Prevalence of CKD Among Adults in Africa: A Systematic Review and Meta-Analysis.

RATIONALE &

OBJECTIVE

Chronic kidney disease (CKD) is a global public health concern, but its burden in Africa is poorly defined. This study estimated CKD prevalence across the African continent.

STUDY

DESIGN

Systematic review and individual participant data meta-analysis.

SETTING & STUDY POPULATION: Populations residing in Africa.

SELECTION CRITERIA: Eligible studies enrolled ≥300 adults, were observational, used community-based designs, and reported CKD prevalence or data necessary to calculate it.

SEARCH STRATEGY: Studies, both published and unpublished, through May 31, 2024, identified through systematic searches of major databases and through networks within the CKD-Africa Collaboration.

DATA EXTRACTION: Data were systematically extracted and verified by the authors. Extracted information included study and publication details, CKD diagnostic criteria, and participant characteristics.

ANALYTICAL APPROACH: Pooled prevalence estimates were calculated using random-effects meta-analysis.

RESULTS

Sixty-seven studies, comprising 91,723 participants from 19 countries, were included. High- and moderate-quality studies accounted for 37% and 52%, respectively, and 6% were unpublished. Pooled CKD prevalence (stages 1-5) was 13.7% (95% CI, 11.0-16.4), and 5.1% (95% CI, 4.3-5.8) for stages 3-5. Regional variation was evident (I2 >98%; P < 0.001), with higher prevalence in western Africa compared to southern Africa. Estimates using aggregated data and individual participant data were consistent.

LIMITATIONS: Variations in the quality of the study data and substantial heterogeneity in prevalence estimates. Lack of assessment of chronic CKD. Reliance on aggregated data for 55% of the sample. Gaps in geographic representation may limit the generalizability of findings.

CONCLUSIONS

Approximately 14% of African adults had CKD, highlighting its public health burden. The precision of this finding was augmented by the use of individual participant data.

REGISTRATION: Registered at Prospero with identification number CRD42019143370.

PLAIN-LANGUAGE SUMMARY: Chronic kidney disease (CKD), a long-term condition in which the kidneys gradually lose their ability to filter waste and fluids from the blood, is an increasing health problem in Africa, but prevalence data have been limited. Previous studies relied on only summaries of studies' data. This analysis combined individual-level and summary data from multiple African countries to provide a more accurate and precise estimate of CKD prevalence. It found that CKD affects a substantial proportion of adults, with rates varying across regions. These findings highlight the potential value of early detection given the availability of effective clinical strategies to manage CKD.