Protein-energy wasting prevalence reaches 47.0% among patients with chronic kidney disease in AfricaNearly half of African kidney disease patients suffer from malnutrition

BACKGROUND: Protein-energy wasting (PEW) is a frequent and prognostically adverse complication of chronic kidney disease (CKD). Despite its clinical importance, African populations have been underrepresented in prior systematic reviews. This study aimed to estimate the pooled prevalence of PEW among patients with CKD in Africa. METHODS: PubMed, AJOL, and EMBASE were systematically searched for relevant studies published between 1980 and 2025. Meta-analytic techniques were used to estimate the pooled prevalence of PEW among African CKD populations. The study protocol was registered on PROSPERO (CRD420251032894). RESULTS: Twenty-five articles comprising 2822 participants across 14 African countries met the inclusion criteria. The mean age of the participants was 49.7 ± 5.2 years. Thirteen studies (52.0%) were from North Africa, 19 studies (76.0%) had high methodological quality, and 17 studies (68.0%) used Subjective Global Assessment (SGA) for PEW assessment. The overall pooled prevalence of PEW among patients with CKD was 47.0% (95% confidence interval: 39.0%-56.0%; n = 25 studies; I2 = 95.5%, P < .001). The prevalence of PEW was significantly higher in the haemodialysis patients compared with non-dialysis CKD patients (52.0% vs 34.0%; P < .001). The pooled prevalence of PEW in studies that used the International Society of Renal Nutrition and Metabolism criteria was 32.0%; Malnutrition Inflammatory Score was 49.0%, SGA was 42.0%; and SGA adaptation was 76.0%. There was a significant difference in the pooled PEW prevalence across diagnostic criteria (P < .001) and African regions (P < .001). CONCLUSION: PEW is highly prevalent among African patients with CKD. Region-specific guidelines and multidisciplinary nutritional interventions are urgently needed to address this burden.