Prevalence and Causes of Acute Kidney Injury and Chronic Kidney Disease in Ghana: A Systematic Review and Meta-Analysis

Abstract

Background

Acute kidney injury (AKI) and chronic kidney disease (CKD) are major contributors to morbidity and mortality globally, with a growing burden in sub-Saharan Africa. In Ghana, kidney disease is increasingly recognized as a public health concern; however, pooled data on its prevalence and etiology is absent. This systematic review and meta-analysis seeks to synthesize available evidence on the prevalence and causes of AKI and CKD in Ghana.

Methods

A systematic literature search was conducted across electronic databases to identify observational studies reporting the prevalence and/or causes of AKI and CKD in Ghana. Eligible studies included hospital-based and community-based investigations published in peer-reviewed journals. Data were extracted on study characteristics, diagnostic criteria, prevalence estimates, and reported etiologies. Study selection followed predefined inclusion and exclusion criteria. Random-effects meta-analysis was performed despite substantial heterogeneity, and results were interpreted with caution.

Results

Twenty-seven (27) studies involving 11,245 participants were included. The pooled prevalence of AKI in Ghana was 21% (95% CI: 9–34%), while the pooled prevalence of CKD was 19% (95% CI: 16–23%). AKI was predominantly reported among hospitalized patients and was mainly attributed to sepsis, hemolysis, hypertensive emergencies, and obstetric complications. CKD was primarily driven by chronic glomerulonephritis, hypertension, and diabetes mellitus across most study populations.

Conclusion

The burden of AKI and CKD in Ghana is high, with approximately one in five patients affected. Preventable causes such as infections, hypertension, diabetes mellitus, and glomerular diseases account for most cases, highlighting the urgent need for improved early detection, standardized diagnostic approaches, and strengthened kidney disease prevention and surveillance in Ghana.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44197-026-00531-0.

Introduction

The kidneys are essential organs that maintain the body’s balance of fluids, electrolytes, and acid-base levels [20]. Kidney diseases encompass a wide spectrum of conditions that impair kidney structure and function, potentially progressing to kidney failure. AKI is defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria as an abrupt decline in kidney function resulting in accumulation of nitrogenous waste products such as urea and creatinine, and it may also present with reduced urine output [22]. Its causes vary by age, region, and setting, but in sub-Saharan Africa, including Ghana, common triggers include infections (e.g., malaria, HIV/AIDS, diarrheal diseases), nephrotoxins, poorly prepared herbal medicines, and complications from obstetrics or surgery [14]. Globally, AKI affects 3–7% of hospitalized patients and 25–30% of those in intensive care, with an estimated 13.3 million cases annually, mostly in low- and middle-income countries (LMICs), contributing to up to 1.4 million deaths [14].

CKD, on the other hand involves irreversible loss of kidney function, preventing proper homeostasis, waste excretion, and hormone production [41]. KDIGO defines CKD as abnormalities of kidney structure or function persisting for more than three months, usually indicated by a reduced estimated glomerular filtration rate (eGFR) or persistent albuminuria [21]. CKD is also a powerful and independent risk factor for cardiovascular disease, and as kidney function declines, the risk of myocardial infarction, heart failure, stroke, and cardiovascular mortality increases substantially, often exceeding the risk of progression to end-stage kidney disease [27]. The financial burden of managing CKD is overwhelming for most patients in developing countries [2]. Globally, CKD affects 5–15% of adults in developed nations, while in parts of Africa, prevalence reaches about 10.4% [2]. In Ghana, CKD accounts for around 5–10% of medical admissions, with higher rates up to 46.9% among hypertensive patients, predominantly affecting males aged 20–50 years [9, 11, 15]. Key risk factors include aging, diabetes mellitus, hypertension, obesity, and cardiovascular diseases, with common pathologies like diabetic glomerulosclerosis and hypertensive nephrosclerosis [11].

Although kidney disease is increasingly recognized as a major public health problem in Ghana, existing evidence remains fragmented across small hospital-based studies using different diagnostic criteria and conducted in limited geographic regions. No previous systematic review or meta-analysis has synthesized national-level data on the prevalence and causes of AKI and CKD in Ghana. This limits health system planning, resource allocation, and disease prevention strategies. In the light of the above we seek to provide pooled national estimates of AKI and CKD prevalence and their major etiologies in Ghana using systematic review and meta-analytic methods.

Methods

Study Design

We registered our systematic review and meta-analysis protocol with PROSPERO (the International Prospective Register of Systematic Reviews) in 2025 under registration number CRD420251243003. Throughout the review process, we carefully followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to maintain methodological quality and transparency at every stage. The PRISMA flow diagram presented in Fig. 1 illustrates how we selected and included studies in our review.

Fig. 1.

PRISMA diagram illustrating the study selection process for the systematic review and meta-analysis

Eligibility Criteria

This review focused on observational studies (cross-sectional, cohort, or case-control designs) that reported the prevalence of CKD or AKI among populations in Ghana. Studies that investigated and reported causes of kidney disease were also included. We excluded studies that were case reports, case series, editorials, commentaries, conference abstracts without full-text availability, studies conducted outside Ghana, and those that did not provide sufficient data for us to extract prevalence information or perform meaningful analysis.

Study Selection and Data Extraction

Two independent reviewers systematically screened all retrieved records by title and abstract against the predefined eligibility criteria. Full-text articles of potentially relevant studies were then obtained and assessed for final inclusion. Any disagreements between reviewers during either screening phase were resolved through discussion and consensus, with consultation of a third senior reviewer when necessary. Data extraction was performed independently by two reviewers using a data extraction template form. Extracted information included study characteristics (author names, publication year, region, population, study design, sample size), participant demographics (age, sex distribution), diagnostic criteria and methods used for kidney disease assessment, prevalence estimates for acute kidney injury and chronic kidney disease and reported causes.

Quality Assessment

The methodological quality of included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Prevalence Studies. The tool evaluates nine domains, including the appropriateness of the sampling frame, sampling method, adequacy of sample size, detailed description of study participants and setting, validity and reliability of outcome measurement, appropriateness of statistical analysis, and adequacy of response rate. Each item was rated as “Yes,” “No,” “Unclear,” or “Not applicable.” For overall risk of bias, studies were classified as low risk if most domains were rated “Yes” with no major methodological concerns, moderate risk if multiple domains were rated “No” or “Unclear,” and high risk if substantial methodological limitations were identified across key domains. Disagreements were resolved through discussion among the reviewers. The results of the risk of bias assessment are summarized graphically.

Statistical Analysis

Statistical analyses were performed using Stata version 15. Prevalence estimates for AKI and CKD were expressed as proportions with 95% confidence intervals (CIs). Pooled prevalence estimates were calculated using random-effects meta-analysis with inverse-variance weighting and the DerSimonian–Laird estimator. Subgroup analyses were conducted for AKI by diagnostic criteria (KDIGO and pRIFLE) and for CKD by eGFR estimation equation (CKD-EPI, Cockcroft–Gault, and MDRD). Sex-stratified analyses were performed where sex-disaggregated data were available. Between-study heterogeneity was assessed using Cochran’s Q test and quantified with the I² statistic. Publication bias was evaluated using funnel plots and Egger’s regression test. All tests were two-sided, and p < 0.05 was considered statistically significant.

Results

Study Selection

The search initially identified 383 articles from PubMed (130), Scopus (36), Cochrane Library (100), Wiley online library (49) and other sources (68). After removing duplicates, 343 articles remained for screening. Based on title and abstract review, 31 articles were selected for full-text assessment. One (1) full text could not be retrieved, and 3 studies did not report the outcomes of interest. Finally, 27 articles were included in the systematic review and meta-analysis.

Characteristics of Included Studies

A total of 27 studies conducted in Ghana were included in this meta-analysis, comprising 11,245 participants overall. Sample sizes ranged from 50 to 2,781 participants. Regarding study design, 13 studies were cross-sectional, 2 were prospective, 4 were retrospective, 4 were case-control, 2 were prospective cross-sectional, and 2 employed retrospective cross-sectional designs. Geographically, studies were conducted across 11 regions of Ghana. The Ashanti Region accounted for the highest number of studies (n = 9), followed by the Greater Accra Region (n = 6). The Volta, Central, and Western Regions each contributed 2 studies, while the Eastern, Brong Ahafo, Bono, South-West, and Upper East Regions each contributed 1 study each (Fig. 2). One study was conducted in a multi-center setting. The study populations were heterogeneous and included individuals with hypertension, diabetes mellitus, CKD, AKI, HIV infection, sickle cell disease, liver cirrhosis, stroke, malaria, and other kidney-related conditions, as well as pediatric populations, homeless individuals, and intensive care unit inpatients. While most studies focused on adult populations, six studies included children or mixed pediatric populations (Table 1).

Fig. 2.

Regional distribution and concentration of included CKD and AKI studies in Ghana

Table 1.

Characteristics of included studies

Author (year)	Study Design	Region	Population	Sample Size
[38, 39]	Cross-sectional study	Multi-center	Adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM)	2781
[12]	Prospective study	Eastern region	Patients with liver cirrhosis	179
[7]	Cross-section study	Greater Accra	Homeless participants	512
[23]	Retrospective study design	Volta Region	T2DM patients	141
[16]	Cross-sectional study	Greater Accra	Participants with SCD	194
[14]	Prospective cross-sectional study	Central Region	Participants admitted to the medical and surgical wards.	145
[3]	Retrospective cross-sectional study	Central Region	Newly diagnosed HIV patients	90
[5]	Retrospective study	Ashanti Region	Pediatrics	664
[9]	Case-control study	Greater Accra	CKD patients	50
[2]	Prospective cross-sectional study	Ashanti Region	CKD patients	203
[31]	Cross-sectional retrospective study	Greater Accra	Children aged 0–17 years with kidney diseases	332
[13]	Cross-sectional study	Central Region	Diabetes patients	200
[25]	Cross-sectional study	Brong Ahafo Region	Hypertensive participants	200
[30]	Retrospective study	Ashanti Region	Patients diagnosed with AKI, CKD, ESKD, and nephrotic syndrome	1426
[11]	Case–control study	Bono region	Hypertensive patients	140
[15]	Cross sectional study	Southwest Region	Adults with diabetes, hypertension or both	208
[33]	Cross-sectional study	Greater Accra Region	Pediatric Patients with Malaria	100
[25, 26]	Cross-sectional study	Volta Region	HIV-infected patients on HAART treatment	170
[35]	Prospective study	Ashanti Region	Stroke survivors	759
[6]	Case-control study	Ashanti Region	Hypertensive and normotensive participants	241
[1]	Cross-sectional study	Ashanti Region	T2DM patients	241
[32]	Cross-sectional study	Upper East Region	People living with HIV/AIDS	442
[4]	Cross-sectional study	Western Region	Sickle cell positive children	212
[29]	Case-control study	Ashanti Region	HIV-Infected Patients	163
[17]	Retrospective study	Western Region	Inpatients at the Intensive Care Unit	1070
[38]	Cross sectional study	Ashanti Region	CKD patients	202
[34]	Cross-sectional study	Ashanti Region	Males and females admitted to the various wards of the hospital	180

Risk of Bias Assessment

Overall, the methodological quality of the included studies was predominantly low to moderate risk of bias. Most of the studies were rated as low risk, demonstrating appropriate sampling strategies, clearly defined study populations, valid outcome measurements, and suitable statistical analyses. Most studies adequately described their study settings and employed standardized diagnostic criteria for outcome assessment. A subset of studies was rated as having moderate risk of bias, primarily due to limitations in sampling methods, inadequate reporting of sample size justification, or unclear response rates. In some studies, insufficient detail regarding participant recruitment or incomplete reporting across certain JBI domains contributed to the moderate risk classification. No study was excluded based on risk of bias assessment. All studies were retained for quantitative synthesis (Supplementary File 1).

The majority of studies were conducted in the middle and southern regions, with the highest concentration observed in the Ashanti Region. In contrast, relatively few studies originated from northern regions of the country, highlighting a marked geographic imbalance. This uneven distribution suggests potential under-representation of kidney disease burden in northern Ghana and underscores regional disparities in kidney research coverage (Fig. 2).

AKI Prevalence

The prevalence of AKI across individual studies, stratified by diagnostic criteria and sex, is presented in Table 2. A meta-analysis of seven studies reporting the prevalence of AKI in Ghana was conducted following methodological quality assessment (Fig. 3). Studies were stratified by AKI diagnostic criteria, resulting in two subgroup analyses based on the KDIGO and pRIFLE definitions. AKI prevalence was expressed as a proportion with corresponding 95% confidence intervals (CIs) and pooled using a random-effects model with study weights estimated via the generic inverse-variance method.

Table 2.

Prevalence of AKI by diagnostic tool and sex in included studies

Author (year)	Diagnostic tool	AKI Cases (Total Number Assessed)	Prevalence	Male AKI cases (Total Males)	Male Prevalence	Female AKI cases (Total Females)	Female Prevalence
[12]	KDIGO	50 (179)	27.9%	30(117)	25.6%	20(62)	32.3%
[14]	KDIGO	23(145)	15.9%	11(68)	16.2%	12(77)	15.6%
[5]	pRIFLE criteria	206(664)	31%	NR	NR	NR	NR
[31]	NR	87(332)	26.2%	NR	NR	NR	NR
[30]	NR	72(1426)	5.1%	37(821)	4.5%	35(605)	5.8%
[33]	KDIGO	2(100)	2.0%	1(45)	2.2%	1(55)	1.8%
	pRIFLE criteria	5(100)	5.0%	3(45)	6.7%	2(55)	3.6%
[17]	pRIFLE criteria	399(1070)	37.3%	181(506)	35.8%	218(564)	38.7%
[34]	KDIGO	44(151)	29.1%	17(66)	25.6%	27(85)	31.8%

KDIGO Kidney Disease: Improving Global Outcomes, pRIFLE Pediatric Risk, Injury, Failure, Loss. End Stage Kidney Disease, NR Not Reported

Fig. 3.

Pooled prevalence of AKI in Ghana by KDIGO and pRIFLE criteria

We carried out a thorough search of the scientific literature, looking through several major databases - PubMed, Wiley Library, Cochrane Library, and Scopus, among others. The search covered studies published over a 15-year period from January 2010 to December 2025. The search strategy employed a carefully constructed combination of Medical Subject Headings (MeSH) terms and free-text keywords related to CKD, AKI, prevalence, risk factors, causes, and Ghana. Reference lists of included studies and relevant reviews were also screened to identify additional eligible studies. Only studies published in English were considered. For PubMed, (Prevalence OR Incidence) AND (determinants OR Predictors) AND (chronic kidney disease OR “CKD”) OR (Acute kidney disease OR ‘’AKI’’) AND (Ghana) (“acute kidney injury” OR “acute renal failure” OR AKI) OR (“chronic kidney disease” OR “chronic renal failure” OR CKD) AND (prevalence OR epidemiology) AND (determinants OR “risk factors” OR “associated factors”) AND Ghana.

Four studies applying the KDIGO criteria were included in the subgroup analysis, yielding a pooled AKI prevalence of 19% (95% CI: 4%–33%), with substantial heterogeneity (I² = 96.7%, p < 0.001). Three studies using the pRIFLE criteria produced a pooled prevalence of 24% (95% CI: 7%–42%).

Across all seven studies, the overall pooled prevalence of AKI was 21% (95% CI: 9%–34%). Between-study heterogeneity was very high (I² = 98.5%, p < 0.001). The pooled prevalence estimates for the KDIGO subgroup, pRIFLE subgroup, and overall analysis were all statistically significant (p ≤ 0.01). Subgroup comparison showed no significant difference in pooled prevalence between studies using KDIGO and pRIFLE criteria (p = 0.61).

CKD Prevalence

A meta-analysis of studies reporting the prevalence of CKD in Ghana was conducted following methodological quality assessment (Fig. 4). Studies were stratified by the eGFR equation used to define CKD, resulting in three subgroup analyses based on the CKD-EPI, C-G, and MDRD equations. CKD prevalence was expressed as a proportion with corresponding 95% confidence intervals (CIs) and pooled using a random-effects model, with study weights estimated using the generic inverse-variance method. Individual study estimates of CKD prevalence according to diagnostic tools and sex are summarized in Table 3.

Fig. 4.

Pooled prevalence of CKD in Ghana by CKD-EPI, C-G and MDRD criteria

Table 3.

Prevalence of CKD by diagnostic tool and sex in included studies

Author (year)	Diagnostic tool	CKD Cases (Total Number Assessed)	Prevalence	Male CKD cases	Male Prevalence	Female CKD cases	Female Prevalence
[38, 39]	CKD-EPI formula	715(2781)	25.7%	188(627)	30.0%	527 (2154)	24.5%
[7]	Cockcroft-Gault (C-G) equation	72(512)	14%	7(232)	3.0%	11(280)	4.0%
	MDRD equation	79(512)	15.4%
[23]	CKD-EPI formula	99 (141)	70.2%	45(64)	70.3%	54(77)	70.1%
[16]	CKD-EPI formula and Schwartz equation were used for children (≤ 17 years)	76 (194)	39.2%	36(84)	42.9%	40(110)	36.4%
[3]	Kidney Disease Outcomes Quality Initiative classification by the National Kidney Foundation	14(90)	15.5%	NR	NR	NR	NR
[13]	KDIGO	74(200)	37.0%	19(39)	48.7%	55(161)	34.2%
[25]	Cockcroft-Gault (C-G) equation	50(200)	25.0%	6(48)	12.5%	44(152)	29.0%
	MDRD equation	19(200)	9.5%	1(48)	2.1%	18(152)	11.8%
	CKD-EPI formula	21(200)	10.5%	2(48)	4.2%	19(152)	12.5%
[30]	NR	1009(1426)	70.8%	577(821)	70.3%	431(605)	71.2%
[11]	MDRD equation	23(140)	16.4%	NR	NR	NR	NR
	CKD-EPI formula	19(140)	13.6%	NR	NR	NR	NR
	Cockcroft-Gault (C-G) equation	20.7(140)	29.0%	NR	NR	NR	NR
[15]	CKD-EPI formula	62(208)	30%	NR	NR	NR	NR
[25, 26]	MDRD equation	29(170)	17.1%	1(30)	3.3%	28(140)	20%
	CKD-EPI formula	32(170)	18.8%	1	3.3%	31(140)	22.1%
[35]	CKD-EPI formula	159(759)	21.0%	NR	NR	NR	NR
[6]	MDRD equation	32(241)	13.3%	NR	NR	NR	NR
	Cockcroft-Gault (C-G) equation	40(241)	16.6%	NR	NR	NR	NR
	CKD-EPI formula	35(241)	14.5%	NR	NR	NR	NR
[1]	CKD-EPI formula	75(241)	31.5%	33(99)	33.3%	42(142)	29.6%
[32]	Cockcroft-Gault (C-G) equation	48(442)	10.9%	10(115)	8.7%	38(327)	11.6%
	MDRD equation	46(442)	10.4%	12(115)	10.4	34(327)	10.4%
	CKD-EPI formula	45(442)	10.2%	12(115)	10.4	33(327)	10.1%
[4]	Schwartz equation	84(212)	39.6%	NR	NR	NR	NR
[29]	MDRD equation	16(162)	9.9%	NR	NR	NR	NR
	CKD-EPI formula	6(162)	3.7%	NR	NR	NR	NR

CKD-EPI Chronic Kidney Disease Epidemiology Collaboration, MDRD Modification of Diet in Kidney Disease, C-G Cockcroft- Gault

Studies that used CKD-EPI equation yielded a pooled CKD prevalence of 24% (95% CI: 18%–31%), with extremely high heterogeneity observed across studies (I² = 97.37%, p < 0.001). For the C-G subgroup, the pooled prevalence was 16% (95% CI: 12%–20%), and heterogeneity remained substantial (I² = 78.51%, p < 0.001). In contrast, studies using the MDRD equation produced a lower pooled CKD prevalence of 13% (95% CI: 10%–15%), with moderate heterogeneity (I² = 53.78%, p = 0.04).

Across all included studies, the overall pooled prevalence of CKD in Ghana was 19% (95% CI: 16%–23%). Between-study heterogeneity in the overall analysis was very high (I² = 95.91%, p < 0.001). The pooled prevalence estimates for the CKD-EPI, C-G, and MDRD subgroups, as well as the overall analysis, were all statistically significant (p < 0.001). Subgroup comparison demonstrated a statistically significant difference in pooled CKD prevalence across the three eGFR estimation equations (p < 0.001).

Gender-Based Prevalence of AKI

A gender-based subgroup analysis was also conducted to assess differences in the prevalence of AKI between males and females in Ghana (Fig. 5). Eligible studies reporting sex-specific AKI prevalence were pooled using a random-effects model, with prevalence expressed as proportions and corresponding 95% CIs.

Fig. 5.

Gender-based subgroup analysis of AKI prevalence in Ghana

Among males, the pooled prevalence of AKI was 18% (95% CI: 6%–31%), with extremely high heterogeneity across studies (I² = 97.86%, p < 0.001). For females, the pooled prevalence was 21% (95% CI: 7%–34%), with similarly high heterogeneity observed (I² = 98.14%, p < 0.001).

When data from both sexes were combined, the overall pooled prevalence of AKI was 19% (95% CI: 12%–27%). Between-study heterogeneity remained substantial (I² = 97.84%, p < 0.001). Subgroup comparison revealed no statistically significant difference in AKI prevalence between males and females (p = 0.79). All pooled prevalence estimates, including male, female, and overall analyses, were statistically significant (p < 0.001).

Gender-Based Prevalence of CKD

A gender-based subgroup meta-analysis was conducted to examine differences in the prevalence of CKD between males and females in Ghana following methodological quality assessment (Fig. 6). Studies reporting sex-disaggregated CKD prevalence were included and pooled using a random-effects model. CKD prevalence was expressed as a proportion with corresponding 95% confidence intervals (CIs), with study weights estimated using the generic inverse-variance method.

Fig. 6.

Gender-based subgroup analysis of CKD prevalence in Ghana

Among male participants, the pooled prevalence of CKD was 35% (95% CI: 15%–54%), with extremely high between-study heterogeneity (I² = 99.01%, p < 0.001). Similarly, among female participants, the pooled CKD prevalence was 34% (95% CI: 20%–49%), and heterogeneity remained extreme (I² = 98.98%, p < 0.001).

Across both genders, the overall pooled prevalence of CKD was 34% (95% CI: 23%–46%). Between-study heterogeneity in the overall analysis was very high (I² = 98.98%, p < 0.001). A formal test for subgroup differences demonstrated no statistically significant difference in CKD prevalence between males and females (p = 0.98). The pooled prevalence estimates for males, females, and the overall analysis were all statistically significant (p < 0.001).

Etiological Distribution of Chronic Kidney Disease

The etiological distribution of AKI and CKD across included studies is summarized in Table 4. A subgroup meta-analysis was conducted on studies reporting comparable etiologies of CKD. Six major causes were identified and analyzed as individual subgroups: obstructive uropathy, hypertension, chronic glomerulonephritis, diabetes mellitus, HIV-associated kidney disease, and autosomal dominant polycystic kidney disease (ADPKD). The pooled estimates are summarized in Fig. 7.

Table 4.

Causes and proportions of AKI and CKD in included studies

Author (year)	Condition (AKI/CKD)	Cause (Original Label in Study)	Cases	Proportion (%)	Total Cases
[5]	AKI	Tumor infiltration of the kidneys	20	9.7	206
		Glomerulonephritides	25	12.1
		Obstructive uropathy	27	13.1
		Hemoglobinuria	31	15.0
[9]	CKD	Obstructive uropathy	2	4	50
		Chronic glomerulonephritis	10	20
		Hypertension and Type 2 diabetes mellitus	13	26
		Hypertension	25	50
[2]	CKD	Autosomal Dominant Polycystic Kidney Disease	2	1.0	203
		Hypertension	4	21.2
		HIV	9	4.4
		Obstructive uropathy	9	4.4
		Diabetes Mellitus	45	22.2
		Chronic glomerulonephritis	67	33
[31]	AKI	Urinary Tract Infection (UTI)	9	10.3	87
		Intravascular hemolysis	49	56.3
[30]	AKI	UTI	8	11.11	72
		HELLP syndrome	8	11.11
		Malignant hypertension	12	16.7
		Sepsis	35	48.61
[30]	CKD	Autosomal Dominant Polycystic Kidney Disease	42	4.16	1009
		DM nephropathy	126	12.48
		Chronic glomerulonephritis	210	20.81
		Hypertension	588	58.3
[38]	CKD	Obstructive uropathy	2	1.0	202
		HIV	5	2.5
		Polycystic kidney disease	14	6.9
		Hypertension	19	9.4
		Diabetes mellitus	40	19.8
		Chronic glomerulonephritis	118	58.4

Fig. 7.

Subgroup analysis of CKD etiologies in Ghana

Obstructive uropathy was reported in three studies and demonstrated a low pooled prevalence of 3% (95% CI: 0%–5%), indicating a minor contribution to CKD burden. In contrast, hypertension-related CKD exhibited substantial variability across four studies, with a pooled prevalence of 30% (95% CI: − 2% to 61%) and extreme heterogeneity (I² = 99.69%), reflecting marked inconsistency in reported estimates.

Chronic glomerulonephritis emerged as the most frequently reported etiology, with four studies yielding a pooled prevalence of 33% (95% CI: 15%–51%). However, this estimate was accompanied by considerable heterogeneity (I² = 97.26%). Diabetes mellitus–associated CKD, also reported in four studies, showed a pooled prevalence of 19% (95% CI: 13%–25%), with high but comparatively lower heterogeneity (I² = 83.02%).

Less frequently reported causes included HIV-associated CKD, with a pooled prevalence of 3% (95% CI: 1%–5%), and ADPKD, accounting for 4% (95% CI: 1%–7%) of CKD cases.

When all etiological subgroups were combined, the overall pooled prevalence of reported CKD causes was 17% (95% CI: 12%–23%). Subgroup comparison demonstrated a statistically significant difference in the distribution of CKD etiologies (p < 0.001), indicating heterogeneity in the underlying causes of CKD across study populations.

Publication Bias

Visual inspection of the funnel plots (Supplementary 1) indicated a largely symmetrical distribution of studies around the pooled effect estimates, with only minor dispersion among studies with larger standard errors. No clear directional asymmetry was observed, and most studies fell within the pseudo 95% confidence limits, suggesting a low likelihood of major publication bias.

These observations were supported by Egger’s regression tests. For AKI, the bias coefficient was 9.66 (95% CI: − 1.56 to 20.89, p = 0.080), and for CKD, it was − 1.45 (95% CI: − 6.35 to 3.45, p = 0.532). In both cases, the results were not statistically significant, providing no clear evidence of publication bias in the meta-analyses.

Discussion

The present meta-analysis provides the first comprehensive national estimates of kidney disease burden in Ghana. We found that 21% of the studied Ghanaian population had AKI and 19% had chronic kidney disease. Prevalence varied with diagnostic criteria: AKI defined by KDIGO criteria yielded a pooled prevalence of 19%, whereas pRIFLE-defined AKI was 24%. For CKD, use of the CKD-EPI equation produced the highest estimate 24%, followed by C–G with 16%, and MDRD producing 13%. These subgroup differences in CKD prevalence were statistically significant, whereas KDIGO and pRIFLE AKI prevalences did not differ significantly. Gender-specific analysis showed virtually no sex disparity: CKD prevalence was 35% in males and 34% in females, and AKI was 18% in males and 21% in females. The included studies spanned 11 regions of Ghana, and while cases were drawn from diverse settings, no clear geographic or age trend was discernible from the pooled data. Only six studies included children or mixed pediatric samples, limiting formal age-stratified analysis.

Burden, Etiology, and Diagnostic Influences on AKI in Ghana

Our pooled prevalence of 21% is consistent with the widely cited “one-in-five adults” incidence in hospitalized patients globally [37]. In Africa, AKI is predominantly community-acquired often resulting from infections and environmental exposures [8]. Similarly, studies from Ghana indicate that infection-related causes are common [30]. In contrast, studies from high-income countries usually report AKI among critically ill or surgical patients, often at similar or lower rates in general wards [19].

AKI appeared slightly more common in females, possibly due to pregnancy-related complications or differences in health-seeking; however, this was not significant. Age-specific data were sparse, as most studies reported on adult populations, with few pediatric reports. Available data suggests that AKI in Ghanaian children is often driven by infections and hemolysis [5], whereas adult AKI more commonly follows sepsis and chronic comorbidities [30].

The etiologic spectrum in Ghana differs from high-income settings. Infections and systemic illnesses remain the dominant causes. Pediatric studies have reported hemoglobinuria from malaria or sickle cell hemolysis, obstructive uropathy, and malignancies account for 37.8% of cases [5]. This pattern is similar to the findings of our meta-analysis, in which infection-related causes particularly sepsis, hemolysis-associated conditions, and urinary tract obstruction together accounted for a substantial proportion of AKI cases across the included studies. Other reported causes in our review, including obstetric complications, further support the dominance of preventable and infection-related etiologies of AKI in Ghana, consistent with previous reports from sub-Saharan Africa [8].

Diagnostic criteria also influenced prevalence estimates. Studies using KDIGO and pRIFLE yielded slightly different prevalences (19% and 24% respectively), although the difference was not statistically significant. In high income countries, AKI more commonly arises in intensive care settings due to ischemia or nephrotoxic esposure. The finding that 1 in 5 hospitalized patients are affected points to the need for preventive measures and improved acute care [24]. Our results support intensifying control of non-communicable disease as better hypertension and diabetes management will reduce progression to CKD. In addition, strengthening maternal and critical care to prevent sepsis and hypertensive crises would reduce AKI cases in young adults.

Burden, Etiology, and Diagnostic Influences on CKD in Ghana

Ghana’s kidney disease burden appears substantial. Our pooled CKD prevalence of 19% exceeds earlier African and global estimates, which have reported prevalences of approximately 13.9% in sub-Saharan Africa [36] and 11–13% worldwide [18]. This higher estimate likely reflects the inclusion of studies conducted largely among high-risk clinical populations. In many high-income countries, CKD prevalence averages 10–12% in general adult populations. Globally, CKD prevalence increases with age, and in Ghana, it likely accumulates in middle and older age, reflecting the late-onset of hypertension and diabetes mellitus.

Ghana’s CKD prevalence is comparable to or higher than other low- and middle-income countries and substantially above most high-income estimates, highlighting a disproportionate NCD burden in this LMIC setting. Ghana’s AKI and CKD rates emphasize that the kidney disease burden in African LMICs is at least as high as elsewhere, driven by distinct local risk factors.

Diagnostic methods strongly influenced prevalence estimates. Studies using the CKD-EPI equation reported markedly higher prevalence (24%) than those using the MDRD formula (13%), reflecting known differences in performance among African populations. The MDRD equation likely underestimates CKD prevalence in Ghana because of calibration limitations, whereas CKD-EPI appears more sensitive in this setting. These findings underscore the dependence of prevalence estimates on diagnostic tools. In addition, between-study heterogeneity was very high across all analyses, likely reflecting differences in study design, settings, and population characteristics. Some studies focused on high-risk clinics, whereas others sampled broader inpatient populations.

Regarding sex and age patterns, no significant gender differences in CKD prevalence were observed. This contrasts with reports from many regions where CKD is more common in females [28]. In Ghana, similar exposure to risk factors and comparable access to hospital care may explain this pattern. However, the high variance across studies suggests that limited data may also have reduced the ability to detect true sex-related differences.

Etiologically, CKD in Ghana is most commonly attributed to hypertension-related nephropathy, chronic glomerulonephritis, and diabetic nephropathy. In our pooled data, chronic glomerulonephritis accounted for 33% of CKD cases, hypertension 30%, and diabetes mellitus 19%. Hypertension is widespread and often poorly controlled in Ghana, explaining its outsized role. Chronic glomerulonephritis likely reflects past infection burdens and limited screening for immunologic kidney diseases. Diabetes mellitus is increasingly common with urbanization, raising its contribution to CKD, though it remains secondary to hypertension. Compared to other regions, Ghana’s pattern mirrors much of sub-Saharan Africa, in which infection- and hypertension-related CKD predominate whereas high-income countries see a larger share of diabetes-related CKD ([36]; [40, 42]).

These high burdens have important clinical and public health implications. A CKD prevalence near one-fifth implies a large pool of patients at risk for ESKD. Additionally, individuals with CKD are at elevated risk of cardiovascular morbidity and mortality, highlighting the dual burden of kidney and cardiovascular complications in this population [10]. Ghana’s healthcare system, with limited dialysis and transplant capacity, may soon face an unsustainable ESKD population. Early detection is thus critical: systematic screening of hypertensive and diabetic patients, and prompt management of even mild kidney dysfunction, could slow progression.

Several limitations must be noted. First, there was substantial heterogeneity across studies. Differences in patient selection, settings, and methodology likely drove this. Diagnostic inconsistency also contributes; as discussed, using different AKI and CKD definitions produced divergent prevalences. Second, pediatric data were scarce, and our meta-analyses are weighted toward adult outcomes, limiting generalizability to children. Third, the geographic distribution of included studies was skewed toward southern Ghana, with limited representation from northern regions. This imbalance limits national generalizability and may underestimate kidney disease burden in rural and deprived populations. Finally, our search was limited to published literature; relevant local reports might have been missed. These limitations suggest caution in interpretation and highlight gaps in Ghanaian nephrology data.

Future Direction

Standardization of diagnostic criteria in future studies is a priority: uniform use of KDIGO for AKI and harmonized eGFR equations would enable clearer comparisons. Longitudinal cohort studies are needed to define the incidence and progression of AKI and CKD in Ghana, and to identify factors predicting poor outcomes. Research should explore genetic and environmental risk factors unique to Ghana such as the APOL1 variants, herbal nephrotoxins, endemic infections and their interplay with common causes.

Conclusion

This review reveals a high prevalence of kidney injury in Ghana, with roughly one in five hospital patients affected by AKI and CKD. Hypertension, chronic glomerulonephritis, and diabetes mellitus emerge as the dominant CKD etiologies, while AKI was mostly attributed to infections and hemolysis. These findings underscore the urgent need for targeted public health interventions in Ghana, including programs to prevent CKD, strengthen infection control measures, and improve the quality of acute care services, in order to reduce the growing burden of kidney disease in the population. Early detection and management of kidney disease should be prioritized within Ghana’s health agenda to prevent progression to end-stage kidney disease and premature death.

Supplementary Information

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Author Contributions

J.A., R.K.D.E and I.A.G. conceptualized and designed the study. J.A., K.A., S.A.B.F., B.O.G., N.L.A., M.O.G., and S.T. conducted the literature search, study screening, and data extraction. P.O, R.K.D.E and I.A.G provided methodological oversight and contributed to study selection and interpretation of findings. Data synthesis and analysis were performed by I.A.G, J.A. and R.K.D.E drafted the initial manuscript. All authors critically reviewed and revised the manuscript.

Funding

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Data Availability

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Declarations

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Consent to Participate and Consent to Publish

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Competing interests

The authors declare no competing interests.