Hypertension is a major risk factor for chronic kidney disease in Arab adults, with undiagnosed CKD prevalence of up to 39%, and CKD prevalence up to 47% among hypertensive patients.
Systematic Review
What is the prevalence, risk factors, and gaps in screening and management of CKD among hypertensive patients in Arab countries?
Chronic kidney disease is highly prevalent and often undiagnosed among hypertensive patients in Arab countries, highlighting an urgent need for systematic screening and targeted interventions.
Effect estimate: Odds ratio for CKD with hypertension 1.66 (95% CI 1.015-2.73); incidence rate 164.8 per 10,000 person-years; prevalence up to 47% in hypertensives
Absolute Event Rate: 38.8% vs 31%
p-value: p=0.043 for HTN as risk factor
Background Chronic kidney disease (CKD) is expected to be the 5th leading cause of years of life lost by 2040. Recently, it emerged as a significant cause of mortality and morbidity, with a high prevalence in Arab countries. Objective Assess CKD among hypertensive (HTN) people in Arab Countries through evaluation of the existing literature on CKD prevalence, risk factors, screening programmes and prevention. Study design A systematic review till April 2024 following PRISMA guidelines. The search strategy was registered in PROSPERO under the identification code CRD42024486068. Methods Databases searched were Medline, Embase, Scopus, PubMed, Cochrane Library. Screening was done using Covidence by three independent reviewers. Results Out of 63 studies screened, 11 were selected for extraction. The prevalence of CKD was higher among elderly, HTN and diabetic patients, with 38.8% having unrecognised CKD. Nearly 39% of the 400 participants in one study had undiagnosed stages 3–5 CKD. Two studies showed that 55.8% and 75% of identified CKD patients had HTN. Physicians reported suboptimal screening rates, with about 77% relying on the estimated glomerular filtration rate as a diagnostic tool. Risk factors for CKD include old age, HTN, dyslipidaemia, family history of CKD, and obesity. Among physicians, 85% recommended a target blood pressure of ≤130/80, 80% advised smoking cessation, 66% prescribed anti-lipids, and 67% recommended weight loss. All studies support the fact that HTN is a risk factor for CKD. Conclusion CKD is an escalating problem in Arab countries, with hypertension as a major risk factor. Many patients remain undiagnosed. A region-specific CKD screening and HTN control programme is urgently needed. The findings are essential for policymakers in strengthening primary care for systematic screening of HTN and CKD. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42024486068.
Rashdi et al. (Mon,) conducted a systematic review in Adults (≥18 years) with hypertension in Arab countries at risk of or with chronic kidney disease. Hypertension management interventions including blood pressure control, screening for CKD using eGFR and albuminuria testing, pharmacologic treatments (ACE inhibitors, ARBs, lipid lowering) vs. No intervention or usual care in observational comparisons was evaluated on Prevalence and incidence of chronic kidney disease (CKD) among hypertensive adults, CKD screening rates, blood pressure control rates and CKD management patterns (Odds ratio for CKD with hypertension 1.66 (95% CI 1.015-2.73); incidence rate 164.8 per 10,000 person-years; prevalence up to 47% in hypertensives, p=p=0.043 for HTN as risk factor). Hypertension is a major risk factor for chronic kidney disease in Arab adults, with undiagnosed CKD prevalence of up to 39%, and CKD prevalence up to 47% among hypertensive patients.