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• W2000821346 abstract "The upsurge in incidence and prevalence of chronic kidney disease (CKD) in both developed and developing nations has necessitated a renewed interest in global CKD prevention because it is now regarded as a public health threat. Although CKD management is consuming a huge proportion of health care finances in developed countries, it is contributing significantly to morbidity, mortality, and decreased life expectancy in developing ones. CKD epidemiological characteristics in Sub-Saharan Africa (SSA) are strikingly different from those observed in other regions. Although middle-aged and elderly populations are predominantly affected in developed countries, in SSA, CKD mainly affects young adults in their economically productive years, with hypertension and infection-related chronic glomerulonephritis as the major causes. Morbidity and mortality are high because most affected individuals cannot access renal replacement therapy. Other contributory factors for this dismal picture include late presentation, limited renal replacement therapy and its unaffordability, absence of kidney disease prevention programs, and the poor literacy level. This gloomy outlook of CKD in the subregion makes prevention the only viable option in the long term while struggling to improve access to renal replacement therapy in the short term. Unfortunately, most countries in SSA have no prevention programs, and where available, they are either institutions or individual based with very little or no governmental support. This review focuses on the burden of CKD in SSA and reviews the available prevention programs with a view to stimulating governments, communities, and organizations to establishing an inexpensive and affordable program in the entire subregion. The upsurge in incidence and prevalence of chronic kidney disease (CKD) in both developed and developing nations has necessitated a renewed interest in global CKD prevention because it is now regarded as a public health threat. Although CKD management is consuming a huge proportion of health care finances in developed countries, it is contributing significantly to morbidity, mortality, and decreased life expectancy in developing ones. CKD epidemiological characteristics in Sub-Saharan Africa (SSA) are strikingly different from those observed in other regions. Although middle-aged and elderly populations are predominantly affected in developed countries, in SSA, CKD mainly affects young adults in their economically productive years, with hypertension and infection-related chronic glomerulonephritis as the major causes. Morbidity and mortality are high because most affected individuals cannot access renal replacement therapy. Other contributory factors for this dismal picture include late presentation, limited renal replacement therapy and its unaffordability, absence of kidney disease prevention programs, and the poor literacy level. This gloomy outlook of CKD in the subregion makes prevention the only viable option in the long term while struggling to improve access to renal replacement therapy in the short term. Unfortunately, most countries in SSA have no prevention programs, and where available, they are either institutions or individual based with very little or no governmental support. This review focuses on the burden of CKD in SSA and reviews the available prevention programs with a view to stimulating governments, communities, and organizations to establishing an inexpensive and affordable program in the entire subregion. The incidence and prevalence of chronic kidney disease (CKD) has increased exponentially in recent years in both developed and developing nations and is consuming a huge proportion of health care finances in developed countries, while contributing significantly to morbidity, mortality, and decreased life expectancy in developing ones. This has necessitated renewed interest in global CKD prevention because it is now regarded as a public health threat.1Barsoum R.S. Chronic kidney disease in the developing world.N Engl J Med. 2006; 354: 997-999Crossref PubMed Scopus (359) Google Scholar, 2DuBose Jr, T.D. American Society of Nephrology Presidential Address 2006: Chronic kidney disease as a public health threat—New strategy for a growing problem.J Am Soc Nephrol. 2007; 18: 1038-1045Crossref PubMed Scopus (36) Google Scholar CKD in Sub-Saharan Africa (SSA) principally affects young adults in their economically productive years and is a leading cause of mortality. Contributory factors for this dismal picture include late presentation to the hospital, limited renal replacement therapy (RRT), limited capacity of health workers in kidney disease prevention, and poor awareness of kidney disease in the community.3Akinsola A. Adelekun T.A. Arogundade F.A. Sanusi A.A. Magnitude of the problem of CRF in Nigerians.Afr J Nephrol. 2004; 8: 24-26Google Scholar, 4Krzesinski J. Sumaili K.E. Cohen E. How to tackle the avalanche of chronic kidney disease in sub-Saharan Africa: The situation in the Democratic Republic of Congo as an example.Nephrol Dial Transplant. 2007; 22: 332-335Crossref PubMed Scopus (34) Google Scholar In a previous report, we identified 5 factors responsible for this rejuvenated attention that included a rapid increase in its prevalence, enormous cost of treatment, and recent data indicating that overt disease is just the tip of the CKD iceberg. In addition, the recent appreciation of its role in increasing cardiovascular disease risk and the detection of successful measures to halt or prevent its progression are also key factors contributing to this renewed interest. Based on these, the developed countries now made CKD prevention the center of attention in their health care planning. Unfortunately, in the developing world, where about 85% of the world population lives, CKD prevention programs are either rudimentary or virtually nonexistent.1Barsoum R.S. Chronic kidney disease in the developing world.N Engl J Med. 2006; 354: 997-999Crossref PubMed Scopus (359) Google Scholar In appreciation of the enormity of the pandemic of renal and cardiovascular disease, particularly in resource-poor settings, the International Society of Nephrology (ISN) convened a workshop in Bellagio, Italy, to stem the increasing trend. The Bellagio Declaration concluded that screening and treatment should focus on cost-beneficial strategies that ought to be affordable by all countries. Vital components of the recommended screening include blood pressure and urinary albumin measurement, as well as effective and affordable treatment strategies to decrease blood pressure and decrease or halt albuminuria.5Dirks J.H. de Zeeuw D. Agarwal S.K. et al.International Society of Nephrology Commission for the Global Advancement of Nephrology Study Group 2004Prevention of chronic kidney and vascular disease: Toward global health equity—The Bellagio 2004 Declaration.Kidney Int Suppl. 2005; 98: S1-S6Crossref PubMed Scopus (99) Google Scholar, 6Correa-Rotter R. Naicker S. Katz I.J. et al.ISN-COMGAN Bellagio Study Group 2004Demographic and epidemiologic transition in the developing world: Role of albuminuria in the early diagnosis and prevention of renal and cardiovascular disease.Kidney Int Suppl. 2004; 92: S32-S37Crossref PubMed Google Scholar The SSA region comprises nearly 50 sovereign African states that lie south of the Sahara Desert. Geographically, the demarcation line is the southern edge of the Sahara Desert, which cuts through Sudan, Chad, Niger, Mali, and Mauritania. SSA countries are grouped into 5 subregions: Eastern Africa, Southern Africa, West Africa, Central Africa, and the islands of the eastern coast of the continent, Madagascar, Mauritius, the Comoros, and the Seychelles (Fig 1). SSA contains approximately 70% of the least developed countries of the world, which have huge debt burdens and poor governmental policies. With an estimated population of about 800 million, predominantly rural (65%), most of the countries have a gross domestic product per capita of less than $1,500, and about half the population lives on less than $1 per day; management of CKD is not just difficult, but impracticable.7Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population ProspectsThe 2006 Revision and World Urbanization Prospects: The 2005 Revision.http://esa.un.org/unppGoogle Scholar This extreme poverty, the increasing prevalence of noncommunicable diseases (such as hypertension and diabetes mellitus), and the ever increasing prevalence of communicable or infectious diseases—exemplified by the scourge of human immunodeficiency virus/acquired immunodeficiency syndrome and hepatitis B virus infection—has led to a phenomenal increase in the incidence and prevalence of CKD in SSA. The overall life expectancy in SSA has decreased significantly in the last 10 years and now averages 46.3 and 44.8 years for women and men, respectively. Although CKD prevalence is on the increase globally, the US Third National Health and Nutrition Examination Survey5Dirks J.H. de Zeeuw D. Agarwal S.K. et al.International Society of Nephrology Commission for the Global Advancement of Nephrology Study Group 2004Prevention of chronic kidney and vascular disease: Toward global health equity—The Bellagio 2004 Declaration.Kidney Int Suppl. 2005; 98: S1-S6Crossref PubMed Scopus (99) Google Scholar showed that only 0.2% of the studied population (16,800) were in end-stage renal disease (ESRD), whereas 4.5% were in overt CKD (stages 3 and 4) and the remaining 6.3% had covert CKD (stages 1 and 2). The implication of this is that for every patient with ESRD, there are more than 200 with overt disease and almost 5,000 with covert disease.8Garg A.X. Kiberd B.A. Clark W.F. Haynes R.B. Clase C.M. Albuminuria and renal insufficiency prevalence guides population screening: Results from the NHANES III.Kidney Int. 2002; 61: 2165-2175Crossref PubMed Scopus (283) Google Scholar The Australian Diabetic Study found that 16% of the 11,247 individuals screened had renal disease, 9.7% of whom had varying degrees of renal impairment.9Chadban S.J. Briganti E.M. Kerr P.G. et al.Prevalence of kidney damage in Australian adults: The AusDiab Kidney Study.J Am Soc Nephrol. 2003; 14: S131-S138Crossref PubMed Google Scholar This clearly indicates that patients with ESRD are undoubtedly a very small fraction of the CKD population in these studies, and this can be extrapolated to most, if not all, communities. Unfortunately, information for CKD prevalence is lacking for most countries and worse still in countries without a renal disease registry, where most countries in SSA belong. Consequently, international comparisons are better hinged on ESRD prevalence than CKD. The exact ESRD prevalence in SSA is difficult to compute; hence, the reliance on hospital prevalence reports in most instances. We earlier assessed the magnitude of chronic renal failure (CRF; including patients with advanced CKD to ESRD) in Nigeria through a questionnaire survey of renal care centers.3Akinsola A. Adelekun T.A. Arogundade F.A. Sanusi A.A. Magnitude of the problem of CRF in Nigerians.Afr J Nephrol. 2004; 8: 24-26Google Scholar We found that CRF was very prevalent, with an overall average of 2% to 4% of medical admissions and between 100 and 120 new patients seen per year. A conservative estimate from this would put the incidence at about 1,000 new cases per year. However, we believed this was a gross underestimation of occurrence because only 60% of the centers responded and only admitted patients, certainly the very ill, were taken into consideration. In our recent retrospective review of ESRD cases managed during a 15-year period, we found an exponential increase from 6% of medical admissions in 1989 to 16% in 2003 (Fig 2).10Arogundade F.A. Sanusi A.A. Akinsola A. Epidemiology of chronic renal failure in Nigeria: Is there a change in trend.Nephrology. 2005; 10 (WCN 2005 Abstracts), 56 (abstr; suppl 1)Google Scholar Diouf et al11Diouf B. Niang A. Ka E.H. Badiane M. Moreira Diop T. Chronical renal failure in one Dakar Hospital Department.Dakar Med. 2003; 48: 185-188PubMed Google Scholar in Dakar University Hospital Internal Medicine Department retrospectively analyzed 243 in-patients with CRF managed during a 3-year period and found that the majority were young and about a third were in ESRD, but only 8.23% received RRT. Naicker,12Naicker S. End-stage renal disease in sub-Saharan and South Africa.Kidney Int Suppl. 2003; 83: S119-S122Crossref PubMed Scopus (149) Google Scholar in her review of ESRD in SSA and South Africa, berated the lack of reliable statistics in SSA, although reported that an estimated 2% to 3% of medical admissions in tropical countries are for renal-related symptoms, with the majority being the glomerulonephritides. Plange-Rhule et al13Plange-Rhule J. Phillips R. Acheampong J.W. Saggar-Malik A.K. Cappuccio F.P. Eastwood J.B. Hypertension and renal failure in Kumasi, Ghana.J Hum Hypertens. 1999; 13: 37-40Crossref PubMed Scopus (48) Google Scholar assessed renal disease– and blood pressure–related admissions and deaths among acute medical admissions during an 8-month period and found that 166 of 593 acute medical admissions (5%) were ascribable to renal disease, of whom 45 patients (27.1%) died, usually of ESRD. In an effort to determine the prevalence of renal disease and consequently the need for renal care and training, Fogazzi et al14Fogazzi G.B. Attolou V. Kadiri S. Fenili D. Priuli F. A nephrological program in Benin and Togo (West Africa).Kidney Int Suppl. 2003; 83: S56-S60Crossref PubMed Scopus (21) Google Scholar established a successful renal care program in 2 West African states (Benin and Togo). They found that 3.3% of all admitted patients had serum creatinine values of 2.0 mg/dL or greater during a 12-month period in a Benin hospital, whereas 1% of all admissions in the same hospital had 3+ or greater albuminuria during the same period (Table 1).Table 1Burden of CKD in Different Regions in Sub-Saharan AfricaReferenceCountryDefinition of CKDLocationResultsProteinuria (%)Hypertension (%)Uremia/Increased Creatinine (%)Arogundade et al (2005)10Arogundade F.A. Sanusi A.A. Akinsola A. Epidemiology of chronic renal failure in Nigeria: Is there a change in trend.Nephrology. 2005; 10 (WCN 2005 Abstracts), 56 (abstr; suppl 1)Google ScholarNigeriaESRDHospital based——8-16Diouf et al (2000)11Diouf B. Niang A. Ka E.H. Badiane M. Moreira Diop T. Chronical renal failure in one Dakar Hospital Department.Dakar Med. 2003; 48: 185-188PubMed Google ScholarSenegalESRDHospital based——33Plange-Rhule et al13Plange-Rhule J. Phillips R. Acheampong J.W. Saggar-Malik A.K. Cappuccio F.P. Eastwood J.B. Hypertension and renal failure in Kumasi, Ghana.J Hum Hypertens. 1999; 13: 37-40Crossref PubMed Scopus (48) Google ScholarGhanaESRDHospital based——5Fogazzi et al (2003)14Fogazzi G.B. Attolou V. Kadiri S. Fenili D. Priuli F. A nephrological program in Benin and Togo (West Africa).Kidney Int Suppl. 2003; 83: S56-S60Crossref PubMed Scopus (21) Google ScholarBeninProteinuria/increased serum creatinineHospital based1—3.3Abioye-Kuteyi et al (1999)18Abioye-Kuteyi E.A. Akinsola A. Ezeoma I.T. Renal disease: The need for community-based screening in rural Nigeria.Afr J Med Pract. 1999; 6: 198-201Google ScholarNigeriaProteinuriaRural community——19.9Asinobi et al (2007)16Asinobi A.O. Bamgboye E.A. Afolabi N.B. Kadiri S. Soyanwo M.A.O. Community approach to prevention of hypertension and chronic kidney disease.in: WCN 2007 Book of Abstracts. 2007: 386Google ScholarNigeriaHypertension/proteinuriaUrban community2.928.2 (adults)10.2 (children)—Abbreviations: CKD, chronic kidney disease; ESRD, end-stage renal disease. Open table in a new tab Abbreviations: CKD, chronic kidney disease; ESRD, end-stage renal disease. Screening aimed at detecting early CKD or its risk factors was conducted in different parts of SSA. The Nigerian Association of Nephrology conducted routine screening during a kidney disease awareness and sensitization campaign and found that 13.6% and 19% of participants had hypertension and proteinuria, respectively.15Ulasi I. Arogundade F.A. Aderibigbe A. et al.Assessment of risk factors for kidney disease in an unselected population of Nigerians: A report of the National Kidney Disease Awareness and Sensitization Programme.Trop J Nephrol. 2006; 1: 73-80Google Scholar Asinobi et al16Asinobi A.O. Bamgboye E.A. Afolabi N.B. Kadiri S. Soyanwo M.A.O. Community approach to prevention of hypertension and chronic kidney disease.in: WCN 2007 Book of Abstracts. 2007: 386Google Scholar conducted a cross-sectional population survey in a multitribal urban community in Ibadan, Nigeria, and found systemic hypertension in 28.2% of 2,348 adults and 10.8% of 1,152 pediatric participants aged 3 years and older. They also found proteinuria in 2.9% of the 3,500 screened participants. Amira et al17Amira C. Sonibare A. Sokunbi D. Sokunbi A. Finnih A. Community based screening for chronic kidney disease risk factors.in: WCN 2007 Book of Abstracts. 2007: 408Google Scholar assessed the prevalence of CKD risk factors in unselected subjects in Lagos, Nigeria, and found hypertension in 36.3% of the 1,416 respondents (514 persons) for whom data were analyzed. They also found that 2.6% (37 persons) had diabetes and 23.9% (338 persons) had overt proteinuria. Abioye-Kuteyi et al18Abioye-Kuteyi E.A. Akinsola A. Ezeoma I.T. Renal disease: The need for community-based screening in rural Nigeria.Afr J Med Pract. 1999; 6: 198-201Google Scholar reported a prevalence of 19.9% of undetected renal diseases in a rural populace in western Nigeria. A National Non-Communicable Disease Survey report published in 1997 found the prevalence of hypertension in Nigeria to be 11.2% using 160/95 mm Hg as a cutoff value; hence, the figures could be much higher if 140/90 mm Hg had been used.19Akinkugbe O.O. Report of Expert Committee on Non-Communicable Disease in Nigeria (1990-1991).in: Federal Ministry of Health, Lagos1997: 1-118Google Scholar From the foregoing, the prevalence of both early and advanced CKD, as well as its risk factors, in SSA are enormous and the cost implication is colossal and beyond the reach of individual patients, thus making prevention the only plausible option, as repeatedly proposed by several investigators.10Arogundade F.A. Sanusi A.A. Akinsola A. Epidemiology of chronic renal failure in Nigeria: Is there a change in trend.Nephrology. 2005; 10 (WCN 2005 Abstracts), 56 (abstr; suppl 1)Google Scholar, 11Diouf B. Niang A. Ka E.H. Badiane M. Moreira Diop T. Chronical renal failure in one Dakar Hospital Department.Dakar Med. 2003; 48: 185-188PubMed Google Scholar, 12Naicker S. End-stage renal disease in sub-Saharan and South Africa.Kidney Int Suppl. 2003; 83: S119-S122Crossref PubMed Scopus (149) Google Scholar, 13Plange-Rhule J. Phillips R. Acheampong J.W. Saggar-Malik A.K. Cappuccio F.P. Eastwood J.B. Hypertension and renal failure in Kumasi, Ghana.J Hum Hypertens. 1999; 13: 37-40Crossref PubMed Scopus (48) Google Scholar, 14Fogazzi G.B. Attolou V. Kadiri S. Fenili D. Priuli F. A nephrological program in Benin and Togo (West Africa).Kidney Int Suppl. 2003; 83: S56-S60Crossref PubMed Scopus (21) Google Scholar, 15Ulasi I. Arogundade F.A. Aderibigbe A. et al.Assessment of risk factors for kidney disease in an unselected population of Nigerians: A report of the National Kidney Disease Awareness and Sensitization Programme.Trop J Nephrol. 2006; 1: 73-80Google Scholar, 16Asinobi A.O. Bamgboye E.A. Afolabi N.B. Kadiri S. Soyanwo M.A.O. Community approach to prevention of hypertension and chronic kidney disease.in: WCN 2007 Book of Abstracts. 2007: 386Google Scholar, 17Amira C. Sonibare A. Sokunbi D. Sokunbi A. Finnih A. Community based screening for chronic kidney disease risk factors.in: WCN 2007 Book of Abstracts. 2007: 408Google Scholar, 18Abioye-Kuteyi E.A. Akinsola A. Ezeoma I.T. Renal disease: The need for community-based screening in rural Nigeria.Afr J Med Pract. 1999; 6: 198-201Google Scholar Although diabetic nephropathy has now emerged as the most common cause of ESRD, accounting for the greatest proportion of patients in RRT programs in developed countries and some developing ones, it is still a distant third common cause of ESRD in SSA. Several studies in Nigeria established that hypertensive nephrosclerosis and chronic glomerulonephritis are leading causes of CRF in Nigeria, but the prevalence of diabetic nephropathy is increasing, and obstructive uropathy also contributes significantly, corroborating reports from other indigenous African patients (Table 2;Fig 3).3Akinsola A. Adelekun T.A. Arogundade F.A. Sanusi A.A. Magnitude of the problem of CRF in Nigerians.Afr J Nephrol. 2004; 8: 24-26Google Scholar, 10Arogundade F.A. Sanusi A.A. Akinsola A. Epidemiology of chronic renal failure in Nigeria: Is there a change in trend.Nephrology. 2005; 10 (WCN 2005 Abstracts), 56 (abstr; suppl 1)Google Scholar, 20Akinsola W. Odesanmi W.O. Ogunniyi J.O. Ladipo G.O. Diseases causing chronic renal failure in Nigerians—A prospective study of 100 cases.Afr J Med Med Sci. 1989; 18: 131-137PubMed Google Scholar, 21Akinkugbe O.O. Nephrology in the tropical setting.Nephron. 1978; 22: 249-252Crossref PubMed Scopus (6) Google Scholar, 22Ojogwu L.I. The pathological basis of endstage renal disease in Nigerians: Experience from Benin City.West Afr J Med. 1990; 9: 193-196PubMed Google Scholar, 23Matekole M. Affram K. Lee S.J. Howie A.J. Michael J. Adu D. Hypertension and end-stage renal failure in tropical Africa.J Hum Hypertens. 1993; 7: 443-446PubMed Google Scholar, 24Abboud O.L. Osman E.M. Musa A.R. The aetiology of chronic renal failure in adult Sudanese patients.Ann Trop Med Parasitol. 1989; 83: 411-414PubMed Google Scholar, 25Diouf B. Ka E.F. Niang A. Diouf M.L. Mbengue M. Diop T.M. Etiologies of chronic renal insufficiency in a adult internal medicine service in Dakar.Dakar Med. 2000; 45: 62-65PubMed Google Scholar, 26Combined report on maintenance dialysis and transplantation in the Republic of South Africa.in: DuToit E. Pascoe M. MacGregor K. Thompson P.D. South African Dialysis and Transplantation Registry Report, Cape Town, South Africa. 1994Google ScholarTable 2Cause of ESRD in Various Regions in Sub-Saharan AfricaCause of ESRDNigeria (Arogundade et al10Arogundade F.A. Sanusi A.A. Akinsola A. Epidemiology of chronic renal failure in Nigeria: Is there a change in trend.Nephrology. 2005; 10 (WCN 2005 Abstracts), 56 (abstr; suppl 1)Google Scholar)Ghana (Matekole et al23Matekole M. Affram K. Lee S.J. Howie A.J. Michael J. Adu D. Hypertension and end-stage renal failure in tropical Africa.J Hum Hypertens. 1993; 7: 443-446PubMed Google Scholar)Sudan (Abboud et al24Abboud O.L. Osman E.M. Musa A.R. The aetiology of chronic renal failure in adult Sudanese patients.Ann Trop Med Parasitol. 1989; 83: 411-414PubMed Google Scholar)Senegal (Diouf et al25Diouf B. Ka E.F. Niang A. Diouf M.L. Mbengue M. Diop T.M. Etiologies of chronic renal insufficiency in a adult internal medicine service in Dakar.Dakar Med. 2000; 45: 62-65PubMed Google Scholar)South Africa (South African Dialysis and Transplant Registry, 199426Combined report on maintenance dialysis and transplantation in the Republic of South Africa.in: DuToit E. Pascoe M. MacGregor K. Thompson P.D. South African Dialysis and Transplantation Registry Report, Cape Town, South Africa. 1994Google Scholar)Hypertension (%)29.848.7—2545.6Chronic glomerulonephritis (%)27.842.3381652.1Diabetes mellitus (%)3.1—920.7—Obstructive uropathy (%)5—12——Unknown (%)30—2034.2—Others (%)3.9——4— Open table in a new tab Various reports of CKD in different parts of SSA showed it is a disease of young adults between the ages of 20 and 50 years, unlike the relatively older age groups affected in developed countries.3Akinsola A. Adelekun T.A. Arogundade F.A. Sanusi A.A. Magnitude of the problem of CRF in Nigerians.Afr J Nephrol. 2004; 8: 24-26Google Scholar, 4Krzesinski J. Sumaili K.E. Cohen E. How to tackle the avalanche of chronic kidney disease in sub-Saharan Africa: The situation in the Democratic Republic of Congo as an example.Nephrol Dial Transplant. 2007; 22: 332-335Crossref PubMed Scopus (34) Google Scholar, 12Naicker S. End-stage renal disease in sub-Saharan and South Africa.Kidney Int Suppl. 2003; 83: S119-S122Crossref PubMed Scopus (149) Google Scholar, 23Matekole M. Affram K. Lee S.J. Howie A.J. Michael J. Adu D. Hypertension and end-stage renal failure in tropical Africa.J Hum Hypertens. 1993; 7: 443-446PubMed Google Scholar, 24Abboud O.L. Osman E.M. Musa A.R. The aetiology of chronic renal failure in adult Sudanese patients.Ann Trop Med Parasitol. 1989; 83: 411-414PubMed Google Scholar, 25Diouf B. Ka E.F. Niang A. Diouf M.L. Mbengue M. Diop T.M. Etiologies of chronic renal insufficiency in a adult internal medicine service in Dakar.Dakar Med. 2000; 45: 62-65PubMed Google Scholar, 26Combined report on maintenance dialysis and transplantation in the Republic of South Africa.in: DuToit E. Pascoe M. MacGregor K. Thompson P.D. South African Dialysis and Transplantation Registry Report, Cape Town, South Africa. 1994Google Scholar Reports from most centers in SSA showed a male preponderance, possibly a reflection of the background prevalence of predisposing illnesses and recognized risk factors.3Akinsola A. Adelekun T.A. Arogundade F.A. Sanusi A.A. Magnitude of the problem of CRF in Nigerians.Afr J Nephrol. 2004; 8: 24-26Google Scholar, 10Arogundade F.A. Sanusi A.A. Akinsola A. Epidemiology of chronic renal failure in Nigeria: Is there a change in trend.Nephrology. 2005; 10 (WCN 2005 Abstracts), 56 (abstr; suppl 1)Google Scholar, 27Bamgboye E. End-stage renal disease in Sub-Saharan Africa.Ethn Dis. 2006; 16: S2-S5PubMed Google Scholar A major bedrock of management of advanced CKD (ESRD) is RRT, which typically is unavailable, and where rarely available, is cost intensive and therefore inaccessible by the majority of affected individuals in SSA. Grassman et al28Grassman A. Gioberge S. Moeller S. Brown G. ESRD patients in 2004: Global overview of patient numbers, treatment modalities and associated trends.Nephrol Dial Transplant. 2005; 20: 2587-2593Crossref PubMed Scopus (397) Google Scholar reported that about 1.8 million people worldwide were undergoing treatment for ESRD at the end of 2004, 77% of whom were on dialysis treatment, whereas the remaining 23% were living with a functioning renal transplant. In North America, Europe, and the Middle East, about 30% of patients live with a functional transplant, whereas the proportion is significantly lower in Asia, Latin America, and Africa, with the majority of patients with ESRD in these regions remaining on dialysis therapy. Despite the staggering magnitude of ESRD in SSA, the region contributes less than 5% of patients on RRT worldwide. The availability of RRT is variable in Africa, but generally is better in North Africa, where figures ranging between 30 to 186.5 per million population have been recorded. Available data indicate that South Africa seems to have the highest treatment rate (about 99 per million population) in SSA.12Naicker S. End-stage renal disease in sub-Saharan and South Africa.Kidney Int Suppl. 2003; 83: S119-S122Crossref PubMed Scopus (149) Google Scholar Dialysis and transplant programs in the rest of Africa are dependent on the availability of funding and donors, with the result that less than 5% of patients with diagnosed ESRD are able to support treatment for longer than 3 months.3Akinsola A. Adelekun T.A. Arogundade F.A. Sanusi A.A. Magnitude of the problem of CRF in Nigerians.Afr J Nephrol. 2004; 8: 24-26Google Scholar, 10Arogundade F.A. Sanusi A.A. Akinsola A. Epidemiology of chronic renal failure in Nigeria: Is there a change in trend.Nephrology. 2005; 10 (WCN 2005 Abstracts), 56 (abstr; suppl 1)Google Scholar, 12Naicker S. End-stage renal disease in sub-Saharan and South Africa.Kidney Int Suppl. 2003; 83: S119-S122Crossref PubMed Scopus (149) Google Scholar, 29Arije A. Kadiri S. Akinkugbe O.O. The viability of haemodialysis as a treatment option for renal failure in developing countries.Afr J Med Med Sci. 2000; 29: 311-314PubMed Google Scholar, 30Bamgboye E.L. Haemodialysis management problems in developing countries with Nigeria as a surrogate.Kidney Int Suppl. 2003; 83: S93-S95Crossref PubMed Scopus (59) Google Scholar This makes preventive nephrology paramount in this subregion. Hemodialysis is the most common modality in SSA, with about 150 dialysis units spread over 13 countries. The majority of the centers are located in 4 countries, namely Nigeria, South Africa, Sudan, and Mauritius. Other countries in the subregion have fewer than 5 such facilities.27Bamgboye E. End-stage renal disease in Sub-Saharan Africa.Ethn Dis. 2006; 16: S2-S5PubMed Google Scholar Problems encountered in these facilities include a limited number of machines, poor technical support, and inadequately trained and poorly motivated staff.3Akinsola A. Adelekun T.A. Arogundade F.A. Sanusi A.A. Magnitude of the problem of CRF in Nigerians.Afr J Nephrol. 2004; 8: 24-26Google Scholar, 12Naicker S. End-stage renal disease in sub-Saharan and South Africa.Kidney Int Suppl. 2003; 83: S119-S122Crossref PubMed Scopus (149) Google Scholar, 27Bamgboye E. End-stage renal disease in Sub-Saharan Africa.Ethn Dis. 2006; 16: S2-S5PubMed Google Scholar Despite the availability of peritoneal dialysis therapy in the region during the last 4 decades, continuous ambulatory peritoneal dialysis is largely unavailable, with very few centers offering this service.31Akinkugbe O.O. Abiose A.O. Peritoneal dialysis in acute renal failure.West Afr Med J. 1967; 1: 165-168Google Sch" @default.
• W2000821346 created "2016-06-24" @default.
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• W2000821346 date "2008-03-01" @default.
• W2000821346 modified "2023-10-01" @default.
• W2000821346 title "CKD Prevention in Sub-Saharan Africa: A Call for Governmental, Nongovernmental, and Community Support" @default.
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