Chronic kidney disease burden among African migrants in three European countries and in urban and rural Ghana: the RODAM cross-sectional study
Chronic kidney disease burden among African migrants in three European countries and in urban and rural Ghana: the RODAM cross-sectional study
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DOI：
10.1093/ndt/gfx347
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发表时间：
2018-10-01
影响因子：
6.1
通讯作者：
Agyemang, Charles
中科院分区：
文献类型：
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作者：
Adjei, David N.;Stronks, Karien;Agyemang, Charles
背景慢性肾脏病（CKD）是撒哈拉以南非洲（SSA）人群的主要负担。然而，尚不清楚非洲农村和城市环境之间以及移民到欧洲后CKD患病率的差异。因此，我们评估了居住在加纳农村和城市以及三个欧洲城市的同质SSA人群（加纳人）中CKD患病率的差异，以及CKD的传统危险因素是否可以解释观察到的差异。此外，我们还评估了高血压和糖尿病患者与非高血压和糖尿病患者相比，CKD的患病率是否存在差异。在这项分析中，使用了非洲移民肥胖和糖尿病研究（RODAM）的数据，这是一项多中心横断面研究。这项研究包括随机抽样的5607名成年加纳人生活在欧洲（1465阿姆斯特丹，577柏林，1041伦敦）和加纳（1445城市和1079农村），年龄在25-70岁。根据肾病的严重程度，使用肾小球滤过率（G1-G5）和白蛋白尿（A1-A3）水平的组合来定义CKD状态，如2012年肾病：改善全球结局严重程度分类所定义的。使用logistic回归分析进行了研究中心之间的比较。即使在调整了年龄、性别和CKD的传统危险因素后，生活在欧洲的加纳人（10.1%）的CKD患病率仍低于生活在加纳的同胞（13.3%）[调整后的比值比（OR）= 0.70，95%置信区间（CI）0.56-0.88，P = 0.002]。与患有高血压和糖尿病的非移民加纳人相比，患有高血压（调整后OR = 0.54，0.44-0.76，P = 0.001）和糖尿病（调整后OR = 0.37，0.22-0.62，P = 0.001）的加纳移民CKD患病率明显较低。在非移民加纳人和移民加纳人之间没有观察到CKD患病率的显着差异，没有高血压和糖尿病。在欧洲的加纳居民中，阿姆斯特丹的CKD发病率低于柏林，而在加纳的加纳居民中，加纳农村的CKD发病率低于加纳城市（调整后OR = 0.68，95%CI 0.53-0.88，P = 0.004），但这些差异可由传统的危险因素解释。我们的研究显示，与生活在加纳的人相比，生活在欧洲的加纳人的CKD患病率存在重要差异，独立于传统的风险因素，高血压和糖尿病患者之间存在显著差异。需要进一步研究，以确定可能解释不同地点之间观察到的差异的因素，以实施干预措施，减少CKD的高负担，特别是在加纳的农村和城市。
Background. Chronic kidney disease (CKD) is a major burden among sub-Saharan African (SSA) populations. However, differences in CKD prevalence between rural and urban settings in Africa, and upon migration to Europe are unknown. We therefore assessed the differences in CKD prevalence among homogenous SSA population (Ghanaians) residing in rural and urban Ghana and in three European cities, and whether conventional risk factors of CKD explained the observed differences. Furthermore, we assessed whether the prevalence of CKD varied among individuals with hypertension and diabetes compared with individuals without these conditions.Methods. For this analysis, data from Research on Obesity & Diabetes among African Migrants (RODAM), a multi-centre cross-sectional study, were used. The study included a random sample of 5607 adult Ghanaians living in Europe (1465 Amsterdam, 577 Berlin, 1041 London) and Ghana (1445 urban and 1079 rural) aged 25-70 years. CKD status was defined according to severity of kidney disease using the combination of glomerular filtration rate (G1-G5) and albuminuria (Al -A3) levels as defined by the 2012 Kidney Disease: Improving Global Outcomes severity classification. Comparisons among sites were made using logistic regression analysis.Results. CKD prevalence was lower in Ghanaians living in Europe (10.1%) compared with their compatriots living in Ghana (13.3%) even after adjustment for age, sex and conventional risk factors of CKD [adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.56-0.88, P = 0.002]. CKD prevalence was markedly lower among Ghanaian migrants with hypertension (adjusted OR = 0.54, 0.44-0.76, P = 0.001) and diabetes (adjusted OR = 0.37, 0.22-0.62, P = 0.001) compared with non-migrant Ghanaians with hypertension and diabetes. No significant differences in CKD prevalence was observed among non-migrant Ghanaians and migrant Ghanaians with no hypertension and diabetes. Among Ghanaian residents in Europe, the odds of CKD were lower in Amsterdam than in Berlin, while among Ghanaian residents in Ghana, the odds of CKD were lower in rural Ghana (adjusted OR = 0.68, 95% CI 0.53-0.88, P = 0.004) than in urban Ghana, but these difference were explained by conventional risk factors.Conclusion. Our study shows important differences in CKD prevalence among Ghanaians living in Europe compared with those living in Ghana, independent of conventional risk factors, with marked differences among those with hypertension and diabetes. Further research is needed to identify factors that might explain the observed difference across sites to implement interventions to reduce the high burden of CKD, especially in rural and urban Ghana.