Hypertension in Africa Research Team (HART), North-West University, Private Bag x6001, Potchefstroom, South Africa.
MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
BMC Nephrol. 2023 Jan 30;24(1):23. doi: 10.1186/s12882-023-03068-7.
Globally, the World Health Organization ranks chronic kidney disease (CKD) as one of the top 10 causes of mortality. In South Africa, where noncommunicable diseases have become leading causes of mortality, the true population prevalence of CKD is unknown and associated risk factors remain understudied. This study aimed to describe the prevalence of kidney dysfunction and associated risk factors in a community from the North West province of South Africa.
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/1.73m, or (ii) urine albuminuria-to-creatinine ratio (uACR) ≥ 3.0 mg/mmol, or a combination (i and ii). Risk factors included age, sex, urban/rural locality, body mass index (BMI), blood pressure (BP), lipid profile, haemoglobin A1c (HbA1C), C-reactive protein (CRP), gamma-glutamyl transferase (GGT), tobacco use, and HIV status.
Mean age of participants was 48 (42;56) years, and 655/1999 (33%) had eGFR < 90 ml/min/1.73m and/or uACR ≥ 3.0 mg/mmol. Compared to those with normal kidney function, participants with eGFR < 90 ml/min/1.73m and/or uACR ≥ 3.0 mg/mmol were older, female, had higher measures of adiposity, systolic, diastolic, and mean arterial blood pressure, serum lipids and C-reactive protein (CRP) (all p ≤ 0.024). In multiple regression analyses eGFR was associated with systolic BP (β = 0.11) and HIV infection (β = -0.09), and 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 respectively), eGFR was associated with age (β = -0.29, β = -0.49), male sex (β = 0.35, β = 0.28), BMI (β = -0.12, β = -0.09), low-density/high-density lipoprotein cholesterol ratio (β = -0.17, β = -0.09) and CRP (β = 0.10, β = 0.09) (all p < 0.005); and uACR was associated with female sex (β = 0.10, β = -0.14), urban locality (β = -0.11, β = -0.08), BMI (β = -0.11, β-0.11), and systolic BP (β = 0.27, β = 0.14) (all p < 0.017).
In this study from the North West province, South Africa, eGFR < 90 ml/min/1.73m and/or uACR ≥ 3.0 mg/mmol was prevalent and associated with modifiable risk factors. The findings may inform screening strategies for kidney disease prevention, focusing on women, obesity, blood pressure control, dyslipidaemia, identifying and treating inflammation, and HIV diagnosis and treatment.
在全球范围内，世界卫生组织将慢性肾脏病（CKD）列为十大死亡原因之一。在南非，非传染性疾病已成为主要的死亡原因，因此，CKD 的真实人群患病率尚不清楚，相关危险因素也研究不足。本研究旨在描述南非西北省一个社区的肾功能障碍患病率和相关危险因素。
本横断面研究纳入了 1999 名年龄大于 30 岁的参与者。肾功能障碍定义为（i）估算肾小球滤过率（eGFR）<90ml/min/1.73m2，或（ii）尿白蛋白/肌酐比值（uACR）≥3.0mg/mmol，或两者兼有。危险因素包括年龄、性别、城乡所在地、体重指数（BMI）、血压（BP）、血脂谱、糖化血红蛋白（HbA1c）、C 反应蛋白（CRP）、γ-谷氨酰转移酶（GGT）、烟草使用和 HIV 状况。
参与者的平均年龄为 48（42；56）岁，655/1999（33%）人有 eGFR<90ml/min/1.73m2 和/或 uACR≥3.0mg/mmol。与肾功能正常者相比，eGFR<90ml/min/1.73m2 和/或 uACR≥3.0mg/mmol 的参与者年龄更大、女性、肥胖程度更高、收缩压、舒张压和平均动脉压、血清脂质和 CRP 更高（均 p≤0.024）。在多元回归分析中，eGFR 与收缩压（β=0.11）和 HIV 感染（β=-0.09）相关，白蛋白尿与 CRP 升高（β=0.12）和 HIV 感染（β=0.11）相关（均 p<0.026）。在两组人群（分别有和没有肾功能障碍的人群）中，eGFR 与年龄（β=-0.29，β=-0.49）、男性（β=0.35，β=0.28）、BMI（β=-0.12，β=-0.09）、低密度/高密度脂蛋白胆固醇比值（β=-0.17，β=-0.09）和 CRP（β=0.10，β=0.09）相关（均 p<0.005）；uACR 与女性（β=0.10，β=-0.14）、城市所在地（β=-0.11，β=-0.08）、BMI（β=-0.11，β=-0.11）和收缩压（β=0.27，β=0.14）相关（均 p<0.017）。
在南非西北省的这项研究中，eGFR<90ml/min/1.73m2 和/或 uACR≥3.0mg/mmol 的患病率较高，与可改变的危险因素相关。研究结果可能为预防肾脏疾病的筛查策略提供信息，重点关注女性、肥胖、血压控制、血脂异常、识别和治疗炎症以及 HIV 的诊断和治疗。
