CI 1.06-2.48, p=0.026), respectively) of CKD than being single. Odds of positive albuminuria were also greater among participants living with human immunodeficiency virus (HIV) (OR 1.64, CI 1.09- 2.47, p=0.018). Gender, age group, smoking status and vegetable consumption, body mass index (BMI) and hypertension were not associated with albuminuria.
The albuminuria prevalence was estimated at 105.9 per 1,000 in Rwanda. Rural residence, partnered status and HIV positivity were identified as main risk factors for albuminuria. Increased early screening of albuminuria to prevent CKD among high-risk groups, especially HIV patients, is therefore recommended.
非传染性疾病（NCDs）是一个日益严重的负担，影响着世界的每一个角落，包括发展中国家。慢性肾脏病（CKD）的病因多种多样，可由其他 NCD 引起或与之并发，如糖尿病和心血管疾病。NCD 的患病率不断上升，加上大多数发展中国家人口老龄化，导致这些国家的 CKD 发病率显著上升。CKD 被称为“最被忽视的 NCD”，极大地影响了患者的生活质量。它也给社会带来了巨大的经济负担。然而，很少有流行病学数据，特别是在撒哈拉以南非洲。因此，在卢旺达评估白蛋白尿作为肾脏损害和 CKD 进展的标志物及其主要危险因素的患病率是必要的。
本研究分析了 2012 年至 2013 年期间首次进行的 NCD 风险因素监测（STEPS）调查中收集的数据，以评估白蛋白尿的患病率。多阶段聚类抽样允许选择一般人群的代表性样本。此外，还进行了描述性、单变量分析和多变量逻辑回归，以回答研究问题。
这项调查带来了一个有代表性的 6998 名参与者的样本，其中 4384 名（62.65%）为女性。中位年龄为 33 岁（四分位间距，IQR 26-44），超过四分之三（78.45%）居住在农村地区。白蛋白尿的患病率为每 1000 人中有 105.9 人。总体而言，半城市和城市居住与较低的 CKD 风险相关（优势比，OR 0.36，CI 0.23-0.56，p<0.001 和 OR 0.34，CI 0.23-0.50，p<0.001），而农村状况则较低。已婚或与伴侣同居的人患 CKD 的可能性更高（OR 1.44（CI 1.03-2.02，p=0.031）和 OR 1.62（CI 1.06-2.48，p=0.026）），而单身者则较低。与 HIV 感染者（HIV）同居的参与者的阳性白蛋白尿的可能性也更高（OR 1.64，CI 1.09-2.47，p=0.018）。性别、年龄组、吸烟状况和蔬菜摄入量、体重指数（BMI）和高血压与白蛋白尿无关。
在卢旺达，白蛋白尿的患病率估计为每 1000 人中有 105.9 人。农村居住、伴侣状况和 HIV 阳性被确定为白蛋白尿的主要危险因素。因此，建议在高危人群，特别是 HIV 患者中，增加早期筛查白蛋白尿以预防 CKD。
