Urade Yusuf, Cassimjee Zaheera, Dayal Chandni, Chiba Sheetal, Ajayi Adekunle, Davies Malcolm
Department of Internal Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Division of Nephrology, Helen Joseph Hospital, Johannesburg, Gauteng, South Africa.
PLOS Glob Public Health. 2024 Apr 18;4(4):e0003119. doi: 10.1371/journal.pgph.0003119. eCollection 2024.
Chronic kidney disease (CKD) is a significant contributor to the global burden of non-communicable disease. Early intervention may facilitate slowing down of progression of CKD; recognition of at-risk patient groups may improve detection through screening. We retrospectively reviewed the clinical records of 960 patients attending a specialist nephrology outpatient clinic during the period 1 January 2011-31 December 2021. A significant proportion (47.8%) of patients were referred with established CKD stage G4 or G5. Non-national immigration status, previous diagnosis with diabetes, and advancing age were associated with late referral; antecedent diagnosis with HIV reduced the odds of late referral. Black African patients comprised most of the sample cohort and were younger at referral and more frequently female than other ethnicities; non-nationals were younger at referral than South Africans. Hypertension-associated kidney disease was the leading ascribed aetiological factor for CKD (40.7% of cases), followed by diabetic kidney disease (DKD) (19%), glomerular disease (12.5%), and HIV-associated kidney disease (11.8%). Hypertension-related (25.9%) and diabetic (10.7%) kidney diseases were not uncommon in people living with HIV. Advancing age and male sex increased the likelihood of diagnosis with hypertensive nephropathy, DKD and obstructive uropathy; males were additionally at increased risk of HIV-associated kidney disease and nephrotoxin exposure, as were patients of Black African ethnicity. In summary, this data shows that hypertension, diabetes, and HIV remain important aetiological factors in CKD in the South African context. Despite the well-described risk of CKD in these disorders, referral to nephrology services occurs late. Interventions and policy actions targeting at-risk populations are required to improve referral practices.
慢性肾脏病（CKD）是全球非传染性疾病负担的重要促成因素。早期干预可能有助于减缓CKD的进展；识别高危患者群体可能会通过筛查改善疾病检测。我们回顾性分析了2011年1月1日至2021年12月31日期间在一家专科肾脏病门诊就诊的960例患者的临床记录。相当一部分（47.8%）患者被诊断为已确诊的CKD G4或G5期。非本国移民身份、既往糖尿病诊断和年龄增长与延迟转诊相关；既往HIV诊断降低了延迟转诊的几率。非洲黑人患者占样本队列的大多数，转诊时年龄更小，女性比例高于其他种族；非本国患者转诊时比南非人年轻。高血压相关性肾脏病是CKD的主要归因病因（40.7%的病例），其次是糖尿病肾病（DKD）（19%）、肾小球疾病（12.5%）和HIV相关性肾脏病（11.8%）。高血压相关（25.9%）和糖尿病（10.7%）肾病在HIV感染者中并不少见。年龄增长和男性性别增加了高血压肾病、DKD和梗阻性肾病的诊断可能性；男性患HIV相关性肾脏病和接触肾毒素的风险也增加，非洲黑人种族的患者也是如此。总之，这些数据表明，在南非背景下，高血压、糖尿病和HIV仍然是CKD的重要病因。尽管在这些疾病中CKD的风险已得到充分描述，但转诊至肾脏病服务机构的时间较晚。需要针对高危人群采取干预措施和政策行动，以改善转诊做法。
