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A decline in estimated glomerular filtration rate (eGFR) was significant if it was \u226525% and included a change to a lower eGFR stage. New\u2010onset RI was defined as an eGFR &lt;50 mL\/min\/1.73m<jats:sup>2<\/jats:sup>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>10\u2009387 patients were included: 11.4% (n = 1182) experienced the decline in eGFR. Of these, 0.6% (n = 62) migrated to eGFR stages IV and V. The incidence was 4.5 (95% CI: 4.3\u20104.8) per 100 patient years. RI developed in 400 patients for an incidence rate of 2.4 (95% CI: 2.2\u20102.6) cases per 100 patient years. Risk factors with effect sizes &gt;2.0, for decline\u2010in\u2010eGFR were baseline eGFR &gt;60 (aHR = 15.6); hyperfiltration (aHR = 5.0); and pregnancy (aHR = 2.4); while for RI, they were hyperfiltration (aHR = 4.1) and pregnancy (aHR = 29).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The incidence of decline\u2010in\u2010eGFR was higher than in other sub\u2010SSA countries, but not RI. 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