CKD in Africans: Diagnosis and Prevention | Management of CKD in Africans
By Chinedu Akpa. B. Pharm. Freelance Health Writer, with medical and editorial review by the DLHA Team
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“One year after my kidney crashed I just had a failed kidney transplant at a hospital. Pray for me”. On August 28, 2024, a well-known Nigerian music video director TG Omori posted these remarks on his X account. They quickly went viral and sparked thousands of responses from his two million followers. His illness brings chronic kidney disease (CKD) and its devastating effects back into the public eye. This was made clear by the outpouring of feelings and responses (nearly ten thousand comments on his X page) from people who had different ideas about what might have caused TG Omori's condition. Some even suggested that phony drinks might have been the reason.
Chronic kidney disease is defined by the Pan American Health Organization as a progressive loss of the kidney's capacity to perform routine functions like removing waste products from the body and regulating blood pressure. [1] CKD is 3-4 times more prevalent in Africa than the rest of the world. [2] In Africa, Sub-Saharan Africa leads the way with 85% prevalence rate when compared to Northern Africa. [3]
The goal of this article is to help you better understand chronic kidney disease (CKD) and share practical steps you can take to protect your health and stay ahead of this condition.
Chronic kidney disease (CKD) is a condition indicating that your kidneys have been damaged and are not working as well as they should. Your kidneys work as filters in your body — filtering and removing wastes, toxins and extra water from your blood while retaining important salts and minerals. Your kidneys also help to maintain bone and red blood cells health. So when you have CKD the normal functions of your kidneys fail and waste, toxins and excess fluid may build up in your blood. Also bone and red cell health are affected.
From a numbers point of view, chronic kidney disease is said to be present when the measure of filtration function of your kidneys, i.e. estimated glomerular filtration rate (eGFR) is 60 ml/min/1.73m² and below. eGFR indicates the amount of blood that is filtered by the kidney per minute per a standardized body surface area (BSA) of 1.73 square meters, which is the average adult BSA. [4]
The loss in the function of the kidney is usually very gradual and oftentimes silent, i.e., it may go unnoticed for months.
When fully established, CKD can lead to kidney replacement therapy such as dialysis or kidney transplant.
Related: Functions of the kidney and how it works
When the kidney is suddenly damaged due to shock, dehydration, infection, or medication, it can cause immediate disturbance of functions, which is known as acute kidney injury (AKI). [5]
It's important to differentiate Chronic Kidney Disease and AKI because although they both involve kidney function and have largely the same symptoms, their clinical consequences, progression and end point are different. The table below provides a snapshot of their differences.
| CHRONIC KIDNEY DISEASE | ACUTE KIDNEY DISEASE |
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Table showing the differences between CKD and AKI
In one of his tweets, TG Omori expressed his belief that drinking alcohol may have been a contributing factor in his kidney failure.
We got in touch with Dr. Abiodun Adeyemo, a nephrologist at Zenith Medical and Kidney Center in Abuja, to find out if there was any truth in TG’s expression. Dr. Adeyemo clarified that alcohol consumption is not a direct cause of chronic kidney disease (CKD) but rather alcohol is the cause of many health issues, including heart disease, stroke, hypertension, and cancer, some of which have a direct link to CKD.
The common causes and risk factors of CKD can be described in two groups:
Modifiable causes and risk factors of CKD include:
Risk factors
There are usually no symptoms until the kidney is badly damaged. However, the following has been found to be some of the symptoms of CKD.
Clinical stages of CKD. image credit: Century Med Den Cent. Click on image to enlarge.
The stages of CKD are defined by the glomerular filtration rate of the kidney per period of time per body surface area. There are 5 stages and each one presents with its own symptoms. [7]
Staging Chronic Kidney Diease by eGFR. Click on image to enlarge.
You may feel completely normal at this stage and not realize you have kidney disease. Modifying your lifestyle and taking your medications as directed can help stop further kidney damage.
This stage appears nearly identical to stage 1.
The kidneys are typically mildly to moderately damaged at this point. You may start to notice some foam or darker urine, swell in your hands and feet, and feel weak and exhausted.
The presentation in 3b becomes more intense than in 3a.
You may have lower back pain, swollen hands and feet, and darker or foamy urine as a result of moderate to severe kidney damage. This is the last stage before kidney failure.
It is now impossible for your kidney to function due to damage. This is typically the time when kidney transplantation and dialysis are advised.
To avoid stage 4 or 5 of CKD, it is critical to lead a healthy lifestyle, see your doctor frequently, and take your prescription drugs as directed. There may be no other option than dialysis or a transplant at these final two stages.
Note: The above GFR levels are relative to young adult levels and have been determined without racial considerations. In the absence of clinical evidence of kidney damage, neither GFR Stage 1 nor stage 2 fulfill the benchmark for CKD.
CKD in Africans: Diagnosis and Prevention →
Related: The Kidney: What Every African Needs to Know
Published: September 27, 2024
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