title: Characteristics of South African patients presenting with kidney disease in rural KwaZulu-Natal: a cross sectional study.
abstract: BACKGROUND
  Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) globally. Diabetes and human immunodeficiency virus (HIV), both prevalent in South Africa, have not been reported as significant causes of ESRD.
  
  
  METHODS
  We evaluated chronic kidney disease (CKD) and cardiovascular disease risk factors in a cross-sectional study of 302 patients (165 females/ 137 males) at a CKD clinic in rural northern KwaZulu-Natal. We included all CKD outpatient clinic attendees and excluded acute renal failure patients. Demographic, clinical and laboratory data collected were analyzed with Stata11 software. Logistic regression analysis was used to determine factors associated with advanced CKD and results expressed as the odds ratio with the 95% confidence interval [OR (95% CI)].
  
  
  RESULTS
  Of 302 patients analyzed, 290 (96%) were black African. Mean age ± SD was 47.1 ± 17.0 years. Approximately 86.4% of females and 54.5% of males were overweight/ obese. Dyslipidaemia was observed in 47.9% females and 29.2% males (P < 0.001). Estimated glomerular filtration rate (eGFR) was <30 ml/min/1.73 m2 in 50.6% patients. CKD risk factors observed were: hypertension (77.8%), diabetes (29.8%), HIV (28.5%), glomerulonephritis (7.0%) and tubulointerstitial diseases (5.6%). Independent factors associated with eGFR <30 ml/min/1.73 m2 at presentation were: HIV [OR = 2.4 (1.3-4.2), P = 0.004] and hypertension [OR = 2.3 (1.3-4.2), P = 0.007].
  
  
  CONCLUSIONS
  Diabetes and HIV are prevalent in CKD patients at primary/regional level healthcare in South Africa. With registry data lacking, dedicated CKD clinics at lower healthcare levels may provide valuable data on CKD epidemiology including changes in aetiology. Primary healthcare practitioners are faced with advanced CKD patients in resource-poor settings, with limited opportunity for upward referral hence the need for nephrology outreach programs.
authors.affiliation: Department of Nephrology, Division of Internal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. madalan@ukzn.ac.za.
authors.forename: Nomandla D
authors.initials: ND
authors.lastname: Madala
authors.forename: Gertrude P
authors.initials: GP
authors.lastname: Thusi
authors.forename: Alain G H
authors.initials: AG
authors.lastname: Assounga
authors.forename: Saraladevi
authors.initials: S
authors.lastname: Naicker
mesh_terms: D017677:Age Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D050171:Dyslipidemias / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors; D012424:Rural Population; D017678:Sex Distribution; D013019:South Africa
references.citation: Eur J Prev Cardiol. 2014 Jun;21(6):682-91
references.pmid: 22952291
references.citation: Am J Hypertens. 2008 Aug;21(8):896-902
references.pmid: 18551103
references.citation: Kidney Int. 2008 Dec;74(12):1516-25
references.pmid: 18813288
references.citation: Acta Diabetol. 2010 Mar;47(1):1-4
references.pmid: 20099002
references.citation: J Am Coll Cardiol. 2008 Jun 24;51(25):2375-84
references.pmid: 18565393
references.citation: J Infect Dis. 2008 Jun 1;197(11):1548-57
references.pmid: 18422458
references.citation: S Afr Med J. 1984 Jun 16;65(24):956-8
references.pmid: 6729642
references.citation: Kidney Int. 2006 Jun;69(12):2243-50
references.pmid: 16672914
references.citation: BMC Nephrol. 2008 Feb 25;9:3
references.pmid: 18298850
references.citation: Ann Intern Med. 2009 May 5;150(9):604-12
references.pmid: 19414839
references.citation: Lancet. 2009 Sep 12;374(9693):934-47
references.pmid: 19709736
references.citation: Am J Kidney Dis. 2008 Mar;51(3):515-23
references.pmid: 18295068
references.citation: Nephrol Dial Transplant. 2010 Mar;25(3):820-4
references.pmid: 19875380
references.citation: Prim Care Diabetes. 2009 Aug;3(3):157-64
references.pmid: 19640820
references.citation: Nephrol Dial Transplant. 2010 Jul;25(7):2178-87
references.pmid: 20100724
references.citation: S Afr Med J. 1982 Feb 20;61(8):263-5
references.pmid: 7058457
references.citation: Clin Pharmacol Ther. 2009 Nov;86(5):566-9
references.pmid: 19641489
references.citation: Kidney Int Suppl. 2005 Sep;(98):S1-6
references.pmid: 16108963
references.citation: J Hum Hypertens. 1990 Aug;4(4):379-83
references.pmid: 2258879
references.citation: Kidney Int Suppl. 2003 Feb;(83):S119-22
references.pmid: 12864889
references.citation: Obes Res. 2002 Oct;10(10):1038-48
references.pmid: 12376585
references.citation: Trop Doct. 2006 Oct;36(4):218-9
references.pmid: 17034695
references.citation: Nephrol Dial Transplant. 2011 Jun;26(6):1853-61
references.pmid: 20980357
references.citation: Clin Chem. 2008 Jul;54(7):1197-202
references.pmid: 18487286
references.citation: Kidney Int. 2006 Sep;70(6):1107-14
references.pmid: 16883316
references.citation: J Nephrol. 2014 Feb;27(1):11-8
references.pmid: 24519861
references.citation: Int Urol Nephrol. 2012 Jun;44(3):847-55
references.pmid: 21373844
references.citation: Pediatrics. 1976 Aug;58(2):259-63
references.pmid: 951142
references.citation: Am J Med. 2008 Apr;121(4):332-40
references.pmid: 18374693
references.citation: J Nephrol. 2010 Mar-Apr;23(2):147-55
references.pmid: 20155721
references.citation: Circulation. 2003 Oct 28;108(17):2154-69
references.pmid: 14581387
references.citation: Kidney Int. 2005 Oct;68(4):1884-7
references.pmid: 16164667