In total, 122 records from bibliographic searches. After screening titles and abstracts, 44 full text papers were assessed for eligibility and 29 studies [11,17,24–32,32–49] were retained.
Prevalence of CKD in Cameroon
Table 2 summarizes the studies that reported on the prevalence of CKD in Cameroon. The prevalence of CKD was reported in 11 studies in Cameroon [11,17,24–32]. All studies were cross-sectional studies, 4 (36.4%) were community-based, and 2 (18.2%) were conducted in rural areas. The average age of the participants ranged from 35-61 years.
Overall, the prevalence of CKD in the general population ranged from 10.0-14.2%, [11,17,31]. The prevalence of CKD ranged from 3.4-14.1% and 10.0-14.2% in the general population in rural [17,26] and urban areas [17,31], respectively.
The prevalence of CKD among patients with hypertension ranged from 12.4-52.1% [27,28,30], Table 2. Thirty percent of hypertensive patients on treatment in a community-based study were diagnosed with CKD [27], and 12.4% in treatment naïve patients [28]. One study reported a prevalence of CKD of 18.5% among patients with type 2 diabetes mellitus [25]. Two studies evaluated the prevalence of CKD among persons living with HIV/AIDS (PLWHA). The prevalence of CKD in PLWHA ranged from 3.0-47.2% [24,32].
The prevalence of CKD among sugarcane plantation workers was 3.4% [26]. The prevalence of CKD among first-degree family relatives of persons living with CKD on hemodialysis was 15.9% [29].
Factors associated with CKD
Table 3 depicts the factors associated with CKD. Advanced age [11,26–28,30,32], female sex [27,29], obesity/adiposity [27,30,50], hyperuricemia/gout [27,30,31], longer duration of HIV [32], CD4 count less than 200 cells/mL [32], hyperkalemia [28], dyslipidemia [28,30], hypertension, diabetes mellitus [11,30,50], smoking [30,50], consumption of alcohol [30,50] and herbal medication [50], self-medication [30] were associated with increased odds of CKD.
Table 2: Prevalence of CKD in Cameroon
First Author
|
Year of
publication
|
Study Design
|
Study Setting
|
Study area
|
Disease specific population
|
Mean Age
(in years)
|
Male
(%)
|
Sample Size
|
Measure of Kidney damage or Function
|
Prevalence of CKD
|
Kaze [24]
|
2013
|
Cross-sectional
|
Hospital-based
|
Urban
|
HAART-naïve PLWHA
|
35.0
|
32.0%
|
104
|
eGFR < 60 based on MDRD and CG or at least 1+ proteinuria
|
3%
|
Kaze [17]
|
2015
|
Cross-sectional
|
Community-based
|
Urban
|
General adult population
|
36.5
|
48.7%
|
119
|
eGFR < 60 based on MDRD, CG and CKD-EPI or albuminuria > 30mg/g
|
10.9%
|
Kaze [17]
|
2015
|
Cross-sectional
|
Community-based
|
Rural
|
General adult population
|
51
|
39.7
|
320
|
eGFR < 60 based on MDRD, CG and CKD-EPI or albuminuria > 30mg/g
|
14.1%
|
Kaze [11]
|
2015
|
Cross-sectional
|
Community-based
|
Urban
|
General adult population
|
45.3
|
53.4%
|
500
|
eGFR < 60 based on MDRD, CG and CKD-EPI or albuminuria > 30mg/g
|
10.0, 11.0 and 14.2% using CKD-EPI, MDRD and CG, respectively.
|
Feteh [25]
|
2016
|
Cross-sectional
|
Hospital-based
|
Urban
|
Patients with type 2 diabetes mellitus
|
56.5
|
53.1%
|
636
|
eGFR < 60 based on MDRD
|
18.5%
|
Kaze [30]
|
2016
|
Cross-sectional
|
Hospital-based
|
Urban
|
Hypertensive adult
|
60.9
|
36.6%
|
336
|
eGFR < 60 based on MDRD, CG and CKD-EPI or albuminuria > 30mg/g
|
49.7%, 50.0% and 52.1% according to MDRD, CKD-EPI and CG equations respectively.
|
Kamdem [28]
|
2017
|
Cross-sectional
|
Hospital-based
|
Urban
|
newly diagnosed and untreated hypertensive patients
|
51.0
|
49.1%
|
839
|
eGFR < 60 based on MDRD
|
12.4%
|
Hamadou [27]
|
2017
|
Cross-sectional
|
Hospital-based
|
Urban
|
Hypertensive patients
|
54.2
|
33%
|
400
|
eGFR < 60 based on CKD-EPI or proteinuria
|
32.3%
|
Ekiti [26]
|
2018
|
Cross-sectional
|
Community-based
|
Rural
|
Sugarcane plantation workers
|
39.0
|
75%
|
204
|
eGFR < 60 based on CKD-EPI or at least 1+ proteinuria
|
3.4%
|
Halle [32]
|
2018
|
Cross-sectional
|
Hospital-based
|
Urban
|
PLWHA attending HIV day clinic
|
37.1
|
26.7%
|
709
|
eGFR < 60 based on MDRD and CKD-EPI or at least 1+ proteinuria
|
44% based on CKD-EPI and
47.2% based on MDRD
|
Kaze [31]
|
2019
|
Cross-sectional
|
Community-based
|
Urban
|
General adult population
|
45.0
|
48.7%
|
433
|
eGFR < 60 based on CKD-EPI or albuminuria > 30mg/g
|
11.7%
|
Temgoua [29]
|
2019
|
Cross-sectional
|
Hospital-based
|
Urban
|
First-degree family relatives of HDP
|
38.3
|
28.0%
|
82
|
eGFR < 60 based on MDRD or at least 1+ proteinuria or diagnosis by a Nephrologist
|
15.9%
|
NR; Not Reported, NA; Not Available; HIV: Human immunodeficiency virus; AIDS: Acquired immune deficiency syndrome; HAART: Highly active antiretroviral therapy; PLWHA: Persons living with HIV/AIDS, OR: odds ratio, CI: confidence interval, GFR: Glomerular Filtration Rate; HDP: Hemodialysis patients; MDRD: Modification of Diet in Renal Disease; CG: Cockcroft-Gault; CKD-EPI: Chronic Kidney Disease Epidemiology
Table 3: Factors associated factors of chronic kidney disease in Cameroon
First Author
|
Year of publication
|
Study Design
|
Study Setting
|
Disease specific population
|
Mean Age
(in years)
|
Sample Size
|
Associated Factors (adjusted Odds Ratio; 95% Confidence Interval)
|
Kaze [17]
|
2015
|
Cross-sectional
|
Community-based
|
General adult population
|
47.0
|
439
|
History of hypertension (aOR: 3.95; 95% CI, 2.09-7.46),
History of diabetes mellitus (aOR: 6.64; 95% CI: 2.63-16.75)
Elevated systolic blood pressure (aOR: 1.01; 95% CI, 1.00-1.02)
|
Kaze [11]
|
2015
|
Cross-sectional
|
Community-based
|
General adult population
|
45.3
|
500
|
Advanced age (aOR: 1.09; 95% CI, 1.07-1.12),
Known hypertension (aOR: 2.40; 95% CI, 1.19-4.82)
Existing diabetes mellitus (aOR: 3.36; 95% CI, 1.02-11.07),
Overweight/obesity (aOR: 0.30; 95% CI, 0.17-0.54)
|
Kaze [30]
|
2016
|
Cross-sectional
|
Hospital-based
|
Hypertensive adult
|
60.9
|
336
|
Advanced age [aOR: 1.05; 95% CI, 1.02-1.07)
Raised systolic blood pressure (aOR: 1.01; 95% CI, 1.00-1.02)
|
Hamadou [27]
|
2017
|
Cross-sectional
|
Hospital-based
|
Hypertensive patients
|
54.2
|
400
|
Age > 50 years (aOR: 1.75; 95% CI: 1.06-2.89),
Females (aOR: 2.21; 95% CI: 1.29-3.78),
obesity (aOR: 1.58; 95% CI: 1.36-1.95),
hyperuricemia (aOR: 3.67; 95% CI: 1.78-7.58)
|
Kamdem [28]
|
2017
|
Cross-sectional
|
Hospital-based
|
newly diagnosed and
untreated hypertensive patients
|
51.0
|
839
|
Age>55 years (aOR: 5.29; 95% CI, 3.33-8.42),
obesity (aOR: 0.15; 95% CI, 0.10-0.26),
hyperkalemia (aOR: 1.33; 95% CI, 1.03-1.72)
|
Ekiti [26]
|
2018
|
Cross-sectional
|
Community-based
|
Sugarcane plantation workers
|
39.0
|
204
|
Age ³ 40years (aOR: 18.7; 95% CI: 1.5-236.4)
|
Halle [32]
|
2018
|
Cross-sectional
|
Hospital-based
|
PLWHA attending HIV day clinic
|
37.1
|
709
|
age > 35 years (aOR: 1.04; 95% CI: 1.02 to 1.06),
longer duration of HIV (aOR: 2.60; 95% CI: 1.53 to 3.95),
history of Hepatitis B (aOR: 3.04; 95% CI, 1.08 to 8.54),
CD4 count less than 200 cells/mL (aOR: 3.64; 95% CI, 2.55 to 5.21)
|
Kaze [31]
|
2019
|
Cross-sectional
|
Community-based
|
General adult population
|
45.0
|
433
|
Increased systolic blood pressure (aOR: 1.02; 95% CI, 1.00-1.04) per mmHg higher SBP), hyperglycemia (aOR: 4.73; 95% CI, 1.24-18.08) and hyperuricemia (aOR: 3.12; 95% CI, 1.58-6.16)
|
HIV: Human immunodeficiency virus; AIDS: Acquired immune deficiency syndrome; HAART: Highly active antiretroviral therapy; PLWHA: Persons living with HIV/AIDS, aOR: adjusted odds ratio, CI: confidence interval, GFR: Glomerular Filtration Rate, CKD-EPI: Chronic Kidney Disease Epidemiology; SBP: systolic blood pressure
Etiologies of chronic kidney disease in Cameroon
Eight studies reported on the etiologies of CKD in Cameroon, Table 4. Overall, hypertension (22.3-59.1%), chronic glomerulonephritis (15.8-56.2%), diabetes mellitus (7.3-24.0%) and HIV (6.6-11.5%) were the main etiological factors of CKD. The etiology was unknown in 13.5%-17.0% of cases [35–42]. Halle et al 2016 reported hypertension (30.9%), glomerulonephritis (15.8%), diabetes mellitus (15.9%) and HIV (6.6%) as the major etiologies of CKD in a chart review of 863 medical records [37]. About and 14.7% of the etiologies of CKD was unknown. In a prospective study of 661 patients, the major etiologies of CKD were hypertension (28.3%), chronic glomerulonephritis (17.5%), diabetes mellitus (13.9%), HIV (6.7%) [39].
Table 4: Etiology of CKD in Cameroon
First author
|
Year of publication
|
Study area
|
Study Design
|
Study setting
|
Study population
|
Mean age
(in years)
|
Male (%)
|
Sample size
|
Etiologies
|
Halle [35]
|
2014
|
Urban
|
Cross-sectional
|
Hospital-based
|
Patients on maintenance hemodialysis
|
49.4
|
66.4
|
113
|
Hypertension (25.6%), Chronic glomerulonephritis (20.6%), diabetes mellitus (17.4%)
|
Kaze [36]
|
2014
|
Urban
|
Cross-sectional
|
Hospital-based
|
Patients on maintenance hemodialysis
|
52.7
|
64.0
|
45
|
Hypertension (29%), chronic glomerulonephritis (24%), Diabetes mellitus (24%)
|
Halle [37]
|
2015
|
Urban
|
Retrospective
cohort
|
Hospital-based
|
Patients with ESRD
|
47.4
|
66.0
|
863
|
Hypertension (30.9%), glomerulonephritis (15.8%), diabetes mellitus (15.9%), HIV (6.6%), unknown (14.7%)
|
Kaze [38]
|
2015
|
Urban
|
Retrospective
cohort
|
Hospital-based
|
Patients admitted in the nephrology unit
|
44.8
|
60.0
|
225
|
Chronic glomerulonephritis (25.9%), hypertension (22.3%), diabetes mellitus (20.1%)
|
Halle [39]
|
2016
|
Urban
|
Prospective cohort
|
Hospital-based
|
Patients on maintenance hemodialysis
|
46.3
|
66.0
|
661
|
Hypertension (28.3%), chronic glomerulonephritis (17.5%), diabetes mellitus (13.9%), hypertension and diabetes (7.3%), HIV (6.7%), unknown (16.9%)
|
Halle [40]
|
2016
|
Urban
|
Cross-sectional
|
Hospital-based
|
Maintenance hemodialysis
|
51
|
66.0
|
97
|
Hypertension (25.8%)
Chronic glomerulonephritis (20.6%)
Diabetes mellitus (17,5%)
|
Luma [41]
|
2017
|
Semi-urban
|
Cross-sectional
|
Hospital-based
|
Hemodialysis patients
|
48
|
65.4
|
104
|
Hypertension (40.4%), chronic glomerulonephritis (19.2%), HIVAN (11.5%), Diabetes mellitus (7.7%), obstructive nephropathy (2.9%), unknown (13.5%)
|
Moor [42]
|
2017
|
Urban
|
Cross-sectional
|
Hospital-based
|
Patients on maintenance hemodialysis
|
55
|
75.0
|
44
|
HTN (59.1%), Diabetes mellitus (11.4%)
|
NR; Not Reported, ESRD; End stage renal disease
Major comorbidities in CKD patients in Cameroon
Thirteen studies discussed the comorbidities of CKD in Cameroon, Table 5. Ten or more of these studies reported hypertension and diabetes mellitus as major comorbidities of CKD. Also, viral infections such as HIV, Hepatitis B and Hepatitis C infections in were also important comorbidities associated with CKD. Furthermore, hyperuricemia, obesity, previous cardiovascular events, malnutrition, anemia, smoking, and alcohol use were major comorbidities.
Table 5: Major comorbidities in Chronic Kidney Disease patients in Cameroon
First author
|
Year of publication
|
Study area
|
Study population
|
Mean age (in years)
|
Sample size
|
Comorbidities
|
Halle [43]
|
2009
|
Urban
|
Patients with CKD
|
50.1
|
140
|
Hypertension (62.1%); diabetes mellitus (25.0%); gout (7.1%); HIV (6.4%)
|
Halle [35]
|
2014
|
Urban
|
ESRD patients on dialysis
|
49.4
|
113
|
Mid-arm muscle circumference (23.9%); heart failure (22.1%); diabetes mellitus (20.3%); HIV (4.4%)
|
Kaze [36]
|
2014
|
Urban
|
Patients on maintenance hemodialysis
|
52.7
|
45
|
Hypertension (95.6%); anemia (42%); left ventricular hypertrophy (60%); valvular heart disease (51.1%); heart failure (33.3%); dyslipidemia (33.3%); diabetes mellitus (24%); tobacco use (22.2%); obesity (4%)
|
Kaze [38]
|
2015
|
Urban
|
Patients with CKD
|
44.8
|
139
|
Hypertension (81.3%); diabetes mellitus (32.2%); tobacco use (15.1%); HIV (10.1%)
|
Mbouemboue [44]
|
2016
|
Semi-urban
|
ESRD
|
45.0
|
35
|
Anemia (Females [100%]; Males [92%])
|
Halle [40]
|
2016
|
Urban
|
Maintenance hemodialysis
|
51.0
|
97
|
Hypertension (25.8%); Diabetes mellitus (17.5%); HCV (20.6%); HIV (8.2%); HBV (6.2%)
|
Kouotou [45]
|
2016
|
Urban
|
Hemodialyzed patients
|
48.6
|
112
|
Hypertension (66.1%); Diabetes mellitus (25.9%); HCV (26.8%)
|
Hamadou [27]
|
2017
|
Urban
|
Patients diagnosed with CKD
|
54.2
|
400
|
Anemia (44.5%), Obesity (39.75%), Diabetes mellitus (32%); hyperuricemia (10.75%); tobacco use (0.8%)
|
Moor [42]
|
2017
|
Urban
|
Patients on maintenance hemodialysis
|
55.0
|
44
|
Hypertension (59.1%); Diabetes mellitus (11.4%); alcohol use (11.4%); tobacco use (4.5%)
|
Luma [41]
|
2017
|
Semi-urban
|
Patients on maintenance hemodialysis
|
48.0
|
104
|
Hypertension (84.6%); HCV (19.2%); HIV (13.5%); HBV (10.6%)
|
Lemogoum [46]
|
2018
|
Urban
|
Patients with CKD
|
52.0
|
150
|
Hypertension (87.3%); dyslipidemia (62.0%); overweight/obesity (53.3%); abdominal obesity (34.0%); Diabetes mellitus (32.7%); previous cardiovascular event (18.0%)
|
Doualla [47]
|
2018
|
Urban
|
Non-dialysed CKD patients
|
55.8
|
103
|
Hypertension (87.4%); Diabetes mellitus (34.0%); gout (21.4%); HIV (12.6%)
|
Halle [34]
|
2019
|
Urban
|
Patients with CKD
|
53.1
|
130
|
Hypertension (70.77%); diabetes mellitus (41.54%); HIV (8.5%); gout (6.9%)
|
CKD = Chronic kidney disease; ESRD = End-stage renal disease; CRF = Chronic renal failure; HIV = Human immunodeficiency syndrome; HBV = Hepatitis B; HCV = Hepatitis C
Treatment of CKD in Cameroon
Most of the CKD patients required hospitalization and eventual dialysis. However, the hospitalization rate was 42.2% in patients referred late and 33.6% of these late referrals were proposed emergency dialysis [43]. Emergency unplanned dialysis on a temporary catheter was required in 88.3% of 863 adult patients with CKD [37].
Cost of CKD management in Cameroon
Data on CKD’s economic burden is scarce in Cameroon. In a one-month retrospective cost analysis of non-dialysis CKD patients in Yaoundé, Cameroon; the total cost for management of CKD was 163 USD with direct medical cost accounting for 86.4% of this and only 1.4% of the 69 participants (median monthly salary of 162 USD) had full health insurance coverage [33].
Mortality of CKD in Cameroon
The mortality rate of CKD in Cameroon ranged between 26.8% and 58.0% during a period of 1 to 10 years of follow up, Table 6 [39,48,49]. An audit of 661 medical records reported a 10-year mortality rate of 44.9% [39]. The highest mortality rate of 58.0% was reported in a 15 months’ prospective study in 197 ESRD patients. Furthermore, the one-year mortality rate of hemodialyzed patients in a retrospective study was 29.8% [49]
Table 6: Mortality of CKD in Cameroon
First author, publication year
|
Study area
|
Study Design
|
Study setting
|
Study population
|
Median age
|
Sample size
|
Mortality rate
|
Halle 2016 [41]
|
Urban
|
Retrospective cohort
|
Hospital-based
|
ESRD patients on hemodialysis
|
46.3
|
661
|
12-month mortality = 26.8%
10-year mortality = 44.9%
|
Fouda 2017 [48]
|
Urban
|
Prospective cohort
|
Hospital-based
|
ESRD patients on dialysis
|
48.0
|
197
|
15-month mortality = 58.0%
|
Halle 2018 [43]
|
Urban
|
Retrospective cohort
|
Hospital-based
|
PLHIV with ESRD on hemodialysis
|
46.0
|
57
|
12-month mortality = 38.6%
|
NR; Not Reported, ESRD; End stage renal disease, PLHIV; People living with Human Immunodeficiency Virus