title: Chronic kidney disease, hypertension, diabetes, and obesity in the adult population of Morocco: how to avoid "over"- and "under"-diagnosis of CKD.
abstract: The prevalence of hypertension, diabetes, obesity, and chronic kidney disease (CKD) in an adult Arabic-Berber population was investigated according to 2012 KDIGO guidelines. A stratified, randomized, representative sample of 10,524 participants was obtained. Weight, height, blood pressure, proteinuria (dipstick), plasma creatinine, estimated glomerular filtration rate, and fasting glycemia were measured. Abnormal results were controlled within 2 weeks; eGFR was retested at 3, 6, and 12 months. The population adjusted prevalences were 16.7% hypertension, 23.2% obesity, 13.8% glycemia, 1.6% for eGFR under 60 ml/min/1.73 m(2) and confirmed proteinuria 1.9% and hematuria 3.4%. Adjusted prevalence of CKD was 5.1%; distribution over KDIGO stages: CKD1: 17.8%; CKD2: 17.2%; CKD3: 52.5% (3A: 40.2%; 3B: 12.3%); CKD4: 4.4%; CKD5: 7.2%. An eGFR distribution within the sex and age categories was constructed using the third percentile as threshold for decreased eGFR. A single threshold (under 60 ml/min/1.73 m(2)) eGFR classifying CKD3-5 leads to "overdiagnosis" of CKD3A in the elderly, overt "underdiagnosis" in younger individuals with eGFR over 60 ml/min/1.73 m(2), below the third percentile, and no proteinuria. By using the KDIGO guidelines in a correct way, "kidney damage" (confirmed proteinuria, hematuria) and the demonstration of chronicity of decreased eGFR <60 ml/min/1.73 m(2), combined with the third percentile as a cutoff for the normality of eGFR for age and sex, overcome false positives and negatives, substantially decrease CKD3A prevalence, and greatly increase the accuracy of identifying CKD.
authors.affiliation: Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Benghanem Gharbi
authors.affiliation: Department of Biostatistics, Center for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium.
authors.forename: Monique
authors.initials: M
authors.lastname: Elseviers
authors.affiliation: Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zamd
authors.affiliation: Ministry of Health, Rabat, Morocco.
authors.forename: Abdelali
authors.initials: A
authors.lastname: Belghiti Alaoui
authors.affiliation: Ministry of Health, Rabat, Morocco.
authors.forename: Naïma
authors.initials: N
authors.lastname: Benahadi
authors.affiliation: Ministry of Health, Rabat, Morocco.
authors.forename: El Hassane
authors.initials: el H
authors.lastname: Trabelssi
authors.affiliation: Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco.
authors.forename: Rabia
authors.initials: R
authors.lastname: Bayahia
authors.affiliation: Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco.
authors.forename: Benyounès
authors.initials: B
authors.lastname: Ramdani
authors.affiliation: University of Antwerp, Antwerp, Belgium. Electronic address: marc.debroe@uantwerpen.be.
authors.forename: Marc E
authors.initials: ME
authors.lastname: De Broe
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018912:Arabs; D001786:Blood Glucose / Q000032:analysis; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006417:Hematuria / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D009765:Obesity / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D015995:Prevalence; D011507:Proteinuria / Q000175:diagnosis / Q000453:epidemiology; D011897:Random Allocation; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000652:urine; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D001786:Blood Glucose; D003404:Creatinine
keywords: Morocco; chronic kidney disease; diabetes; hypertension; obesity; overdiagnosis of CKD; underdiagnosis of CKD