Cameroon

Cameroon (Cameroun)

Chronic kidney disease in Cameroon: a scoping review

The Indomitable Lions enter the 2022 NephroWorldCup as many squads from sub-saharan Africa. As a relative newcomer to the international competition, Cameroon starts its NephroWorldCup journey with a detailed review of the burden of chronic kidney disease (CKD). Such an effort is a necessary first-step in understanding the amount and best allocation of healthcare resources required to successfully care for the population.

Figure 1. Northern (gray) versus sub-Saharan Africa (green) | Courtesy of Jcherlet: Jcherlet / derivative work: Jcherlet (talk) - HDImap_spectrum2006_Africa.png, Public Domain, https://commons.wikimedia.org/w/index.php?curid=12340966

To begin the prevalence of chronic kidney disease is 15% higher in lower/lower-middle income nations than upper income nations. Add to that the observation that the prevalence of CKD is greater in sub-saharan Africa than Northern African nations and we realize that The Indomitable Lions need to understand the burden of CKD within their borders (Figure 1).

Figure 2. Search terms used to find prevalence information

The overall prevalence of CKD in Cameroon is estimated between 10-14.2%; this seems consistent with what we see around the world (Figure 3). Perhaps more striking is that 16% of individuals with CKD have at least one family member with CKD as well (Figure 4).

Typical factors predisposed patients to CKD, including well-studied factors such as hypertension and diabetes. Though HIV/AIDS remains a significant contributor to CKD, with 7-12% of patients having it as the proximate etiology for CKD; a finding that is consistent with data analyzed nearly a decade ago (Figure 5).

The Cameroon squad looked at the available scientific literature to ascertain prevalence. This method is different than what other sub-Saharan nations have done; namely looking at one's own internal health databases (see Scouting Reports for Senegal and Ghana). The researchers performed a literature search of prior studies that analyzed or mentioned prevalence data (Figure 2).

Figure 3. Global prevalence of CKD | Presented at the 2020 European Renal Association meeting | Courtesy of Dr. Alex Hamilton

In some studies, HIV alone wasn't the main viral cause of CKD. Hepatitis B and C continue to cause a significant portion of CKD burden, anywhere from 6-13% and 19-27%, respectively.

Figure 5. CKD prevalence in patients with HIV | Presented at the 2017 World Congress of Nephrology meeting | Courtesy of Dr. Arvind Canchi (zoom in for details)

Alas perhaps the most heartbreaking information uncovered is the 10-year mortality rate for Cameroon citizens with end-stage kidney disease receiving in-center hemodialysis (the only form of dialysis available in 2020): 44.9%. The one-year mortality rate was 29.8%. Perhaps one lesser-known cause driving these high mortality rates is the availability of medical insurance.

In Cameroon, only 1.4% of the CKD population has some form of medical insurance. As we have seen in other nations, expanding access to health insurance can result in near-immediate mortality benefits for patients with ESKD.

The CKD burden in Cameroon is extensive and some of the lesser thought etiologies (e.g., HIV, HBV, HCV) continue to play an important role in the development of end-stage kidney failure. Armed with this knowledge, The Indomitable Lions can begin to chip away and tackle the lowest-hanging fruit first.

Until then, studies like these need to be conducted to show the world how much resources are needed to tackle the real burden that nations (and their people) face with CKD.