Brennan Alana T, Kileel Emma M, Khoza Siyabonga, Crowther Nigel J, Bor Jacob, Fox Matthew P, Rosen Sydney, Hibberd Patricia, Raal Frederick, Chetty Kamy, Mlisana Koleka, George Jaya A
Health Economics and Epidemiology Research Office, University of the Witwatersrand Johannesburg, Johannesburg, Gauteng, South Africa.
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
BMJ Public Health. 2024 Jul;2(1). doi: 10.1136/bmjph-2023-000799. Epub 2024 Jul 30.
Chronic kidney disease (CKD) has emerged as a substantial global health challenge, with a marked rise in associated mortality. However, it often goes undetected until advanced stages, particularly in low-income and middle-income countries such as South Africa. We investigated the prevalence and progression of CKD in South Africa, utilising a subset of data from the National Health Laboratory Services Multi-morbidity Cohort.
This study was a retrospective analysis of adults aged 18-85 years who underwent initial creatinine laboratory testing at government hospitals and clinics from January 2012 to January 2016. CKD was assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, excluding the race factor, with a cut-off of CKD-EPI<60 mL/min/1.73 m. Lab-diagnosed CKD was defined as two estimated glomerular filtration rate measurements <60 mL/min/1.73 m at least 90 days apart. Cox regression and survival curves were used to estimate HRs and rates of progression.
Among 6 106 521 adults tested between 2012 and 2016, 1.5% (95% CI 1.4% to 1.5%) were diagnosed with CKD, with the majority in stage 3. Over follow-up (median: 2 years, IQR: 0.8-3.6 years), 28.2% (95% CI 27.7% to 28.6%) of patients diagnosed as stage 3a progressed to a more severe disease state. Among patients who were in stage 3b at diagnosis, 29.6% (95% CI 29.0% to 30.1%) progressed and 33.3% (95% CI 32.5% to 34.1%) of stage 4 patients progressed. We estimated a 48% higher adjusted hazard of CKD progression for individuals with diabetes (adjusted HR 1.48, 95% CI 1.41 to 1.57) compared with those without. Advancing age also increased the risk, particularly for those aged >50 years.
This study underscores the urgency for early detection and management of CKD in South Africa, particularly for high-risk individuals. Strengthening primary healthcare systems and raising CKD awareness are vital for improved patient outcomes and to alleviate the burden on healthcare resources. Early intervention can delay CKD progression, thus reducing the need for costly treatments like dialysis and transplantation.
慢性肾脏病（CKD）已成为一项重大的全球健康挑战，相关死亡率显著上升。然而，它往往在晚期才被发现，尤其是在南非等低收入和中等收入国家。我们利用国家卫生实验室服务多发病率队列的一部分数据，调查了南非CKD的患病率和病情进展情况。
本研究对2012年1月至2016年1月在政府医院和诊所接受初次肌酐实验室检测的18至85岁成年人进行了回顾性分析。使用慢性肾脏病流行病学协作组（CKD-EPI）公式评估CKD，不考虑种族因素，CKD-EPI<60 mL/min/1.73 m为临界值。实验室诊断的CKD定义为两次估算肾小球滤过率测量值<60 mL/min/1.73 m，且间隔至少90天。采用Cox回归和生存曲线来估计风险比（HRs）和病情进展率。
在2012年至2016年期间接受检测的6106521名成年人中，1.5%（95%CI 1.4%至1.5%）被诊断为CKD，大多数处于3期。在随访期间（中位数：2年，四分位间距：0.8 - 3.6年），诊断为3a期的患者中有28.2%（95%CI 27.7%至28.6%）病情进展为更严重的疾病状态。诊断时处于3b期的患者中，29.6%（95%CI 29.0%至30.1%）病情进展，4期患者中有33.3%（95%CI 32.5%至34.1%）病情进展。我们估计，与无糖尿病的个体相比，糖尿病患者CKD进展的校正风险高48%（校正HR 1.48，95%CI 1.41至1.57）。年龄增长也会增加风险，尤其是对于年龄>50岁的人。
本研究强调了在南非早期发现和管理CKD的紧迫性，特别是对于高危个体。加强初级医疗保健系统和提高对CKD的认识对于改善患者预后和减轻医疗资源负担至关重要。早期干预可以延缓CKD进展，从而减少对透析和移植等昂贵治疗的需求。
