Abstract
Mostly anecdotal reports describe a high prevalence of chronic kidney disease in northwestern Nicaragua, predominantly among younger men, resulting in substantial morbidity and mortality. The true prevalence, nature and aetiology of kidney disease in this region remain unknown. We performed a population-based prevalence study in Quezalguaque, Nicaragua to assess the frequency of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2), and compared the prevalence of reduced eGFR in Quezalguaque with the USA using the NHANES 1999-2006 data. We also conducted an embedded case-control study in a subset of participants to assess kidney disease risk factors. From 1882 eligible households, 771 individuals from 300 households participated in the prevalence study, 98 (13%) of whom had reduced eGFR. Reduced eGFR was more common among older participants, men and participants living at lower altitudes. Among 18-29-year-old participants, 2.6% had reduced eGFR, and among 30-41-year-old participants, 7.4% had reduced eGFR; this compares with 0.2% and 0.8%, respectively, in NHANES. No individuals in these age groups were diabetic. Among cases, only 27% had dipstick proteinuria of 1+ or greater, compared with 7% of controls. Haematuria did not significantly differ between cases and controls (24% versus 18%). In age- and sex-adjusted models, hypertension and residence at lower altitude were independently associated with reduced eGFR, while occupational history was not associated with reduced eGFR. Kidney disease appears common in residents of Quezalguaque, Nicaragua, particularly in younger men, with features most consistent with tubulointerstitial disease. Further research is needed to elucidate the causes of kidney disease in this region.
Highlights
For more than two decades, multiple reports have described a high prevalence of chronic kidney disease (CKD) in northwestern Nicaragua and coastal El Salvador, predominantly among younger men [1,2,3,4,5,6]
There was a higher prevalence of low estimated glomerular filtration rate (eGFR) among older participants, men and participants living at lower altitudes (Table 1)
In the current study, performed in the municipality of Quezalguaque, Nicaragua in response to anecdotal reports of a high prevalence of kidney disease in agricultural regions in northwestern Nicaragua, we found an overall prevalence of decreased eGFR (
Summary
For more than two decades, multiple reports have described a high prevalence of chronic kidney disease (CKD) in northwestern Nicaragua and coastal El Salvador, predominantly among younger men [1,2,3,4,5,6]. Many of these reports have methodological concerns, and a few have reached the peer-reviewed literature. Anecdotal reports describe a high prevalence of chronic kidney disease in northwestern Nicaragua, predominantly among younger men, resulting in substantial morbidity and mortality. Further research is needed to elucidate the causes of kidney disease in this region
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