# Prevalence and Determinants of Chronic Kidney Disease among Patients with Sickle Cell Disease in Tanzania

## TL;DR

This study finds that nearly half of sickle cell disease patients in Tanzania have chronic kidney disease, with early signs like microalbuminuria and diabetes strongly linked to kidney problems.

## Contribution

The study reports the first detailed assessment of kidney disease prevalence and risk factors in SCD patients in Tanzania.

## Key findings

- 49% of SCD patients had kidney disease, with 66.9% prevalence among children and adolescents aged 5–18 years.
- Microalbuminuria and diabetes were strongly associated with kidney disease, with odds ratios of 9.1 and 9.1 respectively.
- Urine creatinine-based criteria detected 14.4% more kidney disease cases than serum creatinine-based criteria.

## Abstract

Chronic Kidney Disease (CKD) is a common complication in Sickle Cell Disease (SCD), accounting for 16–18% of attributable mortality among patients with SCD. Previous studies have identified microalbuminuria, diabetes mellitus (DM) and hypertension as early determinants of CKD in SCD, but few studies have been done in Tanzania to characterize the magnitude and risk factors for kidney disease in this patient population.

This study aimed to assess the prevalence and determinants of kidney disease among SCD patients at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania.

We conducted a cross-sectional study involving 369 patients with SCD. Socio-demographic and clinical data including blood pressure and random blood glucose were collected. Blood and urine samples were analyzed for serum creatinine, urine creatinine, and urine albumin. Statistical analyses, including Chi-square tests and multivariable logistic regression, were performed using IBM SPSS v24.0 to explore the association between socio-demographic and clinicopathological parameters (age, sex, blood pressure, DM, microalbuminuria) with kidney disease (defined as presence of established structural damage of the kidneys or a decreased eGFR [< 60 mL/min/1.73m2] lasting for at least three months). A p-value < 0.05 was considered to be statistically significant.

The prevalence of kidney disease was 49%, with a higher prevalence (66.9%) among study participants aged between 5–18 years. Hypertension was present in 1.1%, DM in 0.5% and microalbuminuria in 30.6% of the study population. Patients with hypertension had a 4.2-fold (OR 4.22, CI 1.18–15.15) increased likelihood of having kidney disease whereas those with DM and microalbuminuria had 9.1-fold (OR 9.13, CI 2.62–31.9) and 2-fold (OR 2.67, CI 1.84–4.16) increased likelihood of having kidney disease, respectively. There was a 14.4% (p-<0.001) discrepancy in kidney disease detection based on urine creatinine compared to serum creatinine-based criteria.

We report a high prevalence and early occurrence of kidney disease among patients with SCD in Tanzania. This study highlights the association between microalbuminuria and other clinical parameters such as hypertension and DM with the occurrence of kidney disease in patients with SCD, underscoring the need for early screening, evaluation and intervention for progressive chronic kidney disease among patients with SCD.