ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

ASN / Education & Meetings / Kidney Week /
Abstract: SA-PO1143

Mild CKD Is Predictive of Higher Mortality in Rural Uganda and Kenya

Session Information

Category: CKD (Non-Dialysis)

  • 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Muiru, Anthony N., University of California San Francisco, San Francisco, California, United States
  • Ayieko, James, Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
  • Kabami, Jane, Infectious Diseases Research Collaboration, Kampala, Central Region, Uganda
  • Atukunda, Mucunguzi, Infectious Diseases Research Collaboration, Kampala, Central Region, Uganda
  • Orori, Gordon Omondi, Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
  • Wafula, Erick Mugoma, Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
  • Adam, Debbie, University of California San Francisco, San Francisco, California, United States
  • Charlebois, Edwin, University of California San Francisco, San Francisco, California, United States
  • Petersen, Maya, University of California Berkeley, Berkeley, California, United States
  • Havlir, Diane, University of California San Francisco, San Francisco, California, United States
  • Kamya, Moses, Infectious Diseases Research Collaboration, Kampala, Central Region, Uganda
  • Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background

Few studies have quantified the strength of the association between CKD and death in rural East Africa.

Methods

Within 22 communities of a cluster-randomized HIV trial conducted in Uganda and Kenya (NCT01864603), we randomly selected 100 households with at least one HIV-positive adult and 100 without any HIV-positive adults. We then chose 1 HIV-positive and 1 HIV-negative adult from the respective households to participate in a CKD sub-study. We determined the community-representative prevalence of CKD in 2016–2017 using weighting to account for sampling (PMC7055898). We then ascertained all-cause mortality through interviews with informants in 2023-4. We employed weighted multivariable logistic regression models to evaluate the association of baseline eGFR categories and all-cause mortality.

Results

So far, we have tracked 1,757 participants from 12 of 22 study communities. The population-weighted mean age at baseline was 39 years, and 54% were female. Prevalence of HIV was 9% (95% CI 8-11%), diabetes 5% (95% CI 4-7%), and hypertension 19% (95% CI 16-22%). An estimated 6% (95% CI 4-7%) had dipstick proteinuria, and only 1% (95% CI 0.7-2%) had eGFR<60 ml/min/1.73m2 (mean 109 ±19 ml/min/1.73m2). Follow-up visits were carried out after an average of 6.3 (±0.5) years, with 1,419 (81%) consenting to participate, 232 (13%) were deemed lost to follow-up, and 106 (6%) were deceased. Among those with baseline eGFR <60 ml/min/1.73m2, 38% were deceased, compared with 5% with eGFR ≥90 ml/min/1.73m2. An eGFR<60 (vs. ≥ 90) ml/min/1.73m2 was associated with a seven-fold increased risk of death (aOR 7.6 95% CI: 2.2-26.2, P=0.001) after adjusting for geographic region, social demographics, health habits, diabetes, hypertension, HIV, and proteinuria. This effect size surpassed the other modifiable risk factors considered in our model.

Conclusion

CKD is a very strong risk factor for future mortality in rural Uganda and Kenya. The strength of association exceeds that observed between stage 5 CKD and deaths in resource-rich settings. This underscores the urgent need to uncover the specific causes of death related to CKD and to develop effective interventions in resource-poor settings.

Funding

  • NIDDK Support