Abstract
Mesoamerican nephropathy, also known as chronic kidney disease of unknown etiology, is widespread in Pacific coastal Central America. The cause of the epidemic is unknown, but the disease may be linked to multiple factors, including diet as well as environmental and occupational exposures. As many as 50% of men in some communities have Mesoamerican nephropathy. Describe prevalence of reduced glomerular filtration rate in a region of Nicaragua suspected to harbor high rates of Mesoamerican nephropathy; and investigate potential risk factors for such reduction associated with agricultural work (such as pesticide exposure and specific agricultural tasks associated with increased heat stress); sugar consumption; and traditional factors such as age, sex, diabetes, hypertension and nephrotoxic medication use. This study uses a cross-sectional design with nested case-control analysis. Cases were individuals with estimated glomerular filtration rates of <60mL/min/1.73m2 and controls were individuals with those >90mL/min/1.73m2, estimated using serum creatinine. Data on nutrition, past medical history, medication and substance use, and agricultural behaviors and exposures were collected using medical questionnaires from June through August, 2012. Venous blood and urine samples were collected to assess hemoglobin A1c, and dipstick proteinuria, respectively; anthropometry and blood pressure measurements were made using standard techniques. Analyses were conducted using chi square, and univariate and multiple logistic regression. Of 424 individuals in the study, 151 had an occupational history in agriculture. Prevalence of glomerular filtration rate <60mL/min/1.73m2 was 9.8% among women and 41.9% among men (male to female ratio = 4.3, p<0.0001). Proteinuria =300 mg/dL was observed in <10% of participants with decreased glomerular filtration rate. Hemoglobin A1c and use of NSAIDs were not associated with decreased glomerular filtration rate. Although systolic and diastolic blood pressure was higher among participants with decreased glomerular filtration rate (p <0.001), hypertension was uncommon. Significant agricultural risk factors for reduced glomerular filtration rate included increased lifetime days cutting sugarcane during the dry season (OR 5.86, 95% CI 2.45-14.01), nondeliberate pesticide inhalation (OR 3.31, 95% CI 1.32-8.31), and sugarcane chewing (OR 3.24, 95% CI 1.39-7.58). Our findings demonstrate a high prevalence of chronic kidney disease not linked to traditional risk factors, and suggest it may be associated instead with occupational exposure to heat stress in conjunction with pesticide inhalation, sugarcane chewing and sugar intake during the workday.
Highlights
INTRODUCCIÓN La nefropatía mesoamericana, también conocida como enfermedad renal crónica de causa desconocida, está extendida en la costa del Pacífico de América Central
Se observaron factores de riesgo significativos para la tasa de filtración glomerular reducida: la duración de la jornada laboral cortando caña de azúcar durante la estación de seca, la inhalación no deliberada de pesticidas, y masticar caña de azúcar
En los modelos ajustados para el total de horas cortando caña de azúcar durante la estación seca, el consumo de bolis y la inhalación de pesticidas fueron marginalmente significativos y el masticar caña de azúcar fue todavía significativo, el total de horas cortando caña de azúcar durante la estación seca retuvo la significación en todos los modelos (p
Summary
OBJECTIVO Describir la prevalencia de la tasa de filtración glomerular disminuido en una región de Nicaragua con muy elevadas tasas de nefropatía mesoamericana, e investigar los factores de riesgo potenciales para esta reducción asociada con el trabajo agrícola (tales como exposición a pesticidas y tareas agrícolas asociadas con el incremento del estrés de calor), el consumo de azúcar, y factores tradicionales como edad, sexo, diabetes, hipertensión y uso de medicamentos nefrotóxicos. Los estudios realizados en hombres que viven en las regiones afectadas de América Central reportan una elevada prevalencia de función renal disminuida, con tasa de filtración glomerular (TFG) estimada
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