51
|
Campese VM. Con: Mesoamerican nephropathy: is the problem dehydration or rehydration? Nephrol Dial Transplant 2017; 32:603-606. [PMID: 28407133 DOI: 10.1093/ndt/gfx033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In recent years, an increasing number of inhabitants of Central America have developed a form of chronic kidney disease, now named Mesoamerican nephropathy. This disease is characterized by minimal proteinuria, hyperuricemia, hypokalemia and reduced glomerular filtration rate. Histologically the kidneys manifest tubulointerstitial nephritis. The cause(s) of this disease remain unknown. Some have proposed that dehydration, in combination with hyperuricemia, may be primarily responsible for Mesoamerican nephropathy. In this article, I propose the hypothesis that the disease may be largely due to rehydration with large amounts of contaminated water, whereas dehydration would play only a contributing role.
Collapse
Affiliation(s)
- Vito M Campese
- Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
52
|
Valcke M, Levasseur ME, Soares da Silva A, Wesseling C. Pesticide exposures and chronic kidney disease of unknown etiology: an epidemiologic review. Environ Health 2017; 16:49. [PMID: 28535811 PMCID: PMC5442867 DOI: 10.1186/s12940-017-0254-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 05/08/2017] [Indexed: 05/20/2023]
Abstract
The main causes of chronic kidney disease (CKD) globally are diabetes and hypertension but epidemics of chronic kidney disease of unknown etiology (CKDu) occur in Central America, Sri Lanka, India and beyond. Althoug also being observed in women, CKDu concentrates among men in agricultural sectors. Therefore, suspicions fell initially on pesticide exposure, but currently chronic heat stress and dehydration are considered key etiologic factors. Responding to persistent community and scientific concerns about the role of pesticides, we performed a systematic review of epidemiologic studies that addressed associations between any indicator of pesticide exposure and any outcome measure of CKD. Of the 21 analytical studies we identified, seven were categorized as with low, ten with medium and four with relatively high explanation value. Thirteen (62%) studies reported one or more positive associations, but four had a low explanation value and three presented equivocal results. The main limitations of both positive and negative studies were unspecific and unquantified exposure measurement ('pesticides'), the cross-sectional nature of most studies, confounding and selection bias. The four studies with stronger designs and better exposure assessment (from Sri Lanka, India and USA) all showed exposure-responses or clear associations, but for different pesticides in each study, and three of these studies were conducted in areas without CKDu epidemics. No study investigated interactions between pesticides and other concommittant exposures in agricultural occupations, in particular heat stress and dehydration. In conclusion, existing studies provide scarce evidence for an association between pesticides and regional CKDu epidemics but, given the poor pesticide exposure assessment in the majority, a role of nephrotoxic agrochemicals cannot be conclusively discarded. Future research should procure assessment of lifetime exposures to relevant specific pesticides and enough power to look into interactions with other major risk factors, in particular heat stress.
Collapse
Affiliation(s)
- Mathieu Valcke
- WHO-PAHO Collaborating Centre on Environmental and Occupational Health Impact Assessment and Surveillance INSPQ-CHUQ-DSPQ, 945, Avenue Wolfe, Québec, G1V 5B3 Canada
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, C.P. 6128 Succursale Centre-Ville, Montreal, H3C 3J7 Canada
| | - Marie-Eve Levasseur
- WHO-PAHO Collaborating Centre on Environmental and Occupational Health Impact Assessment and Surveillance INSPQ-CHUQ-DSPQ, 945, Avenue Wolfe, Québec, G1V 5B3 Canada
| | - Agnes Soares da Silva
- Pan American Health Organization (PAHO), 525 Twenty-third Street, N.W, Washington DC, 20037 USA
| | - Catharina Wesseling
- Department of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, 171 77 Stockholm, SE Sweden
| |
Collapse
|
53
|
Subramanian S, Javaid MM. Kidney Disease of Unknown Cause in Agricultural Laborers (KDUCAL) Is a Better Term to Describe Regional and Endemic Kidney Diseases Such as Uddanam Nephropathy. Am J Kidney Dis 2017; 69:552. [PMID: 28340852 DOI: 10.1053/j.ajkd.2016.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/20/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Srinivas Subramanian
- National University Hospital, National University of Singapore, Singapore, Singapore
| | | |
Collapse
|
54
|
Svarch AE, Arce-Salinas CA, Amaya JL. Leptospirosis in Mesoamerica. CURRENT TROPICAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40475-017-0105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
55
|
Wijkström J, González-Quiroz M, Hernandez M, Trujillo Z, Hultenby K, Ring A, Söderberg M, Aragón A, Elinder CG, Wernerson A. Renal Morphology, Clinical Findings, and Progression Rate in Mesoamerican Nephropathy. Am J Kidney Dis 2017; 69:626-636. [PMID: 28126239 DOI: 10.1053/j.ajkd.2016.10.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/17/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mesoamerican nephropathy (MeN) is a chronic kidney disease affecting rural inhabitants in Central America. We have previously described the renal morphology in 8 patients from El Salvador. To confirm the renal pathology, we have studied kidney biopsies from patients with MeN in Nicaragua. Follow-up urine and blood samples from both biopsy studies were collected to investigate the natural history. STUDY DESIGN Case series. SETTINGS & PARTICIPANTS In the kidney biopsy study, 19 male sugarcane workers in Nicaragua with suspected MeN were investigated with questionnaires, kidney biopsies, and blood and urine analysis. Inclusion criteria were age 20 to 65 years and plasma creatinine level of 1.13 to 2.49mg/dL or estimated glomerular filtration rate (eGFR) of 30 to 80mL/min/1.73m2. Exclusion criteria were proteinuria with protein excretion > 3g/24 h, uncontrolled hypertension, diabetes mellitus, or other known kidney disease. In the follow up-study, blood and urine from the kidney biopsy study in Nicaragua (n=18) and our previous biopsy study of MeN cases in El Salvador (n=7) were collected 1 to 1.5 and 2 to 2.5 years after biopsy, respectively. OUTCOMES Renal morphology, clinical, and biochemical characteristics, change in eGFR per year. MEASUREMENTS eGFR was calculated using the CKD-EPI creatinine (eGFRcr), cystatin C (eGFRcys), and creatinine-cystatin C (eGFRcr-cys) equations. RESULTS In the kidney biopsy study, participants had a mean eGFRcr of 57 (range, 33-96) mL/min/1.73m2. 47% had low plasma sodium and 21% had low plasma potassium levels. 16 kidney biopsies were representative and showed glomerulosclerosis (mean, 38%), glomerular hypertrophy, and signs of chronic glomerular ischemia. Mild to moderate tubulointerstitial damage and mostly mild vascular changes were seen. In the follow up-study, median duration of follow-up was 13 (range, 13-27) months. Mean change in eGFRcr was -4.4±8.4 (range, -27.7 to 10.2) mL/min/1.73m2 per year. Most patients had stopped working with sugarcane cultivation. LIMITATIONS 3 biopsy specimens had 4 or fewer glomeruli. CONCLUSIONS This study confirms the renal morphology of MeN: chronic glomerular and tubulointerstitial damage with glomerulosclerosis and chronic glomerular ischemia. Follow-up data show that eGFRs, on average, deteriorated.
Collapse
Affiliation(s)
- Julia Wijkström
- Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Marvin González-Quiroz
- Research Center on Health, Work and Environment, National Autonomous University of Nicaragua at León, León, Nicaragua; Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mario Hernandez
- Department of Pediatrics, National Autonomous University of Nicaragua at León, León, Nicaragua
| | - Zulma Trujillo
- Servicio de Nefrología, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Kjell Hultenby
- Division of CRC, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anneli Ring
- Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Söderberg
- Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden; Drug Safety and Metabolism, AstraZeneca, Mölndal, Stockholm, Sweden
| | - Aurora Aragón
- Research Center on Health, Work and Environment, National Autonomous University of Nicaragua at León, León, Nicaragua
| | - Carl-Gustaf Elinder
- Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
56
|
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.
Collapse
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
| |
Collapse
|
57
|
Riefkohl A, Ramírez-Rubio O, Laws RL, McClean MD, Weiner DE, Kaufman JS, Galloway RL, Shadomy SV, Guerra M, Amador JJ, Sánchez JM, López-Pilarte D, Parikh CR, Leibler JH, Brooks DR. Leptospira seropositivity as a risk factor for Mesoamerican Nephropathy. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2017; 23:1-10. [PMID: 28209095 PMCID: PMC6060841 DOI: 10.1080/10773525.2016.1275462] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Leptospirosis is postulated as a possible cause of Mesoamerican Nephropathy (MeN) in Central American workers. OBJECTIVES Investigate job-specific Leptospira seroprevalence and its association with kidney disease biomarkers. METHODS In 282 sugarcane workers, 47 sugarcane applicants and 160 workers in other industries, we measured anti-leptospiral antibodies, serum creatinine, and urinary injury biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and N-acetyl-D-glucosaminidase (NAG). RESULTS Leptospira seroprevalence differed among job categories and was highest among sugarcane cutters (59%). Seropositive sugarcane workers had higher NGAL concentrations (relative mean: 1.28; 95% CI: 0.94-1.75) compared to those who were seronegative, with similar findings among field and non-field workers. CONCLUSIONS Leptospira seroprevalence varied by job category. There was some indication that seropositivity was associated with elevated biomarker levels, but results were inconsistent. Additional studies may help establish whether Leptospira infection plays any role in MeN among Central American workers.
Collapse
Affiliation(s)
- Alejandro Riefkohl
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Oriana Ramírez-Rubio
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Preventive Medicine and Public Health Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rebecca L. Laws
- Department of Environmental Health, 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
| | - Daniel E. Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - James S. Kaufman
- Research Service, VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY, USA
| | - Renee L. Galloway
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens & Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean V. Shadomy
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens & Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marta Guerra
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens & Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - José Marcel Sánchez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Damaris López-Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Chirag R. Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT, USA
- Program of Applied Translational Research, Department of Medicine, Yale University, New Haven, CT, USA
| | - Jessica H. Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
58
|
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
|
59
|
Benachour E, Draoui B, Imine B, Asnoune K, Mohamed E. New methodology for the walls design in buildings by numerical simulation of the thermal convection. EPJ WEB OF CONFERENCES 2017. [DOI: 10.1051/epjconf/201714302007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
60
|
Wesseling C, Aragón A, González M, Weiss I, Glaser J, Rivard CJ, Roncal-Jiménez C, Correa-Rotter R, Johnson RJ. Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua. BMJ Open 2016; 6:e011034. [PMID: 27932336 PMCID: PMC5168614 DOI: 10.1136/bmjopen-2016-011034] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To study Mesoamerican nephropathy (MeN) and its risk factors in three hot occupations. DESIGN Cross-sectional. SETTING Chinandega and León municipalities, a MeN hotspot on the Nicaraguan Pacific coast, January-February 2013. PARTICIPANTS 194 male workers aged 17-39 years: 86 sugarcane cutters, 56 construction workers, 52 small-scale farmers. OUTCOME MEASURES (1) Differences between the three occupational groups in prevalences/levels of socioeconomic, occupational, lifestyle and health risk factors for chronic kidney disease (CKD) and in biomarkers of kidney function and hydration; (2) differences in prevalences/levels of CKD risk factors between workers with reduced estimated glomerular filtration rate (eGFRCKD-EPI <80 mL/min/1.73 m2) and workers with normal kidney function (eGFRCKD-EPI ≥80 mL/min/1.73 m2). RESULTS Sugarcane cutters were more exposed to heat and consumed more fluid on workdays and had less obesity, lower blood sugar, lower blood pressure and a better lipid profile. Reduced eGFR occurred in 16%, 9% and 2% of sugarcane cutters, construction workers and farmers, respectively (trend cane > construction > farming, p=0.003). Significant trends (cane > construction > farming) were also observed for high serum urea nitrogen (blood urea nitrogen (BUN) >20 mg/dL), high serum creatinine (SCr >1.2 mg/dL), low urinary pH (≤5.5) and high BUN/SCr ratio (>20) but not for high urinary specific gravity (≥1.030). Sugarcane cutters also more often had proteinuria and blood and leucocytes in the urine. Workers with eGFR <80 mL/min/1.73 m2 reported a higher intake of water and lower intake of sugary beverages. Serum uric acid levels related strongly and inversely to eGFR levels (adj β -10.4 mL/min/1.73 m2, 95% CI -12.2 to -8.5, p<0.001). No associations were observed for other metabolic risk factors, pesticides, non-steroidal anti-inflammatory drugs or alcohol. Among cane cutters, consumption of electrolyte hydration solution appeared preventive (adj β 8.1 mL/min/1.73 m2, p=0.09). CONCLUSIONS Heat stress, dehydration and kidney dysfunction were most common among sugarcane cutters. Kidney dysfunction also occurred to a lesser extent among construction workers, but hardly at all among small-scale farmers. High serum uric acid was associated with reduced kidney function.
Collapse
Affiliation(s)
- Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Aurora Aragón
- Research Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
| | - Marvin González
- Research Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jason Glaser
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- La Isla Foundation, Chicago, Illinois, USA
| | - Christopher J Rivard
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado,USA
| | - Carlos Roncal-Jiménez
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado,USA
| | - Ricardo Correa-Rotter
- Department Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado,USA
| |
Collapse
|
61
|
Hilliard LM, Colafella KMM, Bulmer LL, Puelles VG, Singh RR, Ow CPC, Gaspari T, Drummond GR, Evans RG, Vinh A, Denton KM. Chronic recurrent dehydration associated with periodic water intake exacerbates hypertension and promotes renal damage in male spontaneously hypertensive rats. Sci Rep 2016; 6:33855. [PMID: 27653548 PMCID: PMC5032121 DOI: 10.1038/srep33855] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/05/2016] [Indexed: 01/12/2023] Open
Abstract
Epidemiological evidence links recurrent dehydration associated with periodic water intake with chronic kidney disease (CKD). However, minimal attention has been paid to the long-term impact of periodic water intake on the progression of CKD and underlying mechanisms involved. Therefore we investigated the chronic effects of recurrent dehydration associated with periodic water restriction on arterial pressure and kidney function and morphology in male spontaneously hypertensive rats (SHR). Arterial pressure increased and glomerular filtration rate decreased in water-restricted SHR. This was observed in association with cyclic changes in urine osmolarity, indicative of recurrent dehydration. Additionally, water-restricted SHR demonstrated greater renal fibrosis and an imbalance in favour of pro-inflammatory cytokine-producing renal T cells compared to their control counterparts. Furthermore, urinary NGAL levels were greater in water-restricted than control SHR. Taken together, our results provide significant evidence that recurrent dehydration associated with chronic periodic drinking hastens the progression of CKD and hypertension, and suggest a potential role for repetitive bouts of acute renal injury driving renal inflammatory processes in this setting. Further studies are required to elucidate the specific pathways that drive the progression of recurrent dehydration-induced kidney disease.
Collapse
Affiliation(s)
- Lucinda M Hilliard
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Katrina M Mirabito Colafella
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Louise L Bulmer
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Victor G Puelles
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Reetu R Singh
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Connie P C Ow
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Tracey Gaspari
- Department of Pharmacology, Monash University, Melbourne, Victoria, 3800 Australia
| | - Grant R Drummond
- Department of Pharmacology, Monash University, Melbourne, Victoria, 3800 Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| | - Antony Vinh
- Department of Pharmacology, Monash University, Melbourne, Victoria, 3800 Australia
| | - Kate M Denton
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, 3800, Australia
| |
Collapse
|
62
|
Ganguli A. Uddanam Nephropathy/Regional Nephropathy in India: Preliminary Findings and a Plea for Further Research. Am J Kidney Dis 2016; 68:344-8. [DOI: 10.1053/j.ajkd.2016.04.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/04/2016] [Indexed: 02/08/2023]
|
63
|
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.
Collapse
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.
| |
Collapse
|
64
|
Flores S, Rider AC, Alter HJ. Mesoamerican nephropathy: a novel case of kidney failure in a US ED. Am J Emerg Med 2016; 34:1323.e5-6. [DOI: 10.1016/j.ajem.2015.11.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/18/2015] [Indexed: 12/16/2022] Open
|
65
|
García-Trabanino R, Trujillo Z, Colorado AV, Magaña Mercado S, Henríquez CA. Prevalence of patients receiving renal replacement therapy in El Salvador in 2014. Nefrologia 2016; 36:631-636. [PMID: 27267915 DOI: 10.1016/j.nefro.2016.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/21/2015] [Accepted: 01/14/2016] [Indexed: 01/17/2023] Open
Abstract
El Salvador has the highest renal failure mortality rate in the Americas. Five healthcare providers offer renal replacement therapy (RRT) in the country. The national RRT prevalence has never been reported. AIMS To determine the RRT prevalence in El Salvador and some basic characteristics. METHODS The association of nephrology coordinated a nationwide cross-sectional survey during the third quarter of 2014. 31 renal centres participated in the survey, covering 99.5% of patients. RESULTS National RRT prevalence: 595 per million population (pmp), N=3807, average age 50.4 years, 67.5% male. By modality: peritoneal dialysis (PD) 289 pmp, haemodialysis (HD) 233 pmp, with functioning kidney transplantation 74 pmp (living donor only). Social security covers 25% of the population but treats 49.7% of RRT patients. Generally, higher prevalence was observed in municipalities with renal centres or located on the coast or lowlands. Ninety-five percent of HD patients receive fewer than 3 weekly sessions. Of PD patients, 59% do not belong to a continuous outpatient or automated programme, and 25% still use rigid catheter. Aetiology of chronic kidney disease: unavailable/undetermined 50%, hypertension 21.1%, diabetes 18.9%, glomerulonephritis 6.7%, obstructive causes 1.2%, tubulointerstitial 0.9%, polycystic 0.4% and other 0.7%. DISCUSSION Despite the increase in RRT services, the prevalence is lower than the Latin American average (660 pmp). Three quarters of HD and PD patients are under-dialysed. Obsolete RRT techniques are still used. The presence of Mesoamerican nephropathy influences the demographic characteristics (many young patients, two-thirds male, high prevalence in lowlands and coastlands).
Collapse
Affiliation(s)
- Ramón García-Trabanino
- Asociación de Nefrología e Hipertensión de El Salvador; Fondo Social de Emergencia para la Salud, Usulután, El Salvador.
| | - Zulma Trujillo
- Servicio de Nefrología, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Ana Verónica Colorado
- Servicio de Nefrología, Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | | | - Carlos Atilio Henríquez
- Servicio de Nefrología, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | | |
Collapse
|
66
|
García-Trabanino R, Hernández C, Rosa A, Domínguez Alonso J. Incidence, mortality, and prevalence of end-stage chronic renal disease in the Bajo Lempa region of El Salvador: A ten-year community registry. Nefrologia 2016; 36:517-522. [PMID: 27209436 DOI: 10.1016/j.nefro.2016.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/08/2016] [Accepted: 03/28/2016] [Indexed: 12/18/2022] Open
Abstract
The Bajo Lempa is an impoverished rural coastal region of El Salvador affected by the chronic kidney disease (CKD) epidemic known as Mesoamerican nephropathy. The local community organisation Fondo Social de Emergencia para la Salud (FSES) (Emergency social fund for health) is helping to fight the epidemic in 42 communities of the region (19,223 inhabitants; average age 26.7 years; 48.5% male; 40.2% <18 years). OBJECTIVES To report annual rates of end-stage renal disease (ESRD) incidence and patient mortality in these communities during a 10-year period (2004-2013), and the prevalence of patients receiving renal replacement therapy (RRT) as of 31 December 2013. METHODS The FSES recorded new ESRD cases, basic patient history, form of RRT if received and patient deaths. RESULTS We registered 271 new ESRD cases (annual average 27.1; 89% male; average age 55.6 years, four <18 years). Average annual ESRD incidence rate: 1409.8 per million population (pmp). Two-thirds did not report diabetes or hypertension. 94 patients (34.7%) received RRT: 58 in the Ministry of health, 26 in private services, 9 in social security and 1 in the military health system. 246 patients died (annual average 24.6 deaths; 89.4% male; average age 56.1 years; 92.3% at home). Average annual mortality rate: 128/100,000 population. Prevalence of patients receiving RRT in 2013: 1300.5 pmp (N=25; 84% male; average age 51 years). CONCLUSIONS This region has a high incidence of ESRD. Few receive RRT. Patient mortality is high even with RRT. Most patients are male (9:1). Social determinants influence the high mortality.
Collapse
Affiliation(s)
- Ramón García-Trabanino
- Comité científico, Departamento de Investigación, Hospital Nacional Rosales, San Salvador, El Salvador; Fondo Social de Emergencia para la Salud, Cantón Tierra Blanca, Usulután, El Salvador.
| | - Carolina Hernández
- Fondo Social de Emergencia para la Salud, Cantón Tierra Blanca, Usulután, El Salvador; Sistema Básico de Salud Integral (SIBASI), Usulután, Ministerio de Salud, El Salvador
| | - Adrián Rosa
- Fondo Social de Emergencia para la Salud, Cantón Tierra Blanca, Usulután, El Salvador; Unidad médica Puerto El Triunfo, Instituto Salvadoreño del Seguro Social (ISSS), Usulután, El Salvador
| | - Jesús Domínguez Alonso
- Fondo Social de Emergencia para la Salud, Cantón Tierra Blanca, Usulután, El Salvador; Atención Primaria, Área Sanitaria Jaén Nordeste, Jaén, Andalucía, España
| | | |
Collapse
|
67
|
Wesseling C, Aragón A, González M, Weiss I, Glaser J, Bobadilla NA, Roncal-Jiménez C, Correa-Rotter R, Johnson RJ, Barregard L. Kidney function in sugarcane cutters in Nicaragua--A longitudinal study of workers at risk of Mesoamerican nephropathy. ENVIRONMENTAL RESEARCH 2016; 147:125-32. [PMID: 26866450 DOI: 10.1016/j.envres.2016.02.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 05/09/2023]
Abstract
BACKGROUND Chronic kidney disease is common among sugarcane workers in Central America. The main risk factor seems to be repeated high-intensity work in hot environments. Several cross-sectional studies have been performed but few longitudinal studies. OBJECTIVES The aim of the study was to examine whether kidney function changes over a few months of work during the harvest period. METHODS A group of male sugarcane cutters in Nicaragua (N=29, aged 17-38 years) was examined with renal biomarkers before and after shift on the first day at the start of harvest, on the sixth day during acclimatization, and then in mid-harvest 9 weeks later. A reference group (N=25, mainly office workers) was examined with the same biomarkers at start of harvest, and then at end of harvest 5 months later. RESULTS The pre-shift renal function decreased significantly during 9 weeks of work in the cane cutters. Mean serum creatinine increased (20%), mean estimated glomerular filtration rate decreased (9%, 10mL/min), serum urea N (BUN) increased (41%), and mean urinary neutrophil gelatinase-associated lipocalin (NGAL) increased (four times). The cane cutters also developed cross-shift increases in these biomarkers, in particular serum creatinine and BUN, and in urinary uric acid. The longitudinal decrease in eGFR tended to be associated with the cross-shift increase in serum creatinine. CONCLUSIONS There was a remarkable decrease of glomerular kidney function, after only 9 weeks of harvest. The cross-shift increase in serum creatinine may be caused by dehydration (pre-renal dysfunction), and when repeated on a daily basis this may cause permanently reduced GFR.
Collapse
Affiliation(s)
- Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.
| | - Aurora Aragón
- Research Center on Health, Work and Environment (CISTA), Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua.
| | - Marvin González
- Research Center on Health, Work and Environment (CISTA), Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua; Department of Non-communicable Disease Epidemiology of London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | - Norma A Bobadilla
- Department Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Carlos Roncal-Jiménez
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA.
| | - Ricardo Correa-Rotter
- Department Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA.
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Sweden.
| |
Collapse
|
68
|
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
|
69
|
Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, Chaytor S, Colbourn T, Collins M, Cooper A, Cox PM, Depledge J, Drummond P, Ekins P, Galaz V, Grace D, Graham H, Grubb M, Haines A, Hamilton I, Hunter A, Jiang X, Li M, Kelman I, Liang L, Lott M, Lowe R, Luo Y, Mace G, Maslin M, Nilsson M, Oreszczyn T, Pye S, Quinn T, Svensdotter M, Venevsky S, Warner K, Xu B, Yang J, Yin Y, Yu C, Zhang Q, Gong P, Montgomery H, Costello A. Health and climate change: policy responses to protect public health. Lancet 2015; 386:1861-914. [PMID: 26111439 DOI: 10.1016/s0140-6736(15)60854-6] [Citation(s) in RCA: 740] [Impact Index Per Article: 82.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nick Watts
- Institute for Global Health, University College London, London, UK.
| | - W Neil Adger
- Geography, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Paolo Agnolucci
- Institute for Sustainable Resources, University College London, London, UK
| | - Jason Blackstock
- Department of Science, Technology, Engineering and Public Policy, University College London, London, UK
| | - Peter Byass
- Centre for Global Health Research, Umea University, Umea, Sweden
| | - Wenjia Cai
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Sarah Chaytor
- Public Policy, University College London, London, UK
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Mat Collins
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Adam Cooper
- Department of Science, Technology, Engineering and Public Policy, University College London, London, UK
| | - Peter M Cox
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Joanna Depledge
- Department of Politics and International Studies, University of Cambridge, Cambridge, UK
| | - Paul Drummond
- Institute for Sustainable Resources, University College London, London, UK
| | - Paul Ekins
- Institute for Sustainable Resources, University College London, London, UK
| | - Victor Galaz
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Delia Grace
- International Livestock Research Institute, Nairobi, Kenya
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Michael Grubb
- Institute for Sustainable Resources, University College London, London, UK
| | - Andy Haines
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Hamilton
- Energy Institute, University College London, London, UK
| | - Alasdair Hunter
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Xujia Jiang
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Moxuan Li
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Ilan Kelman
- Institute for Global Health, University College London, London, UK
| | - Lu Liang
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Melissa Lott
- Institute for Sustainable Resources, University College London, London, UK
| | - Robert Lowe
- Energy Institute, University College London, London, UK
| | - Yong Luo
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Georgina Mace
- Centre for Biodiversity and Environment Research, University College London, London, UK
| | - Mark Maslin
- Department of Geography, University College London, London, UK
| | - Maria Nilsson
- Centre for Global Health Research, Umea University, Umea, Sweden
| | | | - Steve Pye
- Energy Institute, University College London, London, UK
| | - Tara Quinn
- Environment and Sustainability Institute, University of Exeter, Exeter, UK
| | - My Svensdotter
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Sergey Venevsky
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Koko Warner
- UN University Institute for Environment and Human Security, Bonn, Germany
| | - Bing Xu
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Jun Yang
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Yongyuan Yin
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Chaoqing Yu
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Qiang Zhang
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Peng Gong
- Centre for Earth System Science, Tsinghua University, Haidian, Beijing, China
| | - Hugh Montgomery
- Institute for Human Health and Performance, University College London, London, UK
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
70
|
Laws RL, Brooks DR, Amador JJ, Weiner DE, Kaufman JS, Ramírez-Rubio O, Riefkohl A, Scammell MK, López-Pilarte D, Sánchez JM, Parikh CR, McClean MD. Biomarkers of Kidney Injury Among Nicaraguan Sugarcane Workers. Am J Kidney Dis 2015; 67:209-17. [PMID: 26454687 DOI: 10.1053/j.ajkd.2015.08.022] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 08/11/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND In Central America, an epidemic of chronic kidney disease of unknown cause disproportionately affects young male agricultural workers. STUDY DESIGN Longitudinal cohort study. SETTING & PARTICIPANTS 284 sugarcane workers in 7 jobs were recruited from one company in northwestern Nicaragua. Blood and urine samples were collected before and near the end of the 6-month harvest season. PREDICTORS Job category (cane cutter, seeder, seed cutter, agrichemical applicator, irrigator, driver, and factory worker); self-reported water and electrolyte solution intake. OUTCOMES & MEASUREMENTS Changes in levels of urinary kidney injury biomarkers normalized to urine creatinine level, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), N-acetyl-β-d-glucosaminidase (NAG), and albumin; serum creatinine-based estimated glomerular filtration rate (eGFR). RESULTS Mean eGFR was 113 mL/min/1.73 m(2) and <5% of workers had albuminuria. Field workers had increases in NGAL and IL-18 levels that were 1.49 (95% CI, 1.06 to 2.09) and 1.61 (95% CI, 1.12 to 2.31) times as high, respectively, as in non-field workers. Cane cutters and irrigators had the greatest increases in NGAL levels during the harvest, whereas cane cutters and seeders had the greatest increases in IL-18 levels. Electrolyte solution consumption was associated with lower mean NGAL and NAG levels among cane cutters and lower mean IL-18 and NAG levels among seed cutters; however, there was no overall effect of hydration among all workers. On average, workers with the largest increases in NGAL and NAG levels during the harvest had declines in eGFRs of 4.6 (95% CI, 1.0 to 8.2) and 3.1 (95% CI, -0.6 to 6.7) mL/min/1.73 m(2), respectively. LIMITATIONS Surrogate exposure measure, loss to follow-up. CONCLUSIONS Results are consistent with the hypothesis that occupational heat stress and volume depletion may be associated with the development of kidney disease, and future studies should directly measure these occupational factors. The presence of urine tubular injury markers supports a tubulointerstitial disease that could occur with repeated tubular injury.
Collapse
Affiliation(s)
- Rebecca L Laws
- 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
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Daniel E Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - James S Kaufman
- Research Service, VA New York Harbor Healthcare System, New York, NY; Department of Medicine, New York University School of Medicine, New York, NY
| | - Oriana Ramírez-Rubio
- Department of Epidemiology, Boston University School of Public Health, Boston, MA; Preventive Medicine and Public Health Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alejandro Riefkohl
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | | | - José Marcel Sánchez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale University and VA Medical Center, New Haven, CT; Program of Applied Translational Research, Department of Medicine, Yale University, New Haven, CT
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| |
Collapse
|
71
|
García-Trabanino R, Jarquín E, Wesseling C, Johnson RJ, González-Quiroz M, Weiss I, Glaser J, José Vindell J, Stockfelt L, Roncal C, Harra T, Barregard L. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador--A cross-shift study of workers at risk of Mesoamerican nephropathy. ENVIRONMENTAL RESEARCH 2015. [PMID: 26209462 DOI: 10.1016/j.envres.2015.07.007] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND An epidemic of progressive kidney failure afflicts sugarcane workers in Central America. Repeated high-intensity work in hot environments is a possible cause. OBJECTIVES To assess heat stress, dehydration, biomarkers of renal function and their possible associations. A secondary aim was to evaluate the prevalence of pre-shift renal damage and possible causal factors. METHODS Sugarcane cutters (N=189, aged 18-49 years, 168 of them male) from three regions in El Salvador were examined before and after shift. Cross-shift changes in markers of dehydration and renal function were examined and associations with temperature, work time, region, and fluid intake were assessed. Pre-shift glomerular filtration rate was estimated (eGFR) from serum creatinine. RESULTS The mean work-time was 4 (1.4-11) hours. Mean workday temperature was 34-36 °C before noon, and 39-42 °C at noon. The mean liquid intake during work was 0.8L per hour. There were statistically significant changes across shift. The mean urine specific gravity, urine osmolality and creatinine increased, and urinary pH decreased. Serum creatinine, uric acid and urea nitrogen increased, while chloride and potassium decreased. Pre-shift serum uric acid levels were remarkably high and pre-shift eGFR was reduced (<60 mL/min) in 23 male workers (14%). CONCLUSIONS The high prevalence of reduced eGFR, and the cross-shift changes are consistent with recurrent dehydration from strenuous work in a hot and humid environment as an important causal factor. The pathophysiology may include decreased renal blood flow, high demands on tubular reabsorption, and increased levels of uric acid.
Collapse
Affiliation(s)
- Ramón García-Trabanino
- Scientific Board, Department of Investigation, Hospital Nacional Rosales, San Salvador, El Salvador.
| | - Emmanuel Jarquín
- Agency for Agricultural Health and Development (AGDYSA), San Salvador, El Salvador.
| | - Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Richard J Johnson
- Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO, United State.
| | - 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 of London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | | - Leo Stockfelt
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, P.B 414, SE 405 30, Gothenburg, Sweden.
| | - Carlos Roncal
- Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO, United State.
| | - Tamara Harra
- Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO, United State.
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, P.B 414, SE 405 30, Gothenburg, Sweden.
| |
Collapse
|
72
|
Heat stress and workload associated with sugarcane cutting - an excessively strenuous occupation! EXTREME PHYSIOLOGY & MEDICINE 2015. [PMCID: PMC4580831 DOI: 10.1186/2046-7648-4-s1-a23] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
73
|
Ramírez-Rubio O, Amador JJ, Kaufman JS, Weiner DE, Parikh CR, Khan U, McClean MD, Laws RL, López-Pilarte D, Friedman DJ, Kupferman J, Brooks DR. Urine biomarkers of kidney injury among adolescents in Nicaragua, a region affected by an epidemic of chronic kidney disease of unknown aetiology. Nephrol Dial Transplant 2015; 31:424-32. [PMID: 26311057 DOI: 10.1093/ndt/gfv292] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/29/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An epidemic of chronic kidney disease (CKD) of non-traditional aetiology has been recently recognized by health authorities as a public health priority in Central America. Previous studies have identified strenuous manual work, agricultural activities and residence at low altitude as potential risk factors; however, the aetiology remains unknown. Because individuals are frequently diagnosed with CKD in early adulthood, we measured biomarkers of kidney injury among adolescents in different regions of Nicaragua to assess whether kidney damage might be initiated during childhood. METHODS Participants include 200 adolescents aged 12-18 years with no prior work history from four different schools in Nicaragua. The location of the school served as a proxy for environmental exposures and geographic locations were selected to represent a range of factors that have been associated with CKD in adults (e.g. altitude, primary industry and CKD mortality rates). Questionnaires, urine dipsticks and kidney injury biomarkers [interleukin-18, N-acetyl-d-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL) and albumin-creatinine ratio] were assessed. Biomarker concentrations were compared by school using linear regression models. RESULTS Protein (3.5%) and glucose (1%) in urine measured by dipstick were rare and did not differ by school. Urine biomarkers of tubular kidney damage, particularly NGAL and NAG, showed higher concentrations in those schools and regions within Nicaragua that were defined a priori as having increased CKD risk. Painful urination was a frequent self-reported symptom. CONCLUSIONS Although interpretation of these urine biomarkers is limited because of the lack of population reference values, results suggest the possibility of early kidney damage prior to occupational exposures in these adolescents.
Collapse
Affiliation(s)
- Oriana Ramírez-Rubio
- Preventive Medicine and Public Health Department, Universidad Autónoma de Madrid, Madrid, Spain Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - James S Kaufman
- Research Service, VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY, USA
| | - Daniel E Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Chirag R Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT, USA Program of Applied Translational Research, Department of Medicine, Yale University, New Haven, CT, USA
| | - Usman Khan
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT, USA Program of Applied Translational Research, Department of Medicine, Yale University, New Haven, CT, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Rebecca L Laws
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Damaris López-Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - David J Friedman
- Renal Division and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph Kupferman
- Renal Division and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
74
|
Wegman D, Glaser J, Johnson RJ, Hogstedt C, Wesseling C. Comment: Mesoamerican nephropathy--new evidence and the need to act now. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2015. [PMID: 26201706 DOI: 10.1179/2049396715y.0000000008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- David Wegman
- Department of Work Environment, University of Massachusetts Lowell , Lowell, MA, USA
| | | | | | | | | |
Collapse
|
75
|
Wesseling C, van Wendel de Joode B, Crowe J, Rittner R, Sanati NA, Hogstedt C, Jakobsson K. Mesoamerican nephropathy: geographical distribution and time trends of chronic kidney disease mortality between 1970 and 2012 in Costa Rica. Occup Environ Med 2015. [PMID: 26199395 DOI: 10.1136/oemed-2014-102799] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Mesoamerican nephropathy is an epidemic of chronic kidney disease (CKD) unrelated to traditional causes, mostly observed in sugarcane workers. We analysed CKD mortality in Costa Rica to explore when and where the epidemic emerged, sex and age patterns, and relationship with altitude, climate and sugarcane production. METHODS SMRs for CKD deaths (1970-2012) among population aged ≥20 were computed for 7 provinces and 81 counties over 4 time periods. Time trends were assessed with age-standardised mortality rates. We qualitatively examined relations between mortality and data on altitude, climate and sugarcane production. RESULTS During 1970-2012, age-adjusted mortality rates in the Guanacaste province increased among men from 4.4 to 38.5 per 100,000 vs. 3.6-8.4 in the rest of Costa Rica, and among women from 2.3 to 10.7 per 100,000 vs. 2.6-5.0 in the rest of Costa Rica. A significant moderate excess mortality was observed among men in Guanacaste already in the mid-1970s, steeply increasing thereafter; a similar female excess mortality appeared a decade later, remaining stable. Male age-specific rates were high in Guanacaste for age categories ≥30, and since the late 1990s also for age range 20-29. The male spatiotemporal patterns roughly followed sugarcane expansion in hot, dry lowlands with manual harvesting. CONCLUSIONS Excess CKD mortality occurs primarily in Guanacaste lowlands and was already present 4 decades ago. The increasing rates among Guanacaste men in hot, dry lowland counties with sugarcane are consistent with an occupational component. Stable moderate increases among women, and among men in counties without sugarcane, suggest coexisting environmental risk factors.
Collapse
Affiliation(s)
- Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Berna van Wendel de Joode
- Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Jennifer Crowe
- Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Ralf Rittner
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Negin A Sanati
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Christer Hogstedt
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Jakobsson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| |
Collapse
|
76
|
Crowe J, Nilsson M, Kjellstrom T, Wesseling C. Heat-related symptoms in sugarcane harvesters. Am J Ind Med 2015; 58:541-8. [PMID: 25851165 DOI: 10.1002/ajim.22450] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Exposure to heat stress is a documented risk for Central American sugarcane harvesters. However, little is known about heat-related illness in this population. METHODS This study examined the frequency of heat-related health effects among harvesters (n = 106) exposed to occupational heat stress compared to non-harvesters (n = 63). Chi-square test and gamma statistic were used to evaluate differences in self-reported symptoms and trends over heat exposure categories. RESULTS Heat and dehydration symptoms (headache, tachycardia, muscle cramps, fever, nausea, difficulty breathing, dizziness, swelling of hands/feet, and dysuria) were experienced at least once per week significantly more frequently among harvesters. Percentages of workers reporting heat and dehydration symptoms increased in accordance with increasing heat exposure categories. CONCLUSIONS A large percentage of harvesters are experiencing heat illness throughout the harvest demonstrating an urgent need for improved workplace practices, particularly in light of climate change and the epidemic of chronic kidney disease prevalent in this population.
Collapse
Affiliation(s)
- Jennifer Crowe
- Regional Institute for Studies on Toxic Substances (IRET), Program on Health, Work and Environment (SALTRA); Universidad Nacional; Heredia Costa Rica
| | - Maria Nilsson
- Umeå Centre for Global Health Research; Umeå University; Umeå Sweden
| | - Tord Kjellstrom
- Umeå Centre for Global Health Research; Umeå University; Umeå Sweden
- Environment International Trust; Mapua New Zealand
| | - Catharina Wesseling
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| |
Collapse
|
77
|
Ramos AM, González-Guerrero C, Sanz A, Sanchez-Niño MD, Rodríguez-Osorio L, Martín-Cleary C, Fernández-Fernández B, Ruiz-Ortega M, Ortiz A. Designing drugs that combat kidney damage. Expert Opin Drug Discov 2015; 10:541-56. [PMID: 25840605 DOI: 10.1517/17460441.2015.1033394] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Kidney disease remains one of the last worldwide frontiers in the field of non-communicable human disease. From 1990 to 2013, chronic kidney disease (CKD) was the top non-communicable cause of death with a greatest increase in global years of life lost while mortality of acute kidney injury (AKI) still hovers around 50%. This reflects the paucity (for CKD) or lack of (for AKI) therapeutic approaches beyond replacing renal function. Understanding what the barriers are and what potential pathways may facilitate the design of new drugs to combat kidney disease is a key public health priority. AREAS COVERED The authors discuss the hurdles and opportunities for future drug development for kidney disease in light of experience accumulated with drugs that made it to clinical trials. EXPERT OPINION Inflammation, cell death and fibrosis are key therapeutic targets to combat kidney damage. While the specific targeting of drugs to kidney cells would be desirable, the technology is only working at the preclinical stage and with mixed success. Nanomedicines hold promise in this respect. Most drugs undergoing clinical trials for kidney disease have been repurposed from other indications. Currently, the chemokine receptor inhibitor CCX140 holds promise for CKD and the p53 inhibitor QPI-1002 for AKI.
Collapse
Affiliation(s)
- Adrián M Ramos
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), Laboratory of Renal and Vascular Pathology and Diabetes , Av. Reyes Católicos 2, 28040, Madrid , Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
78
|
Lebov JF, Valladares E, Peña R, Peña EM, Sanoff SL, Cisneros EC, Colindres RE, Morgan DR, Hogan SL. A population-based study of prevalence and risk factors of chronic kidney disease in León, Nicaragua. Can J Kidney Health Dis 2015; 2:6. [PMID: 25926994 PMCID: PMC4414463 DOI: 10.1186/s40697-015-0041-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/31/2015] [Indexed: 01/13/2023] Open
Abstract
Background Recent studies have shown an excess of chronic kidney disease (CKD) among younger adult males in the Pacific coastal region of Nicaragua and suggest a non-conventional CKD etiology in this region. These studies have been conducted in small, non-representative populations. Objectives We conducted a large population-based cross-sectional study to estimate CKD prevalence in León, Nicaragua, and to evaluate the association between previously investigated risk factors and CKD. Methods Estimated glomerular filtration rate, derived using the MDRD equation, was assessed to determine CKD status of 2275 León residents. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios. León CKD prevalence was also standardized to the demographic distributions of the León Health and Demographic Surveillance System and the León 2005 Census. Results CKD prevalence was 9.1%; twice as high for males (13.8%) than females (5.8%). In addition to gender, older age, rural zone, lower education level, and self-reported high blood pressure, more years of agricultural work, lija (unregulated alcohol) consumption, and higher levels of daily water consumption were significantly associated with CKD. Notably, self-reported diabetes was associated with CKD in adjusted models for females but not males. Conclusions Our findings are comparable to those found in regional studies and further support the hypothesis of a Mesoamerican Nephropathy. Electronic supplementary material The online version of this article (doi:10.1186/s40697-015-0041-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jill F Lebov
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599-7155 USA
| | | | - Rodolfo Peña
- Centro de Investigaciones e Intervenciones en Salud, León, Nicaragua
| | - Edgar M Peña
- Centro de Salud Torre Ramona, Unidad Docente de Medicina Familiar y Comunitaria, Sector II, Zaragoza, España
| | | | | | - Romulo E Colindres
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599-7155 USA
| | - Douglas R Morgan
- Department of Medicine, Vanderbilt University, Nashville, TN USA ; Department of Medicine, UNC Chapel Hill, NC USA
| | - Susan L Hogan
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599-7155 USA
| |
Collapse
|
79
|
Laws RL, Brooks DR, Amador JJ, Weiner DE, Kaufman JS, Ramírez-Rubio O, Riefkohl A, Scammell MK, López-Pilarte D, Sánchez JM, Parikh CR, McClean MD. Changes in kidney function among Nicaraguan sugarcane workers. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2015; 21:241-50. [PMID: 25631575 DOI: 10.1179/2049396714y.0000000102] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is an epidemic of chronic kidney disease (CKD) of unknown etiology in Central American workers. OBJECTIVES To investigate changes and job-specific differences in kidney function over a 6-month sugarcane harvest season, explore the potential role of hydration, and measure proteinuria. METHODS We recruited 284 Nicaraguan sugarcane workers performing seven distinct tasks. We measured urine albumin and serum creatinine and estimated glomerular filtration rate (eGFR). RESULTS eGFR varied by job and decreased during the harvest in seed cutters (-8·6 ml/min/1·73 m(2)), irrigators (-7·4 ml/min/1·73 m(2)), and cane cutters (-5·0 ml/min/1·73 m(2)), as compared to factory workers. The number of years employed at the company was negatively associated with eGFR. Fewer than 5% of workers had albumin-to-creatinine ratio (ACR) >30 mg/g. CONCLUSIONS The decline in kidney function during the harvest and the differences by job category and employment duration provide evidence that one or more risk factors of CKD are occupational.
Collapse
|
80
|
Said S, Hernandez GT. Environmental exposures, socioeconomics, disparities, and the kidneys. Adv Chronic Kidney Dis 2015; 22:39-45. [PMID: 25573511 DOI: 10.1053/j.ackd.2014.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/30/2014] [Accepted: 09/09/2014] [Indexed: 12/27/2022]
Abstract
Kidney disease disproportionately affects racial and ethnic minority populations, the poor, and the socially disadvantaged. The excess risk of kidney disease among minority and disadvantaged populations can only be partially explained by an excess of diabetes, hypertension, and poor access to preventive care. Disparities in the environmental exposure to nephrotoxicants have been documented in minority and disadvantaged populations and may explain some of the excess risk of kidney disease. High-level environmental and occupational exposure to lead, cadmium, and mercury are known to cause specific nephropathies. However, there is growing evidence that low-level exposures to heavy metals may contribute to the development of CKD and its progression. In this article, we summarize the excess risk of environmental exposures among minority and disadvantaged populations. We also review the epidemiologic and clinical data linking low-level environmental exposure to lead, cadmium, and mercury to CKD and its progression. Finally, we briefly describe Mesoamerican nephropathy, an epidemic of CKD affecting young men in Central America, which may have occupational and environmental exposures contributing to its development.
Collapse
|
81
|
Martín-Cleary C, Ortiz A. CKD hotspots around the world: where, why and what the lessons are. A CKJ review series. Clin Kidney J 2014; 7:519-23. [PMID: 25859368 PMCID: PMC4389150 DOI: 10.1093/ckj/sfu118] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 01/13/2023] Open
Abstract
Chronic kidney disease (CKD) is one of the three causes of death that has had the highest increase in the last 20 years. The increasing CKD burden occurs in the context of lack of access of most of the world population to adequate healthcare and an incomplete understanding of the pathogenesis of CKD. However, CKD is not homogeneously distributed. CKD hotspots are defined as countries, region, communities or ethnicities with higher than average incidence of CKD. Analysis of CKD hotspots has the potential to provide valuable insights into the pathogenesis of kidney disease and to improve the life expectancy of the affected communities. Examples include ethnicities such as African Americans in the USA or Aboriginals in Australia, regions such as certain Balkan valleys or Central America and even groups of people sharing common activities or interests such as young women trying to lose weight in Belgium. The study of these CKD hotspots has identified underlying genetic factors, such as ApoL1 gene variants, environmental toxins, such as aristolochic acid and socioeconomic factors leading to nutritional deprivation and inflammation/infection. The CKD hotspots series of CKJ reviews will explore the epidemiology and causes in CKD hotspots, beginning with Australian Aboriginals in this issue. An online map of CKD hotspots around the world will feature the reviewed hotspots, highlighting known or suspected causes as well as ongoing projects to unravel the cause and providing a directory of public health officials, physicians and basic scientists involved in these efforts. Since the high prevalence of CKD in a particular region or population may only be known to local physicians, we encourage readers to propose further CKD hotspots to be reviewed.
Collapse
Affiliation(s)
- Catalina Martín-Cleary
- IIS-Fundacion Jimenez Diaz, School of Medicine , Universidad Autonoma de Madrid, Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN , Madrid , Spain
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine , Universidad Autonoma de Madrid, Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN , Madrid , Spain
| |
Collapse
|
82
|
Affiliation(s)
- Cora Roelofs
- Cora Roelofs is with the Community Health Program, Tufts University, Medford, MA. David Wegman is with the Department of Work Environment, University of Massachusetts Lowell
| | | |
Collapse
|
83
|
Excessive occupational heat exposure: a significant ergonomic challenge and health risk for current and future workers. EXTREME PHYSIOLOGY & MEDICINE 2014; 3:14. [PMID: 25057350 PMCID: PMC4107471 DOI: 10.1186/2046-7648-3-14] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/18/2014] [Indexed: 02/03/2023]
Abstract
Occupational heat exposure threatens the health of a worker not only when heat illness occurs but also when a worker’s performance and work capacity is impaired. Occupational contexts that involve hot and humid climatic conditions, heavy physical workloads and/or protective clothing create a strenuous and potentially dangerous thermal load for a worker. There are recognized heat prevention strategies and international thermal ergonomic standards to protect the worker. However, such standards have been developed largely in temperate western settings, and their validity and relevance is questionable for some geographical, cultural and socioeconomic contexts where the risk of excessive heat exposure can be high. There is evidence from low- and middle-income tropical countries that excessive heat exposure remains a significant issue for occupational health. Workers in these countries are likely to be at high risk of excessive heat exposure as they are densely populated, have large informal work sectors and are expected to experience substantial increases in temperature due to global climate change. The aim of this paper is to discuss current and future ergonomic risks associated with working in the heat as well as potential methods for maintaining the health and productivity of workers, particularly those most vulnerable to excessive heat exposure.
Collapse
|
84
|
Johnson RJ, Rodriguez-Iturbe B, Roncal-Jimenez C, Lanaspa MA, Ishimoto T, Nakagawa T, Correa-Rotter R, Wesseling C, Bankir L, Sanchez-Lozada LG. Hyperosmolarity drives hypertension and CKD--water and salt revisited. Nat Rev Nephrol 2014; 10:415-20. [PMID: 24802066 DOI: 10.1038/nrneph.2014.76] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
An epidemic of chronic kidney disease (CKD) in Mesoamerica is providing new insights into the mechanisms by which salt and water might drive hypertension and CKD. Increasingly, evidence suggests that recurrent dehydration and salt loss might be a mechanism that causes CKD, and experimental studies suggest a key role for increased plasma osmolarity in activating both intrarenal (polyol-fructokinase) and extrarenal (vasopressin) pathways that drive renal injury. Thus, we propose that water and salt might influence blood pressure and kidney disease through the timing and combination of their intake, which affect plasma osmolarity as well as intrarenal and extrarenal mechanisms of renal injury. The type of fluid intake might also be important, as fluids containing fructose can trigger activation of these pathways. Future studies should investigate the effects of salt, sugar and fluid intake on plasma osmolarity as a potential pathogenetic mechanism in renal injury and high blood pressure.
Collapse
Affiliation(s)
- Richard J Johnson
- Division of Nephrology, Eastern Colorado Health Care System, Department of Veteran Affairs, 12700 East 19th Avenue, Room 7015, Aurora, CO 80045, USA
| | - Bernardo Rodriguez-Iturbe
- Universidad del Zulia, Instituto Venezolano de Investigaciones Científicas (IVIC)-Zulia, Maracaibo, Venezuela
| | - Carlos Roncal-Jimenez
- Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA
| | - Takuji Ishimoto
- Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA
| | - Takahiko Nakagawa
- Mitsubishi Tanabe-Kyoto (TMK) project, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Catharina Wesseling
- Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Lise Bankir
- INSERM Unité Mixte de Recherche (UMR)-S 1138/Equipe 2, Centre de Recherche des Cordeliers, Paris, France
| | - Laura G Sanchez-Lozada
- Laboratory of Renal Physiopathology, Intituto Nacional de Cardiología Ignacio Chavez, Mexico City, Mexico
| |
Collapse
|
85
|
|
86
|
Wesseling C, Crowe J, Hogstedt C, Jakobsson K, Lucas R, Wegman DH. Wesseling et al. respond. Am J Public Health 2014; 104:e1-2. [PMID: 24432933 DOI: 10.2105/ajph.2013.301803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Catharina Wesseling
- Catharina Wesseling and Jennifer Crowe are with the Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica. Christer Hogstedt is with the Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden. Kristina Jakobsson is with the Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden. Rebekah Lucas is with the Hothaps Program, Umeå International School of Public Health, Umeå University, Umeå, Sweden. David H. Wegman is with Work Environment, University of Massachusetts, Lowell
| | | | | | | | | | | |
Collapse
|
87
|
Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in Central America: the case for a Mesoamerican nephropathy. Am J Kidney Dis 2014; 63:506-20. [PMID: 24412050 PMCID: PMC7115712 DOI: 10.1053/j.ajkd.2013.10.062] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/30/2013] [Indexed: 12/27/2022]
Abstract
An epidemic of chronic kidney disease of unknown origin has emerged in the last decade in Central America and has been named Mesoamerican nephropathy. This form of chronic kidney disease is present primarily in young male agricultural workers from communities along the Pacific coast, especially workers in the sugarcane fields. In general, these men have a history of manual labor under very hot conditions in agricultural fields. Clinically, they usually present with normal or mildly elevated systemic blood pressure, asymptomatic yet progressive reduction in estimated glomerular filtration rate, low-grade non-nephrotic proteinuria, and often hyperuricemia and or hypokalemia. Diabetes is absent in this population. Kidney biopsies that have been performed show a chronic tubulointerstitial disease with associated secondary glomerulosclerosis and some signs of glomerular ischemia. The cause of the disease is unknown; this article discusses and analyzes some of the etiologic possibilities currently under consideration. It is relevant to highlight that recurrent dehydration is suggested in multiple studies, a condition that possibly could be exacerbated in some cases by other conditions, including the use of nonsteroidal anti-inflammatory agents. At present, Mesoamerican nephropathy is a medical enigma yet to be solved.
Collapse
Affiliation(s)
- Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Catharina Wesseling
- Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO
| |
Collapse
|