title: The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis.
abstract: BACKGROUND
  Amid rapid urbanisation, the HIV epidemic, and increasing rates of non-communicable diseases, people in sub-Saharan Africa are especially vulnerable to kidney disease. Little is known about the epidemiology of chronic kidney disease (CKD) in sub-Saharan Africa, so we did a systematic review and meta-analysis examining the epidemiology of the disease.
  
  
  METHODS
  We searched Medline, Embase, and WHO Global Health Library databases for all articles published through March 29, 2012, and searched the reference lists of retrieved articles. We independently reviewed each study for quality. We used the inverse-variance random-effects method for meta-analyses of the medium-quality and high-quality data and explored heterogeneity by comparing CKD burdens across countries, settings (urban or rural), comorbid disorders (hypertension, diabetes, HIV), CKD definitions, and time.
  
  
  RESULTS
  Overall, we included 90 studies from 96 sites in the review. Study quality was low, with only 18 (20%) medium-quality studies and three (3%) high-quality studies. We noted moderate heterogeneity between the medium-quality and high-quality studies (n=21; I(2)=47·11%, p<0·0009). Measurement of urine protein was the most common method of determining the presence of kidney disease (62 [69%] studies), but the Cockcroft-Gault formula (22 [24%] studies) and Modification of Diet in Renal Disease formula (17 [19%] studies) were also used. Most of the studies were done in urban settings (83 [93%] studies) and after the year 2000 (57 [63%] studies), and we detected no significant difference in the prevalence of CKD between urban (12·4%, 95% CI 11-14) and rural (16·5%, 13·8-19·6) settings (p=0·474). The overall prevalence of CKD from the 21 medium-quality and high-quality studies was 13·9% (95% CI 12·2-15·7).
  
  
  CONCLUSIONS
  In sub-Saharan Africa, CKD is a substantial health burden with risk factors that include communicable and non-communicable diseases. However, poor data quality limits inferences and draws attention to the need for more information and validated measures of kidney function especially in the context of the growing burden of non-communicable diseases.
  
  
  BACKGROUND
  Duke University.
authors.affiliation: Department of Medicine, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA. Electronic address: john.stanifer@duke.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Stanifer
authors.affiliation: Department of Biostatistics, Duke University, Durham, NC, USA.
authors.forename: Bocheng
authors.initials: B
authors.lastname: Jing
authors.affiliation: Department of Medicine, Duke University, Durham, NC, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Tolan
authors.affiliation: School of Medicine, Duke University, Durham, NC, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Helmke
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: Romita
authors.initials: R
authors.lastname: Mukerjee
authors.affiliation: Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Saraladevi
authors.initials: S
authors.lastname: Naicker
authors.affiliation: Department of Medicine, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: Uptal
authors.initials: U
authors.lastname: Patel
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors