Epidemiology of chronic kidney disease in young patients in developing countries

Table 1 Summary of included studies

Ref.	Country	Setting and design	Patients	Intervention	Comparison	Outcome
Abraham et al[22], 2016	India	Prevalence study. South Asia, including India, Bangladesh, Pakistan, Nepal, Bhutan, and Sri Lanka and Afghanistan	132	Screening	N/A	112
Degenaar et al[23], 2003	South Africa	A cross-sectional study with participants recruited from Potchefstroom and its surroundings	956	Questionnaires were used based on demographics, anthropometric, and some other measurements, such as biomarkers, to stratify the population	N/A	Individuals with low eGFR, low uromodulin, and high CKD273 classifier levels exhibited unfavorable cardiovascular profiles; in adjusted analyses, eGFR was inversely associated with HDL-C and GGT, while the CKD273 classifier was positively associated with age, HDL-C, and GGT
Garcia-Garcia et al[9], 2020	Mexico	Cross-sectional prevalence comparison study of Poncitlan to Jalisco in Mexico	51789 in Jalisco and 427 in Poncitlan	Data were collected prospectively in Jalisco using standardized forms on participants aged 2 years or older, and fasting blood glucose levels were measured; blood specimens of participants were used to measure serum creatinine and glucose; urine specimens for dipstick urinalysis, adult hypertension, diabetes mellitus, BMI, percentiles of children calculated > 95th percentile or < 5th percentile classified as overweight or malnourished, respectively		50626; the prevalence of CKD and proteinuria in the studied group was similar to that of the overall Mexican population; in Poncitlan, young patients were more likely to be female but of comparable age compared to other areas; children in Poncitlan were younger but had a similar gender distribution; notably, both CKD and proteinuria rates were significantly higher among young patients from Poncitlan compared to other municipalities; proteinuria was also much more common among children in Poncitlan than among their peers from other areas
Hafez et al[10], 2019	Egypt	Assessed prevalence rate, etiology, and other risk factors for end-stage renal disease (ESRD) in Aswan governorate in upper Egypt, during the period from June 2017 to June 2018	1000	Patients with end-stage renal disease on maintenance hemodialysis; this cross-sectional study was carried out on 1000 patients with ESRD		1000, the leading causes of ESRD in Aswan Governorate are hypertensive renal disease, diabetic nephropathy, and obstructive uropathy; other causes include glomerulonephritis, chronic pyelonephritis, congenital conditions, analgesic nephropathy, preeclampsia, polycystic kidney disease, gouty nephropathy, and lupus nephritis, with some of the causes being unknown
Zekry et al[24], 2023	Egypt	This study included 1000 hemodialysis patients aged 18 to 60 from Fayoum, Egypt	1000	Participants were recruited from local hospitals, and data were gathered from medical records and, when needed, directly from patients or their relatives		1000; the main causes of ESRD were hypertension, kidney stones, unknown causes, and both hypertension and diabetes; significant gender differences were found in the frequency of original kidney diseases
Gautam et al[25], 2024	Nepal	A retrospective prevalence study was conducted from 2022 to 2023 in the pediatric department	1116	This study examines kidney disease patterns in children admitted to the hospital over seven years, focusing on treatments given and patient outcomes	N/A	63 (5.6%); most affected were school-age children, while newborns and infants had the fewest cases; urinary tract infection was the most common condition, followed by acute kidney injury; treatments included medications, dialysis, and surgery; most patients improved and were discharged to the Nephrology clinic; some left against medical advice, died, or were referred elsewhere
Hamilton et al[26], 2020	Malawi	The cross-sectional study from January-August 2018 collected bio samples and anthropometric data in two Malawian population settings	821	Study analyzed data from 821 healthy young patients in Malawi to assess kidney function and its risk factors; researchers collected biological and body measurements and used the CKD-EPI equation to estimate glomerular filtration rate (eGFR); regression models were used to identify factors associated with reduced eGFR	N/A	783
Ulasi and Ijoma[20], 2010	Nigeria	ESRD patients seen at the University of Nigeria Teaching Hospital, Enugu, South-East Nigeria	1538	ESRD patients seen were recruited; records from the accident and emergency department, medical-out-patients, wards, and dialysis unit were used	N/A	908; the outlook for CKD patients in Nigeria is poor due to limited access to renal-replacement therapy, mainly because of high costs; this highlights the importance of prevention to lessen CKD’s impact
Khan et al[27], 1996	Albania	Incidence and outcome study of patients on the need for renal services in Albania	84	A review of case notes for all patients in Tirana who had a serum creatinine concentration of 300 μmol/L or higher during 1992, with their outcomes tracked over two years	The serum creatinine concentration of 300 μmol/L or higher during 1992 was reviewed	65
Gheissari et al[28], 2012	Iran	This study retrospectively analyzed the medical records of children under 19 years old who were hospitalized for CKD at St Alzahra Hospital in Isfahan, Iran, from November 2001 to December 2011	268	The study found that most children with CKD presented with advanced disease, and the majority required dialysis; glomerular diseases were the main cause, and anemia was very common; the transplantation rate was low, and younger children faced a higher risk of death; the incidence and mortality rates of advanced CKD were significant in the population studied	N/A	144
Priyanka et al[19], 2024	India	Prospective cohort study of children aged 1-18 years with biopsy-proven primary FSGS followed from January 2010 to June 2023 in a tertiary-care center in India	73	Children aged 1-18 years with biopsy-proven primary FSGS were enrolled, and their clinical profile, histological characteristics, kidney outcomes, and predictors of adverse outcomes were determined	N/A	52
Halle et al[29], 2009	Cameroon	Medical files of patients received at the outpatient department of nephrology from January 2001 to December 2003 at the Yaounde General Hospital were reviewed	183	Data on etiologic and co-morbidity of CRF recorded	N/A	160
Orta-Sibu et al[30], 2002	Venezuela	A report epidemiological data on renal disorders in children in Venezuela from 14 centers from January 1998 to December 1998	3624.0	Data were collected by chart review in all patients; because some patients are seen first in a small center near their home and then sent to a pediatric nephrology center for further investigations, the name and date of birth were checked in order to avoid double registry	N/A	2031
Wong et al[31], 2015	Cambodia	A retrospective observational study with data collection and analysis of patient records in the Mercy Medical Center (MMC) in Cambodia from April to December 2012	915	Between April and December 2012, 1013 new patient records at Mercy Medical Center in Cambodia were reviewed; of these, 915 adult patients were analyzed; patients with a history of hypertension were excluded from blood pressure analysis, and those with diabetes, hypertension, chronic kidney disease, or renal symptoms were excluded from urinalysis analysis	N/A	820; out of 820 patients without a history of hypertension, 8.9% had abnormal blood pressure, with 7.3% meeting the criteria for high blood pressure and 1.6% having isolated systolic hypertension; additionally, 30.6% showed significant proteinuria or hematuria, and 39.0% had elevated urine white blood cell counts; overall, 53.9% of these patients had at least one urinary abnormality
Plata et al[32], 1998	Bolivia	Educational renal campaign conducted in three selected areas	14082	Fresh urine samples were tested with a dipstick and examined under a microscope; patients with abnormal results received additional tests to confirm diagnoses and were followed for three years	N/A	4261; among 820 patients without hypertension, 8.9% had abnormal blood pressure; over half showed at least one abnormal urinalysis result, with 7.3% having high blood pressure, 1.6% isolated systolic hypertension, 30.6% significant proteinuria or hematuria, and 39% elevated urine white blood cells
Al-Rasheed et al[33], 1996	Saudi Arabia; the classification of Saudi Arabia as “developing country” is debatable and may not fully match current WB categories	Between April 1982 and September 1994, renal biopsies were performed in children at King Khalid University Hospital, Riyadh, Saudi Arabia	167	The reports the distribution of kidney disease types: 23.3% had minimal change lesions, 24% had mesangial proliferative glomerulonephritis, and 24% had focal segmental glomerulosclerosis; there was a higher incidence of congenital nephrotic syndrome and Alport’s syndrome compared to Western countries, while IgA nephropathy was rare (3%), and type II membranoproliferative glomerulonephritis was absent	N/A	156
Lou-Meda[34], 2015	Guatemala	A recent analysis of the Guatemalan Registry of Pediatric CKD included patient records from May 2004 to April 2013	432	Those classified as having CKD stage 2 or greater based on the most recent available estimated glomerular filtration rate (eGFR)	N/A	193
Ndongo et al[35], 2024	Senegal	A cross-sectional study in three northern regions in Senegal with a two-stage cluster sampling	2441	Non-pregnant women, recent hospital patients, those with recent symptoms, and people on renal therapy; data was gathered at participants’ homes using a modified WHO questionnaire; blood samples were analyzed for creatinine, lipids, and sugar; the estimated glomerular filtration rate was calculated using the CKD-EPI 2021 formula; the sample size accounted for a 5% precision, 80% power, and a 10% attrition rate	N/A	High blood pressure was found in 52% and CKD in 17.8% of participants; three out of five people with HBP were previously undiagnosed; CKD was most common among those with known HBP (30.5%), less common in those with undiagnosed HBP (19.1%), and least common in people with normal blood pressure (10.9%); older age and female sex were linked to a higher risk of CKD
Zhang et al[36], 2008	China	Cross-sectional population-level study	13925	13925 representative sample among 124410000 people living in Beijing		1% (1430000) with CKD

N/A: Not applicable; eGFR: Estimated glomerular filtration rate; CKD: Chronic kidney disease; HDL-C: High density lipoprotein cholesterol; GGT: Gamma-glutamyltransferase; ESRD: End-stage kidney disease; CKD-EPT: Chronic kidney disease epidemiology collaboration; FSGS: Focal segmental glomerulosclerosis; CFR: Case fatality rate; MMC: Mercy medical center; WB: World bank; IgA: Immunoglobulin A; WHO: World Health Organization.

Table 2 Individual study prevalence of chronic kidney disease

Ref.	Country	Total patients	Number of CKD cases	Prevalence (95%CI)
Degenaar et al[23], 2003	South Africa	956	240	0.2510 (0.2238-0.2798)
Garcia-Garcia et al[9], 2020	Mexico	52216	5484	0.1050 (0.1024-0.1077)
Hafez et al[10], 2019	Egypt	1,000	53	0.0530 (0.0399-0.0688)
Zekry et al[24], 2023	Egypt	1000	103	0.1030 (0.0849-0.1235)
Gautam et al[25], 2024	Nepal	116	6	0.0517 (0.0192-0.1092)
Hamilton et al[26], 2020	Malawi	821	36	0.0438 (0.0309-0.0602)
Ulasi and Ijoma[20], 2010	Nigeria	212673	79862	0.3755 (0.3735-0.3776)
Khan et al[27], 1996	Albania	84	8	0.0952 (0.0420-0.1791)
Gheissari et al[28], 2012	Iran	653	181	0.2772 (0.2432-0.3132)
Priyanka et al[19], 2024	India	73	21	0.2877 (0.1877-0.4055)
Halle et al[29], 2009	Cameroon	140	23	0.1643 (0.1071-0.2362)
Orta-Sibu et al[30], 2002	Venezuela	3624	59	0.0163 (0.0124-0.0210)
Wong et al[31], 2015	Cambodia	1013	7	0.0069 (0.0028- 0.0142)
Plata et al[32], 1998	Bolivia	14082	22	0.0016 (0.0010-0.0024)
Al-Rasheed et al[33], 1996	Saudi Arabia	167	12	0.0719 (0.0377-0.1222)
Lou-Meda[34], 2015	Guatemala	1545	432	0.2796 (0.2573-0.3027)
Ndongo et al[35], 2024	Senegal	2441	1704	0.6981 (0.6794-0.7162)
Zhang et al[36], 2008	China	8301	47204	0.18 (0.17-0.18)
Abraham et al[22], 2016	India	132	112	0.8485 (0.7757- 0.9049)

CKD: Chronic kidney disease; CI: Confidence interval.