Prévalence de la maladie rénale chronique à Antananarivo, Madagascar

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IntroductionL’insuffisance rénale chronique se définit comme une incapacité du rein à assurer ses fonctions normales et qui persiste au-delà de trois mois. De nos jours, le débit de filtration glomérulaire estimé par les formules se basant sur le dosage de la créatininémie reste le gold standard pour évaluer la fonction rénale. À Madagascar, nous ne disposons pas encore de données nationales concernant l’épidémiologie de cette pathologie probablement liée en partie à la complexité de la réalisation du dosage de la créatininémie. La disponibilité récente des dosages de la créatininémie capillaire évaluée à partir d’un créatinomètre utilisant une bandelette réactive de créatinine a permis de faciliter la détermination du taux de la créatininémie dans les études épidémiologiques. Patients et méthodesCette procédure simple nous a permis de planifier une étude pilote à Antananarivo, la capitale de Madagascar. L’objectif principal était d’évaluer la prévalence de l’insuffisance rénale déterminée à partir de la créatininémie prélevée sur sang capillaire. L’objectif secondaire était de déterminer les facteurs associés à l’insuffisance rénale chronique à Madagascar. Il s’agit d’une étude transversale analytique réalisée pendant une période de trois mois. L’insuffisance rénale chronique se définit comme une baisse du débit de filtration glomérulaire de la créatininémie

IntroductionChronic kidney disease is defined as an inability of the kidney to perform its normal functions and which persists beyond three months. Nowadays, the estimated glomerular filtration rate based on plasmatic creatinine level remains the gold standard to assess renal function. In Madagascar, we miss national data concerning the epidemiology of chronic kidney disease probably due to the complexity of carrying out the serum creatinine assays. The recent availability of creatinometer using a creatinine strip test with capillary creatinine facilitated the determination of the creatinine level in epidemiological study. Patients and methodsThis simple technique allowed us to plan a pilot study in Antananarivo, the capital of Madagascar. The main objective was to assess the prevalence of chronic kidney disease determined from capillary creatinine level. The secondary objective was to determine the factors associated with chronic kidney disease in Madagascar. It is an analytical cross-sectional study over a period of three months. Chronic kidney disease is defined as a decrease of the glomerular filtration rate of capillary creatinine less than 60mL/min/1.73m2 and calculated with Chronic Kidney Disease Epidemiology formula (CKD-EPI). The minimum number of studied population has been assessed and settled at 210 people. Cluster sampling was performed for randomization of participants. ResultsAt the end of the study, 210 people were randomized for screening. The average age was 40 years old with 14.9 as standard deviation. The sex ratio (male/female) was 1.76. The prevalence of chronic kidney disease was 13.8% with extreme values of 9,1 and 18.5. With chronic kidney disease, high blood pressure (hypertension) and diabetes were found respectively in 41.3 and 17.2%. Chronic kidney disease affected mainly in 72.4% of population aged 25 to 54 years old. ConclusionThis is the first study in Africa to screen chronic kidney disease using a creatinine strip test. This prevalence is relatively different compared to other African countries. The limits of the study are the absence of a subsequent control and/or double control of the creatinine, which definitively confirms the chronicity of kidney disease, the absence evaluation of the urinary sediments to determine proteinuria. Nevertheless, the results of our study can be used as data awaiting the results of a multicenter studies. To determine the national prevalence of chronic kidney disease, screening in the six provinces is currently in progress.