CKD incidence, predictors & progression: African migrants vs. Non-Migrants (RODAM cohort study)

Abstract

Abstract Background Limited longitudinal data exist on chronic kidney disease (CKD) in African populations undergoing epidemiological transitions. We investigated incidence, long-term predictors, and progression of CKD among Ghanaians residing in rural- and urban-Ghana, and Ghanaian migrants in the Netherlands (Amsterdam). Methods We analysed data from 2183 participants in the transcontinental population-based prospective RODAM-cohort, followed for approximately seven years. CKD incidence and its progression to end-stage renal disease (ESRD) were defined using KDIGO criteria. CKD incidence was calculated using age-and sex-standardization for those without CKD at baseline. Long-term predictors of CKD incidence were identified using one-step robust Poisson regression. CKD progression to ESRD from baseline was also assessed using robust Poisson regressions. Results Overall age-and-sex standardized CKD incidence was 11.0% (95%CI; 9.3%-12.3%). Rural and urban-Ghanaians had higher CKD incidence (12.5%;8.5%-15.5%; 12.3%;8.2%-15.8%; respectively) than Amsterdam-Ghanaians (7.6%; 5.4%-10.6%). Residence in Amsterdam was associated with lower CKD incidence compared to rural Ghana after adjustments (Incidence Rate Ratio=0.34; 0.13-0.89), but not with urban-Ghana (IRR=1.07; 0.69-1.67). CKD incidence predictors were advanced age, female sex, alcohol consumption, uric acid levels, and hypertension. CKD progression to ESRD was 2.5% (1.4%-3.6%) in rural- Ghana, 2.3% (1.3%-3.2%) in urban-Ghana and 0.0% in Amsterdam. Conclusions One-tenth of Ghanaians developed CKD over seven-years, with higher incidence in Ghana compared to Europe. Age, female sex, alcohol use, uric acid levels, and hypertension were predictive factors. CKD progression to ESRD was minimal. High CKD incidence among Ghanaians, especially among non-migrants, calls for in-depth assessment of contributing factors and targeted interventions. Key messages • We observed higher CKD Rates in Rural/Urban Ghana vs. Amsterdam:Indicating geographic Disparities. • CKD Predictors: Age, Sex, Alcohol, Uric Acid, Hypertension (Minimal ESRD Progression). Interventions target: Non-Migrant Ghanaians.