Chronic kidney disease related to Loa loa microfilaremia in a rural area of the Republic of Congo: a population-based cross-sectional study

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BACKGROUND: Loiasis affects millions in Central Africa and, though historically considered benign, emerging data suggest possible renal involvement. This study investigated the association between Loa microfilaremia and renal function. METHODS: We conducted a cross-sectional study in the Republic of Congo in May-June 2022. Renal function was assessed via estimated glomerular filtration rate (eGFR) using Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) and European Kidney Function Consortium (EKFC) equations, and proteinuria and/or haematuria (renal abnormalities, RAb). Multinomial logistic regression assessed associations between microfilarial density (MFD) and chronic kidney disease (CKD), using EKFC with Dubois correction. Population attributable fractions were estimated from a logistic model including Loa microfilaremia as a binary variable (present versus absent). RESULTS: Among 986 participants, CKD prevalence ranged from 13.4% [95% confidence interval (CI) 11.4-15.7%, CKD-EPI] to 17.6% (95% CI 15.3-20.1%, EKFC) for KDIGO stages 1-5, and from 3.0% (95% CI 2.1-4.3%, CKD-EPI) to 7.6% (95% CI 6.1-9.4%, EKFC) for stages 3-5. Loa MFD was associated with higher odds of CKD, particularly in individuals with RAb. Compared to amicrofilaremic participants, those with Loa MFD ≥ 20 000 mf/ml had significantly increased risk: adjusted relative risk ratio (aRRR) for CKD severity categories (≤ 2nd, 2nd-10th, 10th-50th, > 50th eGFR percentile) with RAb were 8.67 (95% CI 2.62-28.64, P = 0.021), 14.26 (95% CI 3.41-59.68, P < 0.001), 5.50 (95% CI 0.55-61.78, P = 0.145), and 26.21 (95% CI 1.64-417.84, P = 0.021). Population attributable fractions of CKD stages 1-5 to Loa microfilaremia was 14.7% (95% CI 4.3-24.0) and 30.1% (95% CI 16.2-42.8) for CKD stages 1-5 with RAb. CONCLUSIONS: This study provides the first epidemiological evidence linking loiasis to renal impairment, likely via glomerular damage. Given loiasis high endemicity in Central Africa, it may contribute to the burden of unexplained nephropathies. Longitudinal studies and renal biopsies are warranted to clarify underlying mechanisms.

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