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Strasma A, Reyes ÁM, Aragón A, López I, Park LP, Hogan SL, Thielman N, Wyatt C, González-Quiroz M. Kidney disease characteristics, prevalence, and risk factors in León, Nicaragua: a population-based study. BMC Nephrol 2023; 24:335. [PMID: 37953252 PMCID: PMC10641961 DOI: 10.1186/s12882-023-03381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND CKD of unknown etiology (CKDu) disproportionately affects young people in Central America who lack traditional CKD risk factors (diabetes and hypertension) and has instead been variably linked to heat stress, occupational and environmental exposures, nephrotoxic medications, and/or genetic susceptibility. This study aimed to estimate the prevalence of CKD and identify risk factors for traditional CKD and CKDu in Nicaragua. METHODS Surveys and assessment for CKD markers in urine and serum were performed in 15-59 year olds in households of the León municipality of Nicaragua. The survey included questions on demographics, health behaviors, occupation, and medical history. Participants with CKD were subdivided into traditional CKD and suspected CKDu based on history of diabetes, hypertension, or other specified conditions. A multinomial logistic regression model was used to identify factors associated with traditional CKD and suspected CKDu, compared to the non-CKD reference group. RESULTS In 1795 study participants, CKD prevalence was 8.6%. Prevalence in males was twofold higher than females (12% vs 6%). Of those with CKD, 35% had suspected CKDu. Both traditional CKD and CKDu were associated with male sex and increasing age. Traditional CKD was associated with a family history of CKD, history of urinary tract infections, and lower socioeconomic status, while CKDu was associated with drinking well water and a lower body mass index. CONCLUSIONS Both traditional CKD and CKDu are significant burdens in this region. Our study supports previous hypotheses of CKDu etiology and emphasizes the importance of CKD screening.
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Affiliation(s)
- Anna Strasma
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | - Ángel Mejía Reyes
- Bioanalysis and Immunology Research Group, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Aurora Aragón
- WUQU' KAWOQ, Maya Health Alliance, Chimaltenango, Guatemala
| | - Indiana López
- WUQU' KAWOQ, Maya Health Alliance, Chimaltenango, Guatemala
| | - Lawrence P Park
- Duke Global Health Institute, Durham, NC, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Susan L Hogan
- Department of Medicine, Division of Nephrology and Hypertension and the UNC Kidney Center, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Nathan Thielman
- Duke Global Health Institute, Durham, NC, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Christina Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Marvin González-Quiroz
- WUQU' KAWOQ, Maya Health Alliance, Chimaltenango, Guatemala
- Department of Renal Medicine, University College London, London, UK
- School of Medicine, Universidad Nacional de Chimborazo, Riobamba, Ecuador
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2
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Petropoulos ZE, Keogh SA, Jarquín E, López-Pilarte D, Amador Velázquez JJ, García-Trabanino R, Amador Sánchez MR, Guevara R, Gruener A, Allen DR, Leibler JH, Delgado IS, McClean MD, Friedman DJ, Brooks DR, Scammell MK. Heat stress and heat strain among outdoor workers in El Salvador and Nicaragua. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023:10.1038/s41370-023-00537-x. [PMID: 37041408 PMCID: PMC10403352 DOI: 10.1038/s41370-023-00537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND There is growing attention on occupational heat stress in Central America, as workers in this region are affected by a unique form of chronic kidney disease. Previous studies have examined wet bulb globe temperatures and estimated metabolic rates to assess heat stress, but there are limited data characterizing heat strain among these workers. OBJECTIVE The aims were to characterize heat stress and heat strain and examine whether job task, break duration, hydration practices, and kidney function were associated with heat strain. METHODS We used data from the MesoAmerican Nephropathy Occupational Study, a cohort of 569 outdoor workers in El Salvador and Nicaragua who underwent workplace exposure monitoring, including continuous measurement of core body temperature (Tc), heart rate (HR), physical activity, and wet bulb globe temperature (WBGT), over the course of three days in January 2018 - May 2018. Participants represented five industries: sugarcane, corn, plantain, brickmaking, and construction. RESULTS Median WBGTs were relatively high (>27 °C) at most sites, particularly when work shifts spanned the afternoon hours (e.g., 29.2 °C among plantain workers). Sugarcane workers, especially cane cutters in both countries and Nicaraguan agrichemical applicators, had the highest estimated metabolic rates (medians: 299-318 kcal/hr). Most workers spent little time on break (<10% of the shift), as determined by physical activity data. Overall, sugarcane workers-particularly those in Nicaragua-experienced the highest Tc and HR values. However, a few workers in other industries reached high Tc (>39 °C) as well. Impaired kidney function (estimated glomerular filtration rate <90 mL/min/1.73 m2) was associated with higher Tc and HR values, even after adjustment. SIGNIFICANCE This is the largest study to-date examining heat stress and strain among outdoor workers in Central America. Workers at sugar companies regularly experienced Tc > 38°C (76.9% of monitored person-days at Nicaraguan companies; 46.5% at Salvadoran companies). Workers with impaired kidney function had higher measures of Tc and HR. IMPACT STATEMENT This study examined levels of occupational heat stress and heat strain experienced among outdoor workers in five industries in El Salvador and Nicaragua. We characterized heat stress using wet bulb globe temperatures and estimated metabolic rate and heat strain using core body temperature and heart rate. Sugarcane workers, particularly cane cutters and Nicaraguan agrichemical applicators, performed more strenuous work and experienced greater levels of heat strain. Impaired kidney function was associated with higher heart rates and core body temperatures.
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Affiliation(s)
- Zoe E Petropoulos
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Sinead A Keogh
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Emmanuel Jarquín
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
| | - Damaris López-Pilarte
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Ramón García-Trabanino
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
- Centro de Hemodiálisis, San Salvador, El Salvador
- Emergency Social Fund for Health, Tierra Blanca, El Salvador
| | | | - Raúl Guevara
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
| | - Alexa Gruener
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Dustin R Allen
- Department of Health Sciences, Boston University College of Health and Rehabilitation Sciences, Boston, MA, USA
| | - Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Iris S Delgado
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - David J Friedman
- Division of Nephrology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Nayak S, Rehman T, Patel K, Dash P, Alice A, Kanungo S, Palo SK, Pati S. Factors Associated with Chronic Kidney Disease of Unknown Etiology (CKDu): A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11040551. [PMID: 36833085 PMCID: PMC9956943 DOI: 10.3390/healthcare11040551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
(1) Background: Despite ample research, the factors, specific causes, and pathways associated with chronic kidney disease of unknown etiology (CKDu) remain elusive. Therefore, we performed a systematic review to explore the potential etiologies for the development of CKDu globally. (2) Methods: A systematic literature review was conducted using databases CINAHL, Cochrane Library, Embase, Google Scholar, MEDLINE, and PsycINFO on the specific causes and pathophysiology related to CKDu from inception until April 2021. Study selection, data extraction of included articles, and quality appraisal were assessed. The narrative approach was used to summarize and comprehend the findings. (3) Results: Our study included 25 studies, considering 38,351 participants. Twelve studies were case-control, ten were cross-sectional, and three were cohort designs. All articles were from low-and middle-income countries (LMICs). The findings suggest 12 factors are associated with CKDu. Most studies (n = 8) identified farming and water sources as the factors related to CKDu, with heavy metal toxicity coming in second (n = 7). (4) Conclusion: The systematic review reported various factors associated with CKDu, from which most studies reported farming, water sources, and heavy metal poisoning. Considering the findings, the study recommends future strategies and public health initiatives to prevent the epidemiological/environmental factors contributing to CKDu.
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Cajina-Aguirre CL, Strasma AK, Álvarez-Novoa RJ. Global Dialysis Perspective: Nicaragua. KIDNEY360 2023; 4:110-113. [PMID: 36700913 PMCID: PMC10101595 DOI: 10.34067/kid.0005572022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Carmen L. Cajina-Aguirre
- Department of Physiological Sciences, Faculty of Medical Sciences, National Autonomous University of Nicaragua, Managua, Nicaragua
| | - Anna K. Strasma
- Division of Nephrology, Duke University School of Medicine, Durham, North Carolina
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Eguiguren-Jiménez L, Miles J, Ocampo J, Andrade JM. Prevalence and associated risk factors of chronic kidney disease: A case study within SIME clinics in Quito, Ecuador 2019-2021. Front Med (Lausanne) 2022; 9:908551. [PMID: 36059814 PMCID: PMC9437349 DOI: 10.3389/fmed.2022.908551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022] Open
Abstract
Background Ecuador has been experiencing an epidemiological transition due to its demographic and lifestyle changes, where non-communicable diseases are the leading cause of death, including chronic kidney disease (CKD). Quito, Ecuador's capital city, is one of the cities burdened by CKD, yet it is unknown the factors that contribute to the rising incidence of this disease. The purpose of this study was to estimate the prevalence of CKD among non-institutionalized adults in Quito between 2019 and 2021, and to examine its associations with various risk factors. Methods For the analysis of prevalence, the Kidney Disease: Improving Global Outcomes guidelines were used, where an estimated glomerular filtration rate (eGFR) of < 60 ml/min/1.73 m2 was counted as a presumed case of CKD. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to calculate eGFR. Multiple linear regression models were used to determined associations between blood pressure, blood glucose, sex, and zone with eGFR. A t-test of independence was used to determine difference in means between sex and zone and eGFR. Results A prevalence of 7.2% was found, in which almost 45% of the participants were classified within stages 2-4 of this disease. The risk factors that were significantly associated with eGFR were systolic blood pressure (β = -0.43, p < 0.001), sex, and zone (p < 0.001). Conclusions Overall a high prevalence of CKD was found among adults who visited SIME clinics in Quito. Associations between main risk factors and eGFR were found, yet further research is needed to explore CKD in Ecuador and its main cities.
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Affiliation(s)
- Lucía Eguiguren-Jiménez
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, United States
| | - Joshua Miles
- Statistics Department, University of Florida, Gainesville, FL, United States
| | - Jaime Ocampo
- School of Public Health, San Francisco de Quito University, Quito, Ecuador
| | - Jeanette Mary Andrade
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, United States
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Dehghani A, Alishavandi S, Nourimajalan N, Fallahzadeh H, Rahmanian V. Prevalence of chronic kidney diseases and its determinants among Iranian adults: results of the first phase of Shahedieh cohort study. BMC Nephrol 2022; 23:203. [PMID: 35681145 PMCID: PMC9185869 DOI: 10.1186/s12882-022-02832-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Chronic kidney disease (CKD) is one of the major global causes of mortality, described as the most neglected chronic disease. This study aimed to determine the prevalence and determinants of CKD in the setting of the Shahedieh cohort study in Yazd, Iran. Methods This cross-sectional study was conducted on adults in the baseline phase of the Shahedieh cohort study in Yazd, Iran. In this study, 9781 participants aged 30–73-year-old were investigated. The data used in this study included demographic and clinical variables and blood samples. Adjusted odds ratios were employed using multivariate logistic regression; meanwhile, population attributable risks for CKD were calculated and reported. Results CKD prevalence was 27.5% (95%CI: 26.57–28.34) in all participants, 24% in male, and 30.3% in female. The results of multivariate logistic regression analysis identified age (OR = 1.89, 95%CI:1.082–1.96), women (OR = 1.62, 95%CI: 1.45–1.79), BMI ≥ 30 (OR = 1.40,95%CI: 1.20–1.62), diabetes (OR = 1.38, 95%CI: 1.22–1.57), hypertriglyceridemia(OR = 1.20, 95%CI: 1.01–1.43), history of cardiovascular disease (OR = 1.20, 95%CI: 1.01–1.43), hypertension (OR = 1.18, 95%CI: 1.04–1.33), smoking (OR = 1.17, 95% CI: 1.02–1.33), LDL ≥ 130 (OR = 1.15, 95%CI: 1.01–1.31), history of kidney stone (OR = 1.14, 95%CI: 1.01–1.32) and hypercholesterolemia (OR = 1.14, 95%CI: 1.01–1.32) as risk factors for CKD. Among individual factors, obesity (11.25%), Hypertriglyceridemia (9.21%), LDL ≥ 130 (7.12%) had the greatest Population-Attributable Fraction, followed by Hypercholesterolemia (5.2%), diabetes (5.05%), smoking (3.73%) and high blood pressure (2.82%). Conclusion The results showed that the main determinants of CKD are potentially modifiable risk factors. Therefore, implementing early detection and screening programs in people at risk as well as preventive measures such as lifestyle modification programs and risk factors controlling can prevent the disease.
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Affiliation(s)
- Ali Dehghani
- Department of Epidemiology and Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Sadegh Alishavandi
- Department of Epidemiology and Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
| | - Nader Nourimajalan
- Division of Nephrology, Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.,Research Center of Prevention and Epidemiology of Non-Communicable Disease, Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Vahid Rahmanian
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, IR, Iran
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Okpechi IG, Caskey FJ, Gaipov A, Tannor EK, Noubiap JJ, Effa E, Ekrikpo UE, Hamonic LN, Ashuntantang G, Bello AK, Donner JA, Figueiredo AE, Inagi R, Madero M, Malik C, Moorthy M, Pecoits-Filho R, Tesar V, Levin A, Jha V. Early Identification of Chronic Kidney Disease – A Scoping Review of the Global Populations. Kidney Int Rep 2022; 7:1341-1353. [PMID: 35685314 PMCID: PMC9171699 DOI: 10.1016/j.ekir.2022.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Decisions on whether to screen for chronic kidney disease (CKD) or not remain contentious in nephrology. This study provides a global overview of early CKD identification efforts. Methods Guidelines for scoping reviews were followed and studies were identified by searching MEDLINE, EMBASE, Cochrane Library, CINAHL, ISI Web of Science, and PsycINFO. Data extracted from included studies focused on the following 4 themes: study population, measurement methods, interventions used, and available policies. Results We identified 290 CKD screening and detection programs from 83 countries. Overall sample size was 3.72 million (North East Asia: 1.19 million), detection of CKD was the aim in 97.6%, 63.1% used population-based screening methods, and only 12.4% were in rural populations. Reported CKD prevalence (stages 3–5) was higher in targeted- (14.8%) than population-based studies (8.0%). Number of persons needed to screen (NNS) to identify 1 case was also lower in targeted studies (7 vs. 13). Single measurements (80%) and the combination of estimation of glomerular filtration rate with a urine test (albuminuria/proteinuria) (71.4%) were frequently used to detect CKD. Only 2.8% of studies included an intervention such as pharmacotherapy in identified cases. Policies on early identification were available in 30.1% of countries included. Conclusion Methods for early CKD identification vary worldwide, often leading to wide variations in the reported prevalence. Efforts to standardize measurement methods for early detection focusing on high-risk populations and ensuring appropriate interventions are available to those identified with CKD will improve the value of programs and improve patient outcomes.
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Creatinine standardization: a key consideration in evaluating whole blood creatinine monitoring systems for CKD screening. Anal Bioanal Chem 2022; 414:3279-3289. [PMID: 35260937 PMCID: PMC8956531 DOI: 10.1007/s00216-022-03942-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/16/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
Early detection of CKD using point of care creatinine and eGFR testing improves patient management outcomes. We undertook a field study to evaluate the use of a whole blood creatinine/eGFR device to screen a rural Nicaraguan population to determine the variability between creatinine methods and specimen types. All specimens including capillary and venous dried blood spots (DBS) were tested with an isotope dilution liquid chromatography mass spectrometry (ID-LCMS) gold standard method. This is to our knowledge the first time a capillary whole blood (POC) method has been directly compared to the gold standard IDMS method, through the novel approach of using dried blood spots. Capillary and venous whole blood specimens were obtained and tested directly with the BCMS method, and then, DBS samples were prepared. Venous plasma specimens were tested using three laboratory analyzer creatinine methods. DBS were sent to the site performing ID-LCMS. Control samples were also prepared to assess the stability of shipment and storage of DBS. The ID-LCMS method was aligned using primary and secondary standards. Sixty-six (66) patients participated in the study, and the CKD prevalence rate was 7.8%. While all creatinine methods showed a good correlation to ID-LCMS, there was a positive bias (mean absolute bias range: 0.21–0.63 mg/dL). All methods used were 100% sensitive, but specificity varied from 62.7 to 94.9% with PPV ranging from 25 to 62.5%. A correction factor was used to align the values from each method to ID-LCMS which improved the specificity of each method. This study used a unique DBS approach to align capillary whole blood creatinine to ID-LCMS. To ensure reliability of BCMS for identifying screened patients with CKD, it is important to establish IDMS traceability and alignment prior to undertaking CKD studies.
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Butler-Dawson J, Barnoya J, Brindley S, Krisher L, Fan W, Asensio C, Newman LS. Cross-sectional study examining the accuracy of self-reported smoking status as compared to urinary cotinine levels among workers at risk for chronic kidney disease of unknown origin in Guatemala. BMJ Open 2021; 11:e050374. [PMID: 34697113 PMCID: PMC8547360 DOI: 10.1136/bmjopen-2021-050374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES There is a lack of information on cotinine levels in rural populations in low-income and middle-income countries like Guatemala. Therefore, there is a need to explore smoking status and biomarkers of tobacco use in epidemiological research in rural, low-income populations, in particular those at-risk for chronic kidney disease of unknown origin (CKDu). DESIGN We evaluated self-reported smoking status against urinary cotinine levels, the gold standard biomarker of tobacco smoke exposure, among agricultural workers at four separate cross-sectional time points. SETTING Guatemala. PARTICIPANTS 283 sugarcane workers. PRIMARY OUTCOME MEASURES Compared self-reported smoking status and urinary cotinine levels in two agricultural worker studies. RESULTS Self-reported smoking prevalence was 12% among workers. According to cotinine levels (≥50 ng/mL), the smoking prevalence was 34%. Self-reported smoking status had 28% sensitivity and 96% specificity. Urinary cotinine levels show that smoking prevalence is underestimated in this worker population. CONCLUSIONS According to our findings, smoking status should be objectively measured with biomarkers rather than self-reported in CKDu epidemiological research. Self-reported smoking status is likely an underestimate of the true smoking prevalence among agricultural workers. Research on the CKDu epidemic in Central America and other parts of the world might be underestimating tobacco exposure as a potential contributor to the development of CKDu.
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Affiliation(s)
- Jaime Butler-Dawson
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Joaquin Barnoya
- Integra Cancer Institute, Guatemala City, Guatemala
- Unit for Cardiovascular Surgery, Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Stephen Brindley
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Wenyi Fan
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | | | - Lee S Newman
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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Hamilton SA, Jarhyan P, Fecht D, Venkateshmurthy NS, Pearce N, Venkat Narayan KM, Ali MK, Mohan V, Tandon N, Prabhakaran D, Mohan S. Environmental risk factors for reduced kidney function due to undetermined cause in India: an environmental epidemiologic analysis. Environ Epidemiol 2021; 5:e170. [PMID: 34934891 PMCID: PMC8683143 DOI: 10.1097/ee9.0000000000000170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/10/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND An epidemic of chronic kidney disease is occurring in rural communities in low-income and middle-income countries that do not share common kidney disease risk factors such as diabetes and hypertension. This chronic kidney disease of unknown etiology occurs primarily in agricultural communities in Central America and South Asia. Consequently, environmental risk factors including heat stress, heavy metals exposure, and low altitude have been hypothesized as risk factors. We conducted an environmental epidemiological analysis investigating these exposures in India which reports the disease. METHODS We used a random sample population in rural and urban sites in Northern and Southern India in 2010, 2011, and 2014 (n = 11,119). We investigated associations of the heat index, altitude, and vicinity to cropland with estimated glomerular filtration rate (eGFR) using satellite-derived data assigned to residential coordinates. We modeled these exposures with eGFR using logistic regression to estimate the risk of low eGFR, and linear mixed models (LMMs) to analyze site-specific eGFR-environment associations. RESULTS Being over 55 years of age, male, and living in proximity to cropland was associated with increased risk of low eGFR [odds ratio (OR) (95% confidence interval (CI) = 2.24 (1.43, 3.56), 2.32 (1.39, 3.88), and 1.47 (1.16, 2.36)], respectively. In LMMs, vicinity to cropland was associated with low eGFR [-0.80 (-0.44, -0.14)]. No associations were observed with temperature or altitude. CONCLUSIONS Older age, being male, and living in proximity to cropland were negatively associated with eGFR. These analyses are important in identifying subcommunities at higher risk and can help direct future environmental investigations.
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Affiliation(s)
- Sophie A. Hamilton
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
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Lin JJ, Morey F, Wu HY, Yang JY, Peng YS, Mendez D, Chebat M. Prevalence and Risk Factors for Chronic Kidney Disease in Belize: A Population-based Survey. LANCET REGIONAL HEALTH. AMERICAS 2021; 1:100013. [PMID: 36776754 PMCID: PMC9903977 DOI: 10.1016/j.lana.2021.100013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
Background Health resources supporting dialysis and chronic kidney disease (CKD) patients are limited in Central America, and little information about the prevalence and risk factors for CKD in this region is available. Methods The Survey of Risk Factors for Chronic Kidney Disease was a population-based cross-sectional study conducted throughout Belize in 2017. The study aimed to assess the prevalence and risk factors for CKD via structured questionnaires and clinical measurements in Belizeans aged 20-55 years. A two-stage stratified sampling technique was applied. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1·73 m2 or the presence of proteinuria. Findings A total of 7,506 adults with a mean age of 34·6 years old completed the survey; 53·2% were women. The overall CKD prevalence was 13·7%. Women had a higher CKD prevalence than men (14·8% vs. 12·5%), and the overall awareness of CKD was low (3·7%). The prevalences of stage 1, 2, 3a, 3b, 4, and 5 CKD were 2·85%, 2·93%, 6·59%, 1·10%, 0·18%, and 0·06%, respectively. Older age, female sex, Mestizo/Hispanic ethnicity, diabetes, hypertension, hypercholesterolaemia, and obesity were identified as independent risk factors for CKD. Interpretation The prevalence of CKD was 13·7% in Belizeans aged 20-55 years. The study confirms the high burden of CKD in Belize and provides important epidemiological information for Central America. Case management systems and surveillance programmes targeting high-risk populations are crucial for ameliorating the burden of CKD. Funding Capacity Building Project for the Prevention and Control of Chronic Renal Failure in Belize.
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Affiliation(s)
- Jian-Jhang Lin
- International Cooperation and Development Fund (TaiwanICDF), Taipei City, Taiwan
| | | | - Hon-Yen Wu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan,Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan,Corresponding authors: Dr. Hon-Yen Wu, Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan, Telephone: +886-2-7728-1780; Fax: +886-2-7728-1162.
| | - Ju-Yeh Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Sen Peng
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Deysi Mendez
- Ministry of Health and Wellness, Belmopan, Belize,Deysi Mendez, Ministry of Health and Wellness, Belize, East Block, Independence Plaza, Belmopan, Belize, Telephone: +501-822-2326.
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12
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Miller AC, Tuiz E, Shaw L, Flood D, Garcia P, Dhaenens E, Thomson DR, Barnoya J, Montano CM, Rohloff P. Population Estimates of GFR and Risk Factors for CKD in Guatemala. Kidney Int Rep 2021; 6:796-805. [PMID: 33732994 PMCID: PMC7938058 DOI: 10.1016/j.ekir.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is an emerging public health priority in Central America. However, data on the prevalence of CKD in Guatemala, Central America's most populous country, are limited, especially for rural communities. METHODS We conducted a population-representative survey of 2 rural agricultural municipalities in Guatemala. We collected anthropometric data, blood pressure, serum and urine creatinine, glycosylated hemoglobin, and urine albumin. Sociodemographic, health, and exposure data were self-reported. RESULTS We enrolled 807 individuals (63% of all eligible, 35% male, mean age 39.5 years). An estimated 4.0% (95% confidence interval [CI] 2.4-6.6) had CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m2. Most individuals with an eGFR below 60 ml/min per 1.73 m2 had diabetes or hypertension. In multivariable analysis, the important factors associated with risk for an eGFR less than 60 ml/min per 1.73 m2 included a history of diabetes or hypertension (adjusted odds ratio [aOR] 11.21; 95% CI 3.28-38.24), underweight (body mass index [BMI] <18.5) (aOR 21.09; 95% CI 2.05-217.0), and an interaction between sugar cane agriculture and poverty (aOR 1.10; 95% CI 1.01-1.19). CONCLUSIONS In this population-based survey, most observed CKD was associated with diabetes and hypertension. These results emphasize the urgent public health need to address the emerging epidemic of diabetes, hypertension, and CKD in rural Guatemala. In addition, the association between CKD and sugar cane in individuals living in poverty provides some circumstantial evidence for existence of CKD of unknown etiology in the study communities, which requires further investigation.
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Affiliation(s)
- Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eva Tuiz
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Leah Shaw
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - David Flood
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Pablo Garcia
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Eloin Dhaenens
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Dana R. Thomson
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | | | | | - Peter Rohloff
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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13
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Rajapaksha H, Pandithavidana DR, Dahanayake JN. Demystifying Chronic Kidney Disease of Unknown Etiology (CKDu): Computational Interaction Analysis of Pesticides and Metabolites with Vital Renal Enzymes. Biomolecules 2021; 11:261. [PMID: 33578980 PMCID: PMC7916818 DOI: 10.3390/biom11020261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/28/2022] Open
Abstract
Chronic kidney disease of unknown etiology (CKDu) has been recognized as a global non-communicable health issue. There are many proposed risk factors for CKDu and the exact reason is yet to be discovered. Understanding the inhibition or manipulation of vital renal enzymes by pesticides can play a key role in understanding the link between CKDu and pesticides. Even though it is very important to take metabolites into account when investigating the relationship between CKDu and pesticides, there is a lack of insight regarding the effects of pesticide metabolites towards CKDu. In this study, a computational approach was used to study the effects of pesticide metabolites on CKDu. Further, interactions of selected pesticides and their metabolites with renal enzymes were studied using molecular docking and molecular dynamics simulation studies. It was evident that some pesticides and metabolites have affinity to bind at the active site or at regulatory sites of considered renal enzymes. Another important discovery was the potential of some metabolites to have higher binding interactions with considered renal enzymes compared to the parent pesticides. These findings raise the question of whether pesticide metabolites may be a main risk factor towards CKDu.
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Affiliation(s)
| | | | - Jayangika N. Dahanayake
- Department of Chemistry, Faculty of Science, University of Kelaniya, Dalugama, Kelaniya 11600, Western Province, Sri Lanka; (H.R.); (D.R.P.)
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14
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Amaral TLM, Amaral CDA, Vasconcellos MTLD, Monteiro GTR. [Chronic kidney disease among adults in Rio Branco, State of Acre: a population-based survey]. CIENCIA & SAUDE COLETIVA 2021; 26:339-350. [PMID: 33533855 DOI: 10.1590/1413-81232020261.22402018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/24/2019] [Indexed: 01/13/2023] Open
Abstract
The scope of this study was to establish the prevalence of CKD and associated factors among young adults (18-59 years of age) from Rio Branco in the State of Acre. It involved a population-based survey conducted in 2014, in the urban and rural areas of the municipality and CKD was defined as the glomerular filtration rate (GFR) < 60ml/min/1.73m², estimated by the CKD-EPI, and the presence of albuminuria > 29 mg/g. Association measures were estimated by logistic regression, with a confidence level of 95%. The overall prevalence of CKD was 6.2%. The presence of CKD was higher among women, aged 40 to 59 years, with non-white skin color, with lower schooling, and of sedentary disposition. There were statistically significant differences in the distribution according to the presence of CKD in the hypertension, diabetes and hospitalization variables over the past 12 months. CKD among adults was associated with the female sex (OR: 2.41, 95%CI: 1.14-5.12), diabetes (OR: 4.67, 95%CI: 1.28-17.03) and arterial hypertension (OR: 1.98; 95%CI: 1.16-3.37). CKD reveals a high prevalence and is associated with chronic diseases, calling for the need for public health measures for early detection and prevention of its progression.
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Affiliation(s)
- Thatiana Lameira Maciel Amaral
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde e do Desporto, Universidade Federal do Acre. BR 364 Km 04 Distrito Industrial, Campus Universitário. 69920-900 Rio Branco AC Brasil.
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15
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Ruiz-Alejos A, Caplin B, Miranda JJ, Pearce N, Bernabé-Ortiz A. CKD and CKDu in northern Peru: a cross-sectional analysis under the DEGREE protocol. BMC Nephrol 2021; 22:37. [PMID: 33478431 PMCID: PMC7818732 DOI: 10.1186/s12882-021-02239-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/11/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This study estimated the prevalence and risk factors for decreased estimated glomerular filtration rate (eGFR) in those without known hypertension, type 2 diabetes mellitus, or heavy proteinuria as a surrogate marker for chronic kidney disease of unknown cause (CKDu) among adults in the North of Peru. METHODS A cross-sectional study was conducted following the Disadvantaged Populations eGFR Epidemiology (DEGREE) Study protocol. Low eGFR was defined based on a single eGFR ≤60 mL/min/1.7m2 estimated using the CKD-EPI equation. Environmental conditions related to CKDu (i.e., work in agriculture or sugarcane, water source, heat intolerance, and pesticide exposure) were evaluated, in addition to traditional risk factors for CKD (i.e., smoking, heavy drinking, physical activity, hypertension, type 2 diabetes mellitus, urolithiasis, among others). RESULTS A total of 1514 subjects were included in the study, mean age 45.1 (SD: 16.4), and 55.2% were females. Overall, only 26 cases (1.7%; 95%CI: 1.1-2.5%) had an eGFR < 60 mL/min/1.7m2 compatible with CKD definition; when those with hypertension and type-2 diabetes or heavy proteinuria were excluded, according to the DEGREE protocol, the estimate fell to 0.9% (95%CI: 0.4-1.5%). Low physical activity levels (OR = 1.99; 95%CI: 1.18-3.34), hypertension (OR = 2.07; 1.26-3.41), and urolithiasis (OR = 1.97; 95%CI: 1.18-3.27) were factors associated with low eGFR. CONCLUSIONS A low population-based prevalence of low eGFR (as a surrogate for CKDu), both in rural and urban settings areas, in the Northern Peru, was found. Low physical activity levels, hypertension and urolithiasis were factors associated with low eGFR. Interventions to prevent CKD cases may be focused on well-known CV risk factors and urolithiasis.
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Affiliation(s)
- Andrea Ruiz-Alejos
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Miraflores, Lima, Peru
| | - Ben Caplin
- grid.11100.310000 0001 0673 9488Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Jaime Miranda
- grid.11100.310000 0001 0673 9488CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Miraflores, Lima, Peru ,grid.83440.3b0000000121901201Centre for Nephrology, University College London, London, UK
| | - Neil Pearce
- grid.8991.90000 0004 0425 469XDepartment of Medical Statistics and Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK ,grid.8991.90000 0004 0425 469XCentre for Global Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Miraflores, Lima, Peru.
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Redmon JH, Levine KE, Lebov J, Harrington J, Kondash AJ. A comparative review: Chronic Kidney Disease of unknown etiology (CKDu) research conducted in Latin America versus Asia. ENVIRONMENTAL RESEARCH 2021; 192:110270. [PMID: 33035557 DOI: 10.1016/j.envres.2020.110270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The incidence of chronic kidney disease of unknown or uncertain etiology (CKDu) is recognized as a global non-communicable health crisis. The goal of this work is to compare the types of research studies in Latin America and Asia, two regions with increasing CKDu incidence. METHODS A comparative literature review was conducted to evaluate the CKDu research design for peer-reviewed articles published from 2015 to 2019. Full texts were reviewed to identify study location, study type, study design, risk factors evaluated, and if applicable, sample type and number. RESULTS In Asia and Latin America, 82 and 65 articles were identified in total, respectively, with 55 field studies in Asia versus 34 in Latin America. In Asia, research was focused on drinking water (34), heavy metals (20), and agrochemical product usage (19) as potential risk factors. In Latin America, research focused mostly on heat stress/dehydration (36) and agrochemical product usage (18) as potential CKDu risk factors. Biological samples were collected more frequently than environmental samples, especially in Latin America. DISCUSSION Research to pinpoint the risk factors associated with CKDu to date is not standardized and typically limited in geographical scope. The emphasis of CKDu research varies by geographic region, with a greater priority placed on water quality and chemical exposure in Asia, versus dehydration and heat stress in Latin America. Using a harmonized approach to CKDu research would yield improved understanding of the risk factors associated with CKDu and how they compare across affected regions.
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Affiliation(s)
| | | | - Jill Lebov
- RTI International, Research Triangle Park, NC, USA
| | | | - A J Kondash
- RTI International, Research Triangle Park, NC, USA
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17
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Gunasekara T, De Silva PMC, Herath C, Siribaddana S, Siribaddana N, Jayasumana C, Jayasinghe S, Cardenas-Gonzalez M, Jayasundara N. The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9522. [PMID: 33353238 PMCID: PMC7766480 DOI: 10.3390/ijerph17249522] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 12/25/2022]
Abstract
Chronic Kidney Disease (CKD) is a globally prevalent non-communicable disease with significant mortality and morbidity. It is typically associated with diabetes and hypertension; however, over the last two decades, an emergence of CKD of unknown etiology (CKDu) has claimed thousands of lives in several tropical agricultural communities. CKDu is associated with gradual loss of renal function without initial symptoms until reaching complete kidney failure and eventually death. The most impacted are young adult males of lower socio-economic strata. Since the disease progression can be successfully attenuated through early detection, the development of superior screening and management measures is of utmost importance. In contrast to the conventional biomarkers, novel biomarkers with improved sensitivity and specificity are being discussed as promising tools for early diagnosis of the disease. This review summarizes emerging novel biomarkers used in assessing CKD and discusses the current utility and diagnostic potential of such biomarkers for CKDu screening in clinical settings of different communities impacted by CKDu. Our goal is to provide a framework for practitioners in CKDu impacted regions to consider the use of these novel biomarkers through this synthesis. The increased use of these biomarkers will not only help to validate their diagnostic power further and establish potential prognostic value but may also provide critical insights into sites and mechanisms of renal damage.
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Affiliation(s)
- T.D.K.S.C. Gunasekara
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka;
| | - P. Mangala C.S. De Silva
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka;
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Chula Herath
- Department of Nephrology, Sri Jayawardenapura General Hospital, Sri Jayawardenepura Kotte 10100, Sri Lanka;
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Nipuna Siribaddana
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Sudheera Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Matara 81000, Sri Lanka;
| | - Maria Cardenas-Gonzalez
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Mexican Council of Science and Technology, Consejo Nacional de Ciencia y Tecnología, Mexico City 03940, Mexico
| | - Nishad Jayasundara
- The Nicholas School of the Environment, Duke University, Durham, NC 27708, USA;
- The School of Marine Sciences, University of Maine, Orono, ME 04469, USA
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18
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Farag YMK, Karai Subramanian K, Singh VA, Tatapudi RR, Singh AK. Occupational risk factors for chronic kidney disease in Andhra Pradesh: 'Uddanam Nephropathy'. Ren Fail 2020; 42:1032-1041. [PMID: 33040645 PMCID: PMC7580562 DOI: 10.1080/0886022x.2020.1824924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND CKD of unknown etiology (CKDu) has been reported in several countries including India. We previously showed a prevalence of CKD in India to be 17.2% and we found a CKD epidemic in Andhra Pradesh (AP) to be 46.8%. We conducted this study to further explore the unexplained CKD epidemic in AP. METHODS We recruited 1201 adult participants through systematic random sampling from eight administrative divisions. Demographic, medical, and detailed occupational history was collected. Anthropometric measurements and blood pressure were taken and blood and urine samples were collected. Poisson regression model was used to identify potential predictors for CKD. RESULTS We analyzed data for 1184 individuals with mean age of 44.6 ± 14.0 years, of whom 44% were male. Prevalence of CKD was 32.2%. Working as a farmer had 20% more prevalence of CKD compared to non-farmers in the fully adjusted model (PR 1.2, 95% CI 1.01-1.42). Age, alcohol consumption, and chewing tobacco were also independent predictors of CKD. Gender, hypertension, and diabetes were not associated with CKD. CONCLUSIONS The prevalence of CKD in AP is 32.2%. Occupational exposure among farmers could play a potential role in this epidemic. Large longitudinal epidemiologic research studies are needed to trace the causes of this problem.
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Affiliation(s)
- Youssef M K Farag
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Renal Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kuyilan Karai Subramanian
- Renal Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Vikrum A Singh
- Renal Division, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Ajay K Singh
- Renal Division, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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20
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Hamilton SA, Nakanga WP, Prynn JE, Crampin AC, Fecht D, Vineis P, Caplin B, Pearce N, Nyirenda MJ. Prevalence and risk factors for chronic kidney disease of unknown cause in Malawi: a cross-sectional analysis in a rural and urban population. BMC Nephrol 2020; 21:387. [PMID: 32894093 PMCID: PMC7487679 DOI: 10.1186/s12882-020-02034-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND An epidemic of chronic kidney disease of unknown cause (CKDu) is occurring in rural communities in tropical regions of low-and middle-income countries in South America and India. Little information is available from Southern African countries which have similar climatic and occupational characteristics to CKDu-endemic countries. We investigated whether CKDu is prevalent in Malawi and identified its potential risk factors in this setting. METHODS We conducted a cross-sectional study from January-August 2018 collecting bio samples and anthropometric data in two Malawian populations. The sample comprised adults > 18 years (n = 821) without diabetes, hypertension, and proteinuria. Estimates of glomerular filtration rate (eGFR) were calculated using the CKD-EPI equation. Linear and logistic regression models were applied with potential risk factors, to estimate risk of reduced eGFR. RESULTS The mean eGFR was 117.1 ± 16.0 ml/min per 1.73m2 and the mean participant age was 33.5 ± 12.7 years. The prevalence of eGFR< 60 was 0.2% (95% confidence interval (95% CI) 0.1, 0.9); the prevalence of eGFR< 90 was 5% (95% CI =3.2, 6.3). We observed a higher prevalence in the rural population (5% (3.6, 7.8)), versus urban (3% (1.4, 6.7)). Age and BMI were associated with reduced eGFR< 90 [Odds ratio (OR) (95%CI) =3.59 (2.58, 5.21) per ten-year increment]; [OR (95%CI) =2.01 (1.27, 3.43) per 5 kg/m2 increment] respectively. No increased risk of eGFR < 90 was observed for rural participants [OR (95%CI) =1.75 (0.50, 6.30)]. CONCLUSIONS Reduced kidney function consistent with the definition of CKDu is not common in the areas of Malawi sampled, compared to that observed in other tropical or sub-tropical countries in Central America and South Asia. Reduced eGFR< 90 was related to age, BMI, and was more common in rural areas. These findings are important as they contradict some current hypothesis that CKDu is endemic across tropical and sub-tropical countries. This study has enabled standardized comparisons of impaired kidney function between and within tropical/subtropical regions of the world and will help form the basis for further etiological research, surveillance strategies, and the implementation and evaluation of interventions.
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Affiliation(s)
- Sophie A Hamilton
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
- MRC Centre for Environment and Health, Imperial College London, London, UK.
- Imperial College London, School of Public Health, London, UK.
| | - Wisdom P Nakanga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Josephine E Prynn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Institute of Cardiovascular Science, University College London, London, UK
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Departments of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniela Fecht
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Ben Caplin
- Centre for Nephrology, Division of Medicine, University College London, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Moffat J Nyirenda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Departments of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Ferguson R, Leatherman S, Fiore M, Minnings K, Mosco M, Kaufman J, Kerns E, Amador JJ, Brooks DR, Fiore M, Parekh RS, Fiore L. Prevalence and Risk Factors for CKD in the General Population of Southwestern Nicaragua. J Am Soc Nephrol 2020; 31:1585-1593. [PMID: 32471819 DOI: 10.1681/asn.2019050521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 03/24/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Studies have described Mesoamerican nephropathy among agricultural workers of El Salvador and northwestern Nicaragua. Data on prevalence and risk factors for CKD beyond agricultural workers and in other regions in Nicaragua are sparse. METHODS We recruited participants from 32 randomly selected communities in the Department of Rivas's ten municipalities in two phases. In phase 1, we screened participants using a field-based capillary creatinine measuring system and collected self-reported information on lifestyle and occupational, exposure, and health histories. Two years later, in phase 2, we enrolled 222 new participants, performing serum creatinine testing in these participants and confirmatory serum creatinine testing in phase 1 participants. RESULTS We enrolled 1242 of 1397 adults (89%) living in 533 households (median age 41 years; 43% male). We confirmed CKD (eGFR<60 ml/min per 1.73 m2) in 53 of 1227 (4.3%) evaluable participants. In multivariable testing, risk factors for prevalent CKD included age (odds ratio [OR], 1.92; 95% confidence interval [95% CI], 1.89 to 1.96) and self-reported history of hypertension (OR, 1.95; 95% CI, 1.04 to 3.64), diabetes (OR, 2.88; 95% CI, 1.40 to 5.93), or current or past work in the sugarcane industry (OR 2.92; 95% CI, 1.36 to 6.27). CONCLUSIONS Adjusted CKD prevalence was about 5% with repeat confirmatory testing in southwest Nicaragua, lower than in the northwest region. Risk factors included diabetes, hypertension, and current or prior work in the sugarcane industry but not in other forms of agricultural work. Formal CKD surveillance programs in Nicaragua are needed to assess the overall burden of CKD nationally, with a focus on agricultural workers.
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Affiliation(s)
- Ryan Ferguson
- Boston University, School of Public Health, Boston, Massachusetts
| | - Sarah Leatherman
- Boston Cooperative Studies Program Coordinating Center, Veterans Affairs, Boston Healthcare System, Boston, Massachusetts
| | - Madeline Fiore
- University of Massachusetts, School of Medicine, Worcester, Massachusetts
| | - Kailey Minnings
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Martha Mosco
- New York Presbyterian Hospital, Weill Cornell, New York, New York
| | - James Kaufman
- Division of Nephrology, Veterans Affairs New York Harbor Healthcare System and New York University School of Medicine, New York, New York
| | - Eric Kerns
- Division of Nephrology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Juan Jose Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Rulan S Parekh
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.,Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada
| | - Louis Fiore
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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22
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Dally M, Butler-Dawson J, Cruz A, Krisher L, Johnson RJ, Asensio C, Pilloni WD, Asturias EJ, Newman LS. Longitudinal trends in renal function among first time sugarcane harvesters in Guatemala. PLoS One 2020; 15:e0229413. [PMID: 32142520 PMCID: PMC7059928 DOI: 10.1371/journal.pone.0229413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/05/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Chronic kidney disease of unknown origin (CKDu) is an epidemic concentrated in agricultural communities in Central and South America, including young, male sugarcane harvesters. The purpose of this analysis is to understand early changes in kidney function among a cohort of first-time sugarcane harvesters and to determine risk factors for kidney function decline. Methods Joint latent class mixed models were used to model sub-population kidney function trajectory over the course of 4 years (2012–2016). Probability weighted logistic regression was used to determine personal health, community, and individual behavior risk factors associated with sub-population assignment. Data analysis occurred in 2019. Results Of 181 new workers median age 19 years old (IQR: 4), 39 (22%) were identified as having non-stable kidney function with an annual age-adjusted decline of estimated glomerular filtration rate (eGFR) of -1.0 ml/min per 1.73 m2 (95% CI: -3.4, 1.3). Kidney function (OR: 0.96; 95% CI: 0.93, 0.98), mild hypertension (OR: 5.21; 95% CI: 2.14, 13.94), and having a local home of residence (OR: 7.12; 95% CI: 2.41, 26.02) prior to employment in sugarcane were associated with non-stable eGFR sub-population assignment. Conclusions Mild hypertension may be an early indicator of the development of CKDu. A better understanding of preexisting risk factors is needed to determine why individuals are entering the workforce with reduced kidney function and elevated blood pressure and increased risk of renal function decline.
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Affiliation(s)
- Miranda Dally
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
| | - Jaime Butler-Dawson
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Alex Cruz
- Pantaleon, Guatemala City, Guatemala
| | - Lyndsay Krisher
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | | | | | - Edwin J. Asturias
- Division of Pediatric Infectious Diseases, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States of America
- Center for Global Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Lee S. Newman
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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Wesseling C, Glaser J, Rodríguez-Guzmán J, Weiss I, Lucas R, Peraza S, da Silva AS, Hansson E, Johnson RJ, Hogstedt C, Wegman DH, Jakobsson K. Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress. Rev Panam Salud Publica 2020; 44:e15. [PMID: 31998376 PMCID: PMC6984407 DOI: 10.26633/rpsp.2020.15] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/09/2020] [Indexed: 12/30/2022] Open
Abstract
The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.
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Affiliation(s)
- Catharina Wesseling
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - Jason Glaser
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Julieta Rodríguez-Guzmán
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Ilana Weiss
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Rebekah Lucas
- University of BirminghamUniversity of BirminghamBirminghamUnited KingdomUniversity of Birmingham, Birmingham, United Kingdom
| | - Sandra Peraza
- University of El SalvadorUniversity of El SalvadorSan SalvadorEl SalvadorUniversity of El Salvador, San Salvador, El Salvador
| | - Agnes Soares da Silva
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Erik Hansson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
| | - Richard J. Johnson
- University of Colorado at DenverUniversity of Colorado at DenverAuroraUnited States of AmericaUniversity of Colorado at Denver, Aurora, United States of America
| | - Christer Hogstedt
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - David H. Wegman
- University of Massachusetts LowellUniversity of Massachusetts LowellLowellUnited States of AmericaUniversity of Massachusetts Lowell, Lowell, United States of America
| | - Kristina Jakobsson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
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The incidence, prevalence and trends of Chronic Kidney Disease and Chronic Kidney Disease of uncertain aetiology (CKDu) in the North Central Province of Sri Lanka: an analysis of 30,566 patients. BMC Nephrol 2019; 20:338. [PMID: 31462219 PMCID: PMC6714078 DOI: 10.1186/s12882-019-1501-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 07/29/2019] [Indexed: 01/25/2023] Open
Abstract
Background Chronic Kidney Disease (CKD) of uncertain origin (CKDu) has affected North Central Province (Anuradhapura and Polonnaruwa districts) of Sri Lanka. The cause is still unknown. The objective of this study was to describe the incidence, prevalence and trend of CKD/CKDu in North Central Province of Sri Lanka. Methods A cross sectional survey conducted in North Central Province with GPS mapping in CKDu highly affected areas. The diagnosis of CKD and staging were made according to the Kidney Disease: Improving Global Outcomes paper. Descriptive statistics used with chi-square test for evaluating dichotomous variables. Log rank test was used to compare survival rates. The population data was obtained from the 2011 Census. Results There were 30,566 CKD/CKDu patients in the North Central Province. Incidence of 0.10 in 2009, 0.39 in 2016 in Anuradhapura district, decreased slightly to 0.29 in 2017. Incidence of 0.09 in 2009, 0.46 in 2016 in Polonnaruwa district, decreased slightly to 0.41 in 2017. The point prevalence in high incidence areas ranged from 2.44–4.35. The 5 year survival rate was 71.2 (Anuradhapura 72.4 and Polonnaruwa 68.3, p = 0.0212). More than 70, 40 and 33% of patients were over 50, 60 and 70 years of age respectively. A male preponderance was seen in all the divisional areas (ranging from 1.3:1 to 2.6:1) and in all the age groups. Farmers were the most affected (70.6% Anuradhapura district and 65.1% Polonnaruwa district). Majority in CKD stage I (4943, 69.6%). There were 1685 deaths (17.5% of total CKD/CKDu patients, 67.6% of total deaths in CKD/CKDu patients) occurring within the first 3 years of diagnosis. GPS mapping shows that there is a clustering of households with CKD/CKDu. Conclusions The incidence of CKD/CKDu increased up to 2016 with a slight decrease in 2017. The most vulnerable age group was 40 to 60 years. There is a male preponderance. Farmers at a higher risk. Majority were in CKD stage 1. More than two thirds of the deaths of CKD/CKDu patients occurred within three years of diagnosis with disparities in 5 year survival rate among the two districts. There is clustering of cases.
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25
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Ranasinghe AV, Kumara GWGP, Karunarathna RH, De Silva AP, Sachintani KGD, Gunawardena JMCN, Kumari SKCR, Sarjana MSF, Chandraguptha JS, De Silva MVC. The incidence, prevalence and trends of Chronic Kidney Disease and Chronic Kidney Disease of uncertain aetiology (CKDu) in the North Central Province of Sri Lanka: an analysis of 30,566 patients. BMC Nephrol 2019. [PMID: 31462219 DOI: 10.1186/s12882‐019‐1501‐0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic Kidney Disease (CKD) of uncertain origin (CKDu) has affected North Central Province (Anuradhapura and Polonnaruwa districts) of Sri Lanka. The cause is still unknown. The objective of this study was to describe the incidence, prevalence and trend of CKD/CKDu in North Central Province of Sri Lanka. METHODS A cross sectional survey conducted in North Central Province with GPS mapping in CKDu highly affected areas. The diagnosis of CKD and staging were made according to the Kidney Disease: Improving Global Outcomes paper. Descriptive statistics used with chi-square test for evaluating dichotomous variables. Log rank test was used to compare survival rates. The population data was obtained from the 2011 Census. RESULTS There were 30,566 CKD/CKDu patients in the North Central Province. Incidence of 0.10 in 2009, 0.39 in 2016 in Anuradhapura district, decreased slightly to 0.29 in 2017. Incidence of 0.09 in 2009, 0.46 in 2016 in Polonnaruwa district, decreased slightly to 0.41 in 2017. The point prevalence in high incidence areas ranged from 2.44-4.35. The 5 year survival rate was 71.2 (Anuradhapura 72.4 and Polonnaruwa 68.3, p = 0.0212). More than 70, 40 and 33% of patients were over 50, 60 and 70 years of age respectively. A male preponderance was seen in all the divisional areas (ranging from 1.3:1 to 2.6:1) and in all the age groups. Farmers were the most affected (70.6% Anuradhapura district and 65.1% Polonnaruwa district). Majority in CKD stage I (4943, 69.6%). There were 1685 deaths (17.5% of total CKD/CKDu patients, 67.6% of total deaths in CKD/CKDu patients) occurring within the first 3 years of diagnosis. GPS mapping shows that there is a clustering of households with CKD/CKDu. CONCLUSIONS The incidence of CKD/CKDu increased up to 2016 with a slight decrease in 2017. The most vulnerable age group was 40 to 60 years. There is a male preponderance. Farmers at a higher risk. Majority were in CKD stage 1. More than two thirds of the deaths of CKD/CKDu patients occurred within three years of diagnosis with disparities in 5 year survival rate among the two districts. There is clustering of cases.
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Affiliation(s)
| | | | | | - Ambepitiyawaduge Pubudu De Silva
- Renal Disease Prevention and Research Unit, Ministry of Health, Colombo, Sri Lanka. .,National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka.
| | | | | | | | | | - Janaka Sri Chandraguptha
- Renal Disease Prevention and Research Unit, Ministry of Health, Colombo, Sri Lanka.,Office of Additional Secretary (Development), Ministry of Health, Colombo, Sri Lanka
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26
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Nakanga WP, Prynn JE, Banda L, Kalyesubula R, Tomlinson LA, Nyirenda M, Crampin AC. Prevalence of impaired renal function among rural and urban populations: findings of a cross-sectional study in Malawi. Wellcome Open Res 2019; 4:92. [PMID: 31656860 PMCID: PMC6798316 DOI: 10.12688/wellcomeopenres.15255.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Sub-Saharan Africa faces region-specific risk factors for chronic kidney disease (CKD), such as nephrotoxic herbal medicines, antiretroviral therapy and infections, in addition to hypertension and diabetes. However, large epidemiological studies from this area are scarce. Methods: In a cross-sectional survey of non-communicable diseases, we conducted a prevalence sub-study of CKD in two Malawian populations. Study participants (N=5264) of 18 years of age and above were recruited and data on demographics and CKD risk factors were collected. Glomerular filtration rate was estimated (eGFR) using the CKD-EPI equation. Results: The prevalence of eGFR<60ml/min/1.73m 2 was 1.4% (95% CI 1.1 - 1.7%) and eGFR<90ml/min/1.73m 2 was 20.6% (95% CI 19.5 - 21.7%). The rural area had higher age-standardized prevalence of both eGFR<60ml/min/1.73m 2, at 1.8% (95% CI 1.4 - 2.3) and eGFR <90 ml/min/1.73m², at 21.1% (95% CI 19.9 - 22.3), than urban location, which had a prevalence of 1.5%, (95% CI 1.0 - 2.2) and 19.4% (95% CI 18.0 - 20.8), respectively, with overlapping confidence intervals. The prevalence of CKD was lower in females than in males in both rural and urban areas. Older age (p < 0.001), a higher level of education (p = 0.03) and hypertension (p < 0.001) were associated with a higher adjusted odds ratio (aOR) of low eGFR. Diabetes was associated with a reduced aOR of eGFR<90ml/min/1.73m 2 of 0.69 (95% CI 0.49-0.96; p=0.03). Of participants with eGFR<60ml/min/1.73m 2, 14 (19.4%) had no history of hypertension, diabetes or HIV, while 36 (50%) had a single risk factor of being hypertensive. Conclusion s: Impaired renal function is prevalent, but lower than expected, in rural and urban Malawi. Further research is needed to increase understanding of CKD incidence, survival and validation of eGFR calculations in this population.
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Affiliation(s)
- Wisdom P Nakanga
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
- University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | | | - Louis Banda
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Robert Kalyesubula
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Entebbe, Uganda
| | - Laurie A Tomlinson
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Moffat Nyirenda
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Entebbe, Uganda
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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27
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Chicas R, Mix J, Mac V, Flocks J, Dickman NE, Hertzberg V, McCauley L. Chronic Kidney Disease Among Workers: A Review of the Literature. Workplace Health Saf 2019; 67:481-490. [PMID: 31179873 DOI: 10.1177/2165079919843308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For the past two decades, agricultural workers in regions of Central America have reported an epidemic of chronic kidney disease of undetermined etiology (CKDu) that is not associated with established risk factors of chronic kidney disease. Several hypotheses have emerged, but the etiology of CKDu remains elusive and controversial. The aim of this literature review was to describe the potential risk factors of CKDu in Mesoamerica and implications for the U.S. agricultural worker population. PubMed and CINAHL databases were searched for articles published between 2000 and 2018 that examined CKDu in Mesoamerica; 29 original studies were included in this review. CKDu is a multifactorial disease that is often asymptomatic with hallmark characteristics of elevated serum creatinine and blood urea nitrogen (BUN), low glomerular filtration rate, electrolyte abnormalities, and non-nephrotic proteinuria. Reducing the global prevalence of CKDu will require more robust studies on causal mechanisms and on interventions that can reduce morbidity and mortality in vulnerable populations.
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28
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Amaral TLM, Amaral CDA, Vasconcellos MTLD, Monteiro GTR. Prevalence and factors associated to chronic kidney disease in older adults. Rev Saude Publica 2019; 53:44. [PMID: 31066822 PMCID: PMC6536103 DOI: 10.11606/s1518-8787.2019053000727] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/13/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To verify the prevalence of chronic kidney disease and the factors associated to it in older adults (≥ 60 years). METHODS This is a population-based research conducted in 2014, involving 1,016 older adults living in urban and rural areas of the municipality of Rio Branco, Acre. Chronic kidney disease was defined by glomerular filtration rate < 60 ml/min/1.73 m 2 , estimated by the equations of the Chronic Kidney Disease Epidemiology Collaboration, and the presence of albuminuria > 29 mg/g. Association measure were estimated by gross and adjusted odds ratio (OR), with a confidence level of 95% (95%CI). RESULTS The overall prevalence of chronic kidney disease was 21.4% in older adults, with the associated factors age, diabetes (OR = 3.39; 95%CI 2.13–5.40), metabolic syndrome (OR = 2.49; 95%CI 1.71–3.63), self-assessment of poor health (OR = 1.79; 95%CI 1.10–2.91), arterial hypertension (OR = 1.82; 95%CI 1.04–3.19) and obesity (OR = 1.69; 95%CI 1.02–2.80). CONCLUSIONS The prevalence of chronic kidney disease was high in older adults, being associated with age, self-assessment of health as bad or very bad, obesity, diabetes and metabolic syndrome.
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Affiliation(s)
- Thatiana Lameira Maciel Amaral
- Universidade Federal do Acre . Centro de Ciências da Saúde e do Desporto . Programa de Pós-Graduação em Saúde Coletiva . Rio Branco , AC , Brasil
| | - Cledir de Araújo Amaral
- Instituto Federal de Educação, Ciência e Tecnologia do Acre . Campus Rio Branco. Rio Branco , AC , Brasil
| | | | - Gina Torres Rego Monteiro
- Universidade Federal do Acre . Centro de Ciências da Saúde e do Desporto . Programa de Pós-Graduação em Saúde Coletiva . Rio Branco , AC , Brasil.,Fundação Oswaldo Cruz . Escola Nacional de Saúde Pública Sérgio Arouca . Rio de Janeiro , RJ , Brasil
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29
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Chapman E, Haby MM, Illanes E, Sanchez-Viamonte J, Elias V, Reveiz L. Risk factors for chronic kidney disease of non-traditional causes: a systematic review. Rev Panam Salud Publica 2019; 43:e35. [PMID: 31093259 PMCID: PMC6461065 DOI: 10.26633/rpsp.2019.35] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/19/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To evaluate the potential associations between chronic kidney disease of uncertain or non-traditional etiology (CKDnT) and agrochemicals, heat stress, heavy metals, and other factors identified in the literature in any region of the world and at any time. METHODS This was a systematic review of the most frequent exposures suspected to be possible causes of CKDnT. A search was conducted of PubMed, LILACS, World Wide Science electronic databases, among other sources. Only medium- and high-quality studies were included. The synthesis of evidence included a narrative synthesis, meta-analysis, and meta-regression. RESULTS Four systematic reviews and 61 primary studies were included. Results of the meta-analysis suggest that exposure to agrochemicals and working in agriculture increase the risk of CKDnT, but this only reached significance for working in agriculture. When cross-sectional studies were excluded, agrochemical exposure became significant. However, there is substantial heterogeneity in the effect sizes. CONCLUSIONS Based on the existing evidence and the precautionary principle, it is important to implement preventive measures to mitigate the damage caused by CKDnT to both agricultural workers and their communities (i.e., improvement of working conditions, cautious management of agrochemicals, etc.). More high-quality research is needed to measure impact and to build the evidence base.
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Affiliation(s)
- Evelina Chapman
- Campus Universitário Darcy Ribeiro Campus Universitário Darcy Ribeiro Oswaldo Cruz Foundation (Fiocruz) Brasilia Brazil Oswaldo Cruz Foundation (Fiocruz), Campus Universitário Darcy Ribeiro, Brasilia, Brazil
| | - Michelle M Haby
- Universidad de Sonora Universidad de Sonora Department of Chemical and Biological Sciences HermosilloSonora Mexico Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo, Sonora, Mexico
| | - Eduardo Illanes
- Universidad Mayor, a Ringgold standard institution Universidad Mayor, a Ringgold standard institution School of Psychology Santiago Chile School of Psychology, Universidad Mayor, a Ringgold standard institution, Santiago, Chile
| | - Julian Sanchez-Viamonte
- Facultad de Ciencias Médicas de la Universidad Nacional de La Plata Facultad de Ciencias Médicas de la Universidad Nacional de La Plata Escuela Universitaria de Recursos Humanos del Equipo de Salud Informática en Ciencias de la Salud Buenos Aires Argentina Informática en Ciencias de la Salud, Escuela Universitaria de Recursos Humanos del Equipo de Salud, Facultad de Ciencias Médicas de la Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Vanessa Elias
- Pan American Health Organization/World Health Organization Pan American Health Organization/World Health Organization Department of Evidence and Intelligence for Action in Health WashingtonDC United States of America Department of Evidence and Intelligence for Action in Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | - Ludovic Reveiz
- Pan American Health Organization/World Health Organization Pan American Health Organization/World Health Organization Department of Evidence and Intelligence for Action in Health WashingtonDC United States of America Department of Evidence and Intelligence for Action in Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America
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30
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O’Callaghan-Gordo C, Shivashankar R, Anand S, Ghosh S, Glaser J, Gupta R, Jakobsson K, Kondal D, Krishnan A, Mohan S, Mohan V, Nitsch D, P A P, Tandon N, Narayan KMV, Pearce N, Caplin B, Prabhakaran D. Prevalence of and risk factors for chronic kidney disease of unknown aetiology in India: secondary data analysis of three population-based cross-sectional studies. BMJ Open 2019; 9:e023353. [PMID: 30850400 PMCID: PMC6429742 DOI: 10.1136/bmjopen-2018-023353] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/26/2018] [Accepted: 01/04/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To assess whether chronic kidney disease of unknown aetiology (CKDu) is present in India and to identify risk factors for it using population-based data and standardised methods. DESIGN Secondary data analysis of three population-based cross-sectional studies conducted between 2010 and 2014. SETTING Urban and rural areas of Northern India (states of Delhi and Haryana) and Southern India (states of Tamil Nadu and Andhra Pradesh). PARTICIPANTS 12 500 individuals without diabetes, hypertension or heavy proteinuria. OUTCOME MEASURES Mean estimated glomerular filtration rate (eGFR) and prevalence of eGFR below 60 mL/min per 1.73 m2 (eGFR <60) in individuals without diabetes, hypertension or heavy proteinuria (proxy definition of CKDu). RESULTS The mean eGFR was 105.0±17.8 mL/min per 1.73 m2. The prevalence of eGFR <60 was 1.6% (95% CI=1.4 to 1.7), but this figure varied markedly between areas, being highest in rural areas of Southern Indian (4.8% (3.8 to 5.8)). In Northern India, older age was the only risk factor associated with lower mean eGFR and eGFR <60 (regression coefficient (95% CI)=-0.94 (0.97 to 0.91); OR (95% CI)=1.10 (1.08 to 1.11)). In Southern India, risk factors for lower mean eGFR and eGFR <60, respectively, were residence in a rural area (-7.78 (-8.69 to -6.86); 4.95 (2.61 to 9.39)), older age (-0.90 (-0.93 to -0.86); 1.06 (1.04 to 1.08)) and less education (-0.94 (-1.32 to -0.56); 0.67 (0.50 to 0.90) for each 5 years at school). CONCLUSIONS CKDu is present in India and is not confined to Central America and Sri Lanka. Identified risk factors are consistent with risk factors previously reported for CKDu in Central America and Sri Lanka.
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Affiliation(s)
- Cristina O’Callaghan-Gordo
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Roopa Shivashankar
- Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
| | - Shuchi Anand
- StanfordUniversity School of Medicine, Stanford, CA, USA
| | | | - Jason Glaser
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- LaIsla Network, Ada, Michigan, USA
| | - Ruby Gupta
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Kristina Jakobsson
- Occupationaland Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Occupationaland Environmental Medicine, Lund University, Lund, Sweden
| | - Dimple Kondal
- Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
| | - Anand Krishnan
- Centrefor Community Medicine, All India Institute of Medical Sciences, New Delhi, Haryana, India
| | - Sailesh Mohan
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Viswanathan Mohan
- Diabetes Research, Madras Diabetes Research Foundation, Chennai, India
- Dr.Mohan’s Diabetes Specialities Centre, Chennai, India
| | - Dorothea Nitsch
- Departmentof Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Praveen P A
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
- Departmentof Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Departmentof Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - K M Venkat Narayan
- EmoryGlobal Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Centrefor Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Centrefor Nephrology, University College London Medical School, London, UK
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
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González-Quiroz M, Pearce N, Caplin B, Nitsch D. What do epidemiological studies tell us about chronic kidney disease of undetermined cause in Meso-America? A systematic review and meta-analysis. Clin Kidney J 2018; 11:496-506. [PMID: 30094014 PMCID: PMC6070103 DOI: 10.1093/ckj/sfx136] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/18/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The aim of this systematic review is to examine the epidemiological knowledge and gaps in understanding of the potential causes of chronic kidney disease of undetermined cause (CKDu) in Meso-America. METHODS A systematic literature search of epidemiological studies of CKDu was conducted in PubMed, Embase and Web of Science from January 2000 to January 2017. Study quality was assessed by adapting the tool from Higgins et al. for observational studies. Where applicable, the summary prevalence odds ratio (POR) and 95% confidence interval (CI) were calculated using a random effects model. RESULTS Twenty-five epidemiological studies were included in the analysis of risk factors for CKDu. The quality assessment of each occupational and community study was medium. The PORs for CKDu were males versus females 2.42 (95% CI 1.76-3.08), family history of CKD (versus none) 1.84 (95% CI 1.37-2.30), high water intake (versus low) 1.61 (95% CI 1.01-2.21) and low altitude (versus highland) 2.09 (95% CI 1.00-3.17). There were no significant associations between CKDu and pesticide exposure (versus no) 1.17 (95% CI 0.87-1.46), alcohol consumption (versus no) 1.34 (95% CI 0.84-1.84), non-steroidal anti-inflammatory drugs (versus no) 0.99 (95% CI 0.60-1.39) and heat stress (versus no) 1.52 (95% CI -0.91 - 3.95). CONCLUSION Our meta-analysis showed positive associations for males (versus females) and family history of CKD, water intake, lowland altitude and CKDu. There were no significant associations with pesticide exposure, non-steroidal anti-inflammatory drugs intake, heat stress and alcohol consumption.
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Affiliation(s)
- Marvin González-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Nephrology, University College London, London, UK
| | - Neil Pearce
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Centre for Nephrology, University College London, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Ekiti ME, Zambo JB, Assah FK, Agbor VN, Kekay K, Ashuntantang G. Chronic kidney disease in sugarcane workers in Cameroon: a cross-sectional study. BMC Nephrol 2018; 19:10. [PMID: 29334929 PMCID: PMC5769452 DOI: 10.1186/s12882-017-0798-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/14/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Agricultural workers especially in sugarcane plantations have a high risk of chronic kidney disease (CKD). Little is known about CKD among sugarcane plantation workers in Cameroon. This study sought to evaluate the prevalence and identify factors associated with CKD in sugarcane plantation workers in Cameroon. METHODS We conducted an analytic cross-sectional study including 204 adult workers at the sugarcane plantation complex in Mbandjock, Cameroon; over 500 m above sea level. Chronic kidney disease (proteinuria as estimated by urine dipstick analysis and/or estimated glomerular filtration rate < 60 ml/min/1.73 m2 persistent after 3 months) was the outcome of interest. Those with abnormal results were seen again after 3 months to confirm the diagnosis. We evaluated the association between CKD and participant age, sex, contract-type, duration of employment, socio-economic status, workspace, exposure to agrochemicals, heavy metals and heat, selected risk factors and co-morbid conditions. RESULTS The overall prevalence of CKD was 3.4%. The factory workers were the most affected (7%), compared to the field (2.4%) and office workers (0%). 2.9% of the participants had persistent proteinuria, mild in every case, and 0.5% of them had an estimated glomerular filtration rate < 60 ml/min/1.73 m2. Age ≥ 40 years was an independent predictor of CKD. CONCLUSION The prevalence of CKD among employees of the Mbandjock sugarcane plantation is low, probably reflecting the preventive measures against heat stress and dehydration in place.
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Affiliation(s)
- Martin E. Ekiti
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
- Occupational Health Service, National Refining Company (SONARA), P.O. Box 365, Limbe, Cameroon
| | - Jean-Berthelot Zambo
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
- Cameroon Sugar Company (SOSUCAM), Mbandjock, Cameroon
| | - Felix K. Assah
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
| | - Valirie N. Agbor
- Ibal sub-Divisional Hospital, Oku, Northwest Region, Bamenda, Cameroon
| | - Krystel Kekay
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
| | - Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
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Moreno Velásquez I, Castro F, Gómez B, Cuero C, Motta J. Chronic Kidney Disease in Panama: Results From the PREFREC Study and National Mortality Trends. Kidney Int Rep 2017; 2:1032-1041. [PMID: 29270512 PMCID: PMC5733821 DOI: 10.1016/j.ekir.2017.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/25/2017] [Accepted: 05/31/2017] [Indexed: 12/28/2022] Open
Abstract
Introduction The magnitude of chronic kidney disease (CKD) in Panama has yet to be described. We investigated the association between sociodemographic and cardiovascular exposures with CKD in 2 Panamanian provinces. Further, we analyzed national trends of CKD mortality from 2001 to 2014. Methods Data were derived from Prevalencia de Factores de Riesgo de Enfermedad Cardiovascular (PREFREC [Survey on Risk Factors Associated With Cardiovascular Disease]), a cross-sectional study designed to analyze the prevalence of risk factors associated with cardiovascular disease. Biomarkers of kidney function were measured in 3590 participants. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 and/or albuminuria ≥30 mg/g creatinine. Odds ratios (ORs) with 95% confidence intervals (CIs) for CKD were calculated using logistic regression. We calculated age-standardized CKD mortality rates in the country using the National Mortality Register. Annual percentage change and 95% CIs were estimated to evaluate the trends over time. Results The prevalence of CKD was 12% (reduced eGFR: 3.3%; albuminuria; 9.9%). CKD was associated with hypertension (OR: 1.8; 95% CI: 1.2−2.7), age 60 years or older (OR: 1.9; 95% CI: 1.2−2.9), and previous myocardial infarction (OR: 2.4; 95% CI: 1.0−5.7), whereas monthly family income was inversely associated with CKD (OR: 0.4; 95% CI: 0.1−0.9) (adjusted). A sustained increase in the trend of CKD mortality was observed from 2001 to 2006, followed by a decreasing trend in subsequent years. Coclé province had the highest adjusted mortality rate. Discussion CKD poses a significant health problem for Panama. Health inequalities and an increase of cardiometabolic risk factors warrant robust epidemiological surveillance, improved diagnosis, and treatment. Further national studies aimed to address geographical disparities are necessary.
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Affiliation(s)
- Ilais Moreno Velásquez
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
- Correspondence: Ilais Moreno Velásquez, Gorgas Memorial Institute for Health Studies, 0816-02593 Panama City, Panama.Gorgas Memorial Institute for Health Studies0816-02593 Panama CityPanama
| | - Franz Castro
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Beatriz Gómez
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - César Cuero
- Ministry of Health, Panama City, Panama
- Latin American Dialysis and Transplant Registry, National Society of Nephrology, Panama City, Panama
| | - Jorge Motta
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
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Johnson RJ. Pro: Heat stress as a potential etiology of Mesoamerican and Sri Lankan nephropathy: a late night consult with Sherlock Holmes. Nephrol Dial Transplant 2017; 32:598-602. [PMID: 28407135 DOI: 10.1093/ndt/gfx034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Epidemics of chronic kidney disease are now recognized in Central America, Mexico, India and Sri Lanka, and there is also some evidence that similar epidemics may be occurring in the USA, Thailand and elsewhere. A common denominator for each location is manually working outside in extremely hot environments. Here we review the evidence that the primary etiology may be heat stress related to repeated subclinical or clinical acute kidney injury that eventually manifests as chronic kidney disease. In some aspects, the disease may manifest as subclinical heat stroke, subclinical rhabdomyolysis or a subclinical tumor lysis syndrome. While toxins could be involved, it would be difficult to attribute this as a main mechanism, given the wide range of occupations and geographic regions manifesting this disease. While some of the epidemics may be due to better reporting, we believe the most important reasons are increasing heat extremes (heat waves) coupled with hydration with sugary or, less commonly, alcoholic beverages.
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Affiliation(s)
- Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado, USA
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35
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González-Quiroz M, Camacho A, Faber D, Aragón A, Wesseling C, Glaser J, Le Blond J, Smeeth L, Nitsch D, Pearce N, Caplin B. Rationale, description and baseline findings of a community-based prospective cohort study of kidney function amongst the young rural population of Northwest Nicaragua. BMC Nephrol 2017; 18:16. [PMID: 28086816 PMCID: PMC5237152 DOI: 10.1186/s12882-016-0422-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/20/2016] [Indexed: 12/16/2022] Open
Abstract
Background An epidemic of Mesoamerican Nephropathy (MeN) is killing thousands of agricultural workers along the Pacific coast of Central America, but the natural history and aetiology of the disease remain poorly understood. We have recently commenced a community-based longitudinal study to investigate Chronic Kidney Disease (CKD) in Nicaragua. Although logistically challenging, study designs of this type have the potential to provide important insights that other study designs cannot. In this paper we discuss the rationale for conducting this study and summarize the findings of the baseline visit. Methods The baseline visit of the community-based cohort study was conducted in 9 communities in the North Western Nicaragua in October and November 2014. All of the young men, and a random sample of young women (aged 18–30) without a pre-existing diagnosis of CKD were invited to participate. Glomerular filtration rate (eGFR) was estimated with CKD-EPI equation, along with clinical measurements, questionnaires, biological and environmental samples to evaluate participants’ exposures to proposed risk factors for MeN. Results We identified 520 young adults (286 males and 234 females) in the 9 different communities. Of these, 16 males with self-reported CKD and 5 females with diagnoses of either diabetes or hypertension were excluded from the study population. All remaining 270 men and 90 women, selected at random, were then invited to participate in the study; 350 (97%) agreed to participate. At baseline, 29 (11%) men and 1 (1%) woman had an eGFR <90 mL/min/1.73 m2. Conclusion Conducting a community based study of this type requires active the involvement of communities and commitment from local leaders. Furthermore, a research team with strong links to the area and broad understanding of the context of the problem being studied is essential. The key findings will arise from follow-up, but it is striking that 5% of males under aged 30 had to be excluded because of pre-existing kidney disease, and that despite doing so 11% of males had an eGFR <90 mL/min/1.73 m2 at baseline. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0422-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marvin González-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), Campus Médico, Facultad de Ciencias Médica, Edificio C (CISTA), León, Nicaragua. .,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for Nephrology, University College London Medical School, London, UK.
| | - Armando Camacho
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), Campus Médico, Facultad de Ciencias Médica, Edificio C (CISTA), León, Nicaragua
| | | | - Aurora Aragón
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), Campus Médico, Facultad de Ciencias Médica, Edificio C (CISTA), León, Nicaragua
| | - Catharina Wesseling
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Centre for Nephrology, University College London Medical School, London, UK
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García-Trabanino R, Cerdas M, Madero M, Jakobsson K, Barnoya J, Crowe J, Jarquín E, Guzmán-Quilo C, Correa-Rotter R. Nefropatía mesoamericana: revisión breve basada en el segundo taller del Consorcio para el estudio de la Epidemia de Nefropatía en Centroamérica y México (CENCAM). NEFROLOGÍA LATINOAMERICANA 2017. [DOI: 10.1016/j.nefrol.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Quinteros E, Ribó A, Mejía R, López A, Belteton W, Comandari A, Orantes CM, Pleites EB, Hernández CE, López DL. Heavy metals and pesticide exposure from agricultural activities and former agrochemical factory in a Salvadoran rural community. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:1662-1676. [PMID: 27796975 DOI: 10.1007/s11356-016-7899-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/11/2016] [Indexed: 06/06/2023]
Abstract
Pesticide handling in farming activities involves substantial hazards for the rural population and for the environment. In Latin America, it is estimated that the population at risk of being affected by heavy metals is over 4 million. This research describes the different types of exposure to pesticides and heavy metals in a rural population (Loma del Gallo), considering both environmental and occupational exposure. This study consists of an inspection in a former pesticide factory (QUIMAGRO), analysis of heavy metals in samples from surface and ground water in the community close to the factory, and a survey to the local population about their perceptions of pesticide exposures. Containers with 34.6 tons of chemicals improperly stored were identified in the former factory and removed by the government. Arsenic and cadmium were found in groundwater, and the highest values were 0.012 and 0.004 mg/l, respectively. These contaminants were also detected in most surface water samples, with maximum values of 0.026 and 0.0001 mg/l, respectively. Results of the survey show that of the 44 participants 42 % were farmers. Farmers used 19 different pesticide products containing 11 active ingredients. The most used active ingredients were paraquat (65 %), methamidophos (35 %), and atrazina (29 %). Eighty-two percent of the farmers did not use personal protective equipment. In addition to the pesticides used in the agriculture of the area, pesticide containers were removed from the QUIMAGRO area, but the pollution was still present at time of sampling and it is evident by the odor of the site. Surface water had the major concentration of heavy metals than the groundwater. Loma del Gallo population has been exposed to toxic pesticide from QUIMAGRO and agriculture for many years. The farmers carry out mishandling of pesticides and they not use PPE.
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Affiliation(s)
- Edgar Quinteros
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador.
| | - Alexandre Ribó
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Roberto Mejía
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Alejandro López
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Wilfredo Belteton
- National Reference Laboratory, Ministry of Health El Salvador, Alameda Roosvelt, Edificio Max Bloch, frente a parque Cuscatlán, San Salvador, El Salvador
| | - Aimee Comandari
- Department of General Science, College of Southern Nevada, 6375 W. Charleston Blvd, Las Vegas, NV, 89146, USA
| | - Carlos M Orantes
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Ernesto B Pleites
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Carlos E Hernández
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Dina L López
- Department of Geological Sciences, Ohio University, Clippinger Laboratories 316, Athens, OH, 45701-2979, USA
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Kupferman J, Amador JJ, Lynch KE, Laws RL, López-Pilarte D, Ramírez-Rubio O, Kaufman JS, Lau JL, Weiner DE, Robles NV, Verma KP, Scammell MK, McClean MD, Brooks DR, Friedman DJ. Characterization of Mesoamerican Nephropathy in a Kidney Failure Hotspot in Nicaragua. Am J Kidney Dis 2016; 68:716-725. [PMID: 27575010 DOI: 10.1053/j.ajkd.2016.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mesoamerican nephropathy (MeN) is a kidney disease of unknown cause that mainly affects working-age men in Central America. Despite being a major cause of morbidity and mortality in this region, its clinical characteristics have not been well defined. STUDY DESIGN Cross-sectional family-based study. SETTING & PARTICIPANTS 266 members of 24 families with high chronic kidney disease (CKD) burdens in a MeN hotspot in Northwestern Nicaragua. We compared clinical and biochemical characteristics of affected individuals first with their unaffected relatives and then with NHANES (National Health and Nutrition Examination Survey) participants with CKD in order to reveal identifying features of MeN. PREDICTOR CKD defined as serum creatinine level ≥ 1.5mg/dL in men and ≥1.4mg/dL in women. OUTCOMES Clinical and biochemical parameters, including serum sodium, potassium, bicarbonate, calcium, magnesium, phosphorus, and uric acid. RESULTS Hyperuricemia, in many cases severe, was common among patients with MeN. Uric acid levels in patients with MeN were higher than those in NHANES participants (mean, 9.6 vs 7.4mg/dL for men in each group) despite more frequent use of uric acid-lowering medications in Nicaraguan individuals (71.7% vs 11.2%). In multivariable linear mixed-effects regression analysis, uric acid levels were 2.0mg/dL (95% CI, 1.0-3.0; P<0.001) higher in patients with MeN compared with their NHANES counterparts after adjusting for age, estimated glomerular filtration rate, and uric acid-lowering therapies. In contrast to prior reports, hyponatremia and hypokalemia were not common. LIMITATIONS CKD defined by single serum creatinine measurement; population likely not representative of full MeN phenotype spectrum across Central America; major differences between MeN and NHANES groups in important characteristics such as age, ancestry, and recruitment method. CONCLUSIONS Hyperuricemia out of proportion to the degree of decreased kidney function was common among Nicaraguan patients with MeN. Our results suggest that rather than being solely a consequence of CKD, hyperuricemia may play a role in MeN pathogenesis, a hypothesis that deserves further study.
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Affiliation(s)
- Joseph Kupferman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Katherine E Lynch
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Rebecca L Laws
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | | | - Oriana Ramírez-Rubio
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - James S Kaufman
- Research Service, VA New York Harbor Healthcare System and Department of Medicine, New York University School of Medicine, New York, NY
| | - Jorge Luis Lau
- Universidad Nacional Autónoma de Nicaragua, León, Nicaragua
| | - Daniel E Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Ninoska Violeta Robles
- Centro Nacional de Diagnóstico y Referencia, Nicaraguan Ministry of Health, Managua, Nicaragua
| | - Karina P Verma
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.
| | - David J Friedman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Campese VM. The Mesoamerican nephropathy: a regional epidemic of chronic kidney disease? Nephrol Dial Transplant 2016; 31:335-6. [DOI: 10.1093/ndt/gfv430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/13/2022] Open
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