Measurement of kidney function in Malawi, South Africa, and Uganda: a multicentre cohort study

作者：June Fabian, Robert Kalyesubula, Joseph Mkandawire, Christian Holm Hansen, Dorothea Nitsch, Eustasius Musenge, Wisdom P. Nakanga, Josephine E. Prynn, Gavin Dreyer, Tracy Snyman, Billy Ssebunnya, Michèle Ramsay, Liam L Smeeth, Stephen Tollman, Saraladevi Naicker, Amelia Catharine Crampin, Robert Newton, Jaya A. George, Laurie A. Tomlinson, Louis Banda, Steven Bello, Keith R. Branson, Christina Chisambo, Odala Chithodwe, Charity Kanyenda, Cynthia Katundu, Noel Kayange, Marriot Kayolo, Veronica Kuchipanga, Dorothy Makoka Kyumba, Adrian Malunga, Beatson Mvula, Elisah Mweso, Efrida Mwiba, Lydia Ngwira, Lawrence Nkhwazi, Maureen Thindwa, Itayi Adams, K O Barrow, Claudia Beltramo, Carolyn Bouter, Geoffrey Patrick Candy, Shingirai Chipungu, Tafadzwa Chitagu, Phumzile Dlamini, Xavier Gomez Olive Casas, Mwawi Gondwe, Pearl Gumede, Chodziwadziwa Whiteson Kabudula, Brenda Kagodora, Kathleen Kahn, Lungile Khambule, Bongekile L. Khoza, Dorcus Khoza, Simon Khoza, Weekend Khoza, Jonathan B. Levin, Dorcas Lesolang, Melody Mabuza, Heather Maher, Nontsikeleko Mahime, Willy Malupi, Gontse Maphatahanyi, Nonhlanhla Mashaba, Gift Mathebula, Busisiwe Mayindi, Brian Mdaka, Memory Mhembere, Mevian Mkansi, Rrhandzu Mnisi, Vusi Mnisi, Conrad Mogane, Tshepiso Mokoena, Walter Ndlovu, Zandy Ndlovu, Fortunate Ngobeni, Khanyisile Ngobeni, Nyiko Ngobeni, Tsakani Ngobeni, Ngoni Ngwarai, Doreen Nkuna, Median Ntimane, Terrence Ntimane, Obed Nxumalo, Daniel Ohene‐Kwofie, Florah Sihlangu, Bianca Silubane, Cassandra Claire Soo, Jeffrey Tibane, Rhian Twine, Surprise Ubisi, Mboyo-Di-Tamba Vangu, Alisha N. Wade, Floidy Wafawanaka, Gershim Asiki, Dominic Bukenya, Innocent Erone, Grace Tumwekase, Elizabeth Kabunga, Ayoub Kakande, Pontiano Kaleebu, Anatoli Kamali, Ronald Asuptas Kiranda, Sylivia Kushemererwa, Moses Kwizera, Kagina Josephine Nabukenya, Teddy Nakimera, Cptilda Naluggwa, Sureyah Nassimbwa, Moffat Nyirenda, Rose Nabwato, Ronald Makanga, Janet Seeley, Nambi Eva Sejjemba, Grace Seremba, Vincent Alumadri, Nick Bird · 发表于：The Lancet Global Health · 年份：2022 · DOI：10.1016/s2214-109x(22)00239-x · 被引用次数：94 · 研究领域：Chronic Kidney Disease and Diabetes、Renal Diseases and Glomerulopathies、Acute Kidney Injury Research

Background The burden of kidney disease in many African countries is unknown. Equations used to estimate kidney function from serum creatinine have limited regional validation. We sought to determine the most accurate way to measure kidney function and thus estimate the prevalence of impaired kidney function in African populations. Methods We measured serum creatinine, cystatin C, and glomerular filtration rate (GFR) using the slope-intercept method for iohexol plasma clearance (mGFR) in population cohorts from Malawi, Uganda, and South Africa. We compared performance of creatinine and cystatin C-based estimating equations to mGFR, modelled and validated a new creatinine-based equation, and developed a multiple imputation model trained on the mGFR sample using age, sex, and creatinine as the variables to predict the population prevalence of impaired kidney function in west, east, and southern Africa. Findings Of 3025 people who underwent measured GFR testing (Malawi n=1020, South Africa n=986, and Uganda n=1019), we analysed data for 2578 participants who had complete data and adequate quality measurements. Among 2578 included participants, creatinine-based equations overestimated kidney function compared with mGFR, worsened by use of ethnicity coefficients. The greatest bias occurred at low kidney function, such that the proportion with GFR of less than 60 mL/min per 1·73 m 2 either directly measured or estimated by cystatin C was more than double that estimated from creatin...