Diabetic nephropathy in Africa: A systematic review

Table 3 Prevalence and incidence of chronic kidney disease in people with diabetes across studies in Africa

Ref.	Country	Sample size	Type of diabetes	Duration of follow-up	Diagnostic criteria for CKD	Prevalence	Incidence	Comments
Motala et al[37], 2001	South Africa	219	T1DM and T2DM	16.10 (4.9) T1DM; 18.6 (5.7) T2DM; at least 10 yr	Persistent proteinuria (dipstix proteinuria on three or more consecutive occasions over 18 mo in the at absence of infection or cardiac failure)	Not applicable	24.6%
Elbagir et al[26], 1995	Sudan	128	Insulin-treated	Not applicable	Proteinuria (≥ 30 mg/dL)	22%	Not applicable
Sobngwi et al[44], 1999	Cameroon	64	T1DM and T2DM	Not applicable	Proteinuria	53.1%	Not applicable
Katchunga et al[30], 2010	DR Congo	98	T2DM	Not applicable	MDRD: CKD stage ≥ 2 according to the National Kidneyfoundation	18.1%	Not applicable
Choukem et al[22], 2012	Cameroon	420	T2DM	Not applicable	Proteinuria (30 mg/24 h)	31%	Not applicable
Keeton et al[31], 2004	South Africa	59	T2DM	12 yr	Urine Albumin-to-Creatinine Ratio (no detail)		After 12 yr of follow-up or death, 94.9% (56/59) had a proteinuria with a mean duration from diabetes onset to proteinuria of 9.7 (5.9) yr	83% (49/59) had an elevated SCr atthe end of the study and in 66.1% (39/59) the SCr level had doubled during the study
Pruijm et al[39], 2008	Seychelles	1218	All types	Not applicable	Microalbuminuria: Urine Albumin-to-Creatinine Ratio 3.4-33.9 mg albumin/mmol creatinine	36.1%	Not applicable
Alebiosu[16], 2003	Nigeria	342	T1DM and T2DM	Not applicable	Persistent proteinuria	28.4%	Not applicable
Bouaziz et al[20], 2012	Tunisia	73	T2DM	Not applicable	Microalbuminuria: < 2.8 g/mol for women and < 2.3 g/mol for men	11%	Not applicable
Ajayi et al[15], 2014	Nigeria	65	T2DM	Not applicable	MDRD: eGFR ≤ 60 mL/min per 1.73 m2	43.1%	Not applicable
Levitt et al[32], 1997	South Africa	243	T2DM and T1DM	Not applicable	Urine Albumin-to-Creatinine Ratio > 3.4 mm/mmol	36.7%	Not applicable
					Persistent proteinuria (for at least 3 consecutive visits)	5.3%
Majaliwa et al[34], 2007	Tanzania	99	T1DM	Not applicable	Proteinuria (no detail)	29.3%	Not applicable
Marshall et al[36], 2013	Rwanda	286	T1DM	Not applicable	Microalbuminuria: Urine Albumin-to-Creatinine Ratio = 30-299 mg/gMacroalbuminuria or overt nephropathy: Urine Albumin-to-Creatinine Ratio ≥ 300 mg/g	Microalbuminuria: 21%; Macroalbuminuria: 5%	Not applicable
Alebiosu et al[18], 2003	Nigeria	465	T2DM	Not applicable	Proteinuria and eGFR	41.1%	Not applicable	The method for the estimation of the GFR is not indicated
Gill et al[28], 2005	South Africa	88	T1DM	20 yr	Persistent dipstick proteinuria		Death of renal cause after 20 yr = 18.4% (9/49)	Death due to chronic renal failure after 20 yr of follow-up was 9/49 (after exclusion of lost to follow)
Djrolo et al[24], 2001	Benin	152	T1DM and T2DM	Not applicable	Proteinuria (no detail)	20%	Not applicable
Rotchford et al[43], 2002	South Africa	253	T1DM and T2DM	Not applicable	Microalbuminuria > 2.5 mg/mmol in men or 3.5 mg/mmol in women	46.4%	Not applicable
Rissassi et al[42], 2009	DR congo	181	T1DM	Not applicable	Microalbuminuria: Urine Albumin-to-Creatinine Ratio = 30-299 mg/gMacroalbuminuria: Urine Albumin-to-Creatinine Ratio ≥ 300 mg/g	21.9% (microalbuminuria) and 7.3% (macroalbuminuria)	Not applicable
Rahlenbeck et al[40], 1997	Ethiopia	170	T1DM and T2DM	Not applicable	Microalbuminuria: > 30 mg/LMacroalbuminuria: > 300 mg/L	T1DM: 32% (microalbuminuria) and 15% (macroalbuminuria)T2DM: 37% (microalbuminuria) and 20% (macroalbuminuria)	Not applicable
Wanjohi et al[45], 2002	Kenya	100	T2DM	Not applicable	Proteinuria ≥ 20 mg	26%	Not applicable
Nambuya et al[38], 1996	Uganda	252	T1DM and T2DM	Not applicable	Proteinuria (no detail)	17.1%	Not applicable	Newly diagnosed patients
Rasmussen et al[41], 2013	Zambia	101	T1DM and T2DM	Not applicable	Microalbuminuria: ACR = 3.5-35.0 for women and 2.5-25.0 mg/mmol for menMacroalbuminuria were ACR> 35.0 for women and > 25.0 for men	Microalbuminuria: 23.8%Macroalbuminuria: 8.9%	Not applicable	There were 33 patients with diabetes alone, and 68 patients with diabetes and hypertension
Bentata et al[19], 2013	Morocco	72	T1DM	5 yr	Microalbuminuria: albumin excretion rate 30-300 mg/24 hMacroalbuminuria: albumin excretion rate > 300 mg/24 hNephrotic proteinuria: albumin excretion rate ≥ 3000 mg/24 hRenal failure: eGFR < 60 mL/min (MDRD)	At the time of enrollementMicroalbuminuria: 48.6%Macroalbuminuria: 36.1%Nephrotic proteinuria: 15.3%	The incidence of end stage renal disease after 5 yr: 34.7%	Urinary assays done onadmission were repeated on three specimens atthree-monthly intervals
Gill et al[27], 2008	Ethiopia	105	T1DM and T2DM	Not applicable	Nephropathy: ACR> 25.0 mg/mmol and retinopathy presentMicroalbuminuria: ACR> 2.5 and < 25.0 mg/mmol in men and > 3.5 and< 25.0 mg/mmol in women	Nephropathy: 2%Microalbuminuria: 51%		Urinary ACR levels (toassess microalbuminuria and nephropathy) were done on59 patients, as those with haematuria and/or urinary infection were excluded
Bouzid et al[21], 2011	Tunisia	689	T2DM	Not applicable	CKD: eGFR < 60 mL/min per 1.73 m2 (Cockroft-Gault)Microalbuminuria: albumin excretion rate 30-300 mg/24 hMacroalbuminuria: albumin excretion rate > 300 mg/24 h	CKD: 19.8%Microalbuminuria: 13%Macroalbuminuria: 10.1%	Not applicable	Macroalbuminuria was significantly associated with CKD (P < 0.00001)
Janmohamed et al[29], 2013	Tanzania	369	T1DM and T2DM	Not applicable	CKD: eGFR < 60 mL/min per 1.73 m2 (Cockroft-Gault) or microalbuminuria (> 20 mg/L) or overt protienuria	CKD: 83.7%eGFR < 60 mL/min per 1.73 m2: 24.7%Microalbuminuria: 45.8%Overt proteinuria: 34.1%	Not applicable
Danquah et al[23], 2012	Ghana	671	T2DM	Not applicable	Proteinuria ≥ 20 mg/L	43%	Not applicable
Lutale et al[33], 2007	Tanzania	244	T1DM and T2DM	Not applicable	Microalbuminuria: AER 20-200 μg/minMacroalbuminuria: AER > 200 μg/minRenal failure: eGFR < 60 mL/min per 1.73 m2:	Microalbuminuria: 12.1% (T1DM); 9.8% (T2DM)Macroalbuminuria: 1.1% (T1DM); 7.2% (T2DM)Renal failure: 4.6% (T1DM); 22% (T2DM)	Not applicable
Worku et al[46], 2010	Ethiopia	305	T1DM (38%) and T2DM (62%)	Not applicable	Proteinuria (no detail)	15.7%	Not applicable
Makulo et al[35], 2010	DR Congo	81	No precision	Not applicable	Microalbuminuria: ACR 30-299 mg/gMacroalbuminuria: ACR ≥ 300 mg/gRenal failure: eGFR < 60 mL/min per 1.73 m2	Microalbuminuria: 43.5%Macroalbuminuria: 12%Renal failure: 21.4%	Not applicable
Eghan et al[25], 2007	Ghana	109	T1DM and T2DM	Not applicable	Microalbuminuria: ACR 30-300 mg/g	43.1%	Not applicable
Alebiosu et al[17], 2004	Nigeria	162	T2DM	Not applicable	Not applicable	Not applicable	Not applicable	The study did not assess the prevalence or incidence of diabetic nephropathy, but its predictors

ACR: Albumin-to-Creatinine Ratio; T1DM: Type 1 diabetes mellitus; T2DM: Type 2 diabetes mellitus; CKD: Chronic kidney disease; eGFR: Epidermal growth factor receptor.