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Ekiti ME, Zambo JB, Assah FK, Agbor VN, Kekay K, Ashuntantang G. Chronic kidney disease in sugarcane workers in Cameroon: a cross-sectional study. BMC Nephrol 2018; 19:10. [PMID: 29334929 PMCID: PMC5769452 DOI: 10.1186/s12882-017-0798-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/14/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Agricultural workers especially in sugarcane plantations have a high risk of chronic kidney disease (CKD). Little is known about CKD among sugarcane plantation workers in Cameroon. This study sought to evaluate the prevalence and identify factors associated with CKD in sugarcane plantation workers in Cameroon. METHODS We conducted an analytic cross-sectional study including 204 adult workers at the sugarcane plantation complex in Mbandjock, Cameroon; over 500 m above sea level. Chronic kidney disease (proteinuria as estimated by urine dipstick analysis and/or estimated glomerular filtration rate < 60 ml/min/1.73 m2 persistent after 3 months) was the outcome of interest. Those with abnormal results were seen again after 3 months to confirm the diagnosis. We evaluated the association between CKD and participant age, sex, contract-type, duration of employment, socio-economic status, workspace, exposure to agrochemicals, heavy metals and heat, selected risk factors and co-morbid conditions. RESULTS The overall prevalence of CKD was 3.4%. The factory workers were the most affected (7%), compared to the field (2.4%) and office workers (0%). 2.9% of the participants had persistent proteinuria, mild in every case, and 0.5% of them had an estimated glomerular filtration rate < 60 ml/min/1.73 m2. Age ≥ 40 years was an independent predictor of CKD. CONCLUSION The prevalence of CKD among employees of the Mbandjock sugarcane plantation is low, probably reflecting the preventive measures against heat stress and dehydration in place.
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Affiliation(s)
- Martin E. Ekiti
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
- Occupational Health Service, National Refining Company (SONARA), P.O. Box 365, Limbe, Cameroon
| | - Jean-Berthelot Zambo
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
- Cameroon Sugar Company (SOSUCAM), Mbandjock, Cameroon
| | - Felix K. Assah
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
| | - Valirie N. Agbor
- Ibal sub-Divisional Hospital, Oku, Northwest Region, Bamenda, Cameroon
| | - Krystel Kekay
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
| | - Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, P.O. Box 1364, Yaounde, Cameroon
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102
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Prevalence and association of chronic kidney disease, diabetes, hypertension, and hyperuricemia in an adult urban population of El Salvador. NEFROLOGÍA LATINOAMERICANA 2017. [DOI: 10.1016/j.nefrol.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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103
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Obrador GT, Schultheiss UT, Kretzler M, Langham RG, Nangaku M, Pecoits-Filho R, Pollock C, Rossert J, Correa-Rotter R, Stenvinkel P, Walker R, Yang CW, Fox CS, Köttgen A. Genetic and environmental risk factors for chronic kidney disease. Kidney Int Suppl (2011) 2017; 7:88-106. [PMID: 30675423 DOI: 10.1016/j.kisu.2017.07.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In order to change the current state of chronic kidney disease knowledge and therapeutics, a fundamental improvement in the understanding of genetic and environmental causes of chronic kidney disease is essential. This article first provides an overview of the existing knowledge gaps in our understanding of the genetic and environmental causes of chronic kidney disease, as well as their interactions. The second part of the article formulates goals that should be achieved in order to close these gaps, along with suggested timelines and stakeholders that are to be involved. A better understanding of genetic and environmental factors and their interactions that influence kidney function in healthy and diseased conditions can provide novel insights into renal physiology and pathophysiology and result in the identification of novel therapeutic or preventive targets to tackle the global public health care problem of chronic kidney disease.
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Affiliation(s)
- Gregorio T Obrador
- Department of Epidemiology, Biostatistics and Public Health, Universidad Panamericana School of Medicine, Mexico City, Mexico
| | - Ulla T Schultheiss
- Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany.,Renal Division, Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Matthias Kretzler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Robyn G Langham
- Monash Rural Health, Monash University, Clayton VIC, Australia
| | - Masaomi Nangaku
- Department of Hemodialysis and Apheresis, Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Roberto Pecoits-Filho
- Department of Internal Medicine, School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil
| | - Carol Pollock
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zuibrán, Mexico City, Mexico
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Caroline S Fox
- Genetics and Pharmacogenomics, Merck Research Laboratories, Boston, Massachusetts, USA
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
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104
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Nerbass FB, Pecoits-Filho R, Clark WF, Sontrop JM, McIntyre CW, Moist L. Occupational Heat Stress and Kidney Health: From Farms to Factories. Kidney Int Rep 2017; 2:998-1008. [PMID: 29270511 PMCID: PMC5733743 DOI: 10.1016/j.ekir.2017.08.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/02/2017] [Accepted: 08/21/2017] [Indexed: 12/24/2022] Open
Abstract
Millions of workers around the world are exposed to high temperatures, intense physical activity, and lax labor practices that do not allow for sufficient rehydration breaks. The extent and consequences of heat exposure in different occupational settings, countries, and cultural contexts is not well studied. We conducted an in-depth review to examine the known effects of occupational heat stress on the kidney. We also examined methods of heat-stress assessment, strategies for prevention and mitigation, and the economic consequences of occupational heat stress. Our descriptive review summarizes emerging evidence that extreme occupational heat stress combined with chronic dehydration may contribute to the development of CKD and ultimately kidney failure. Rising global temperatures, coupled with decreasing access to clean drinking water, may exacerbate the effects of heat exposure in both outdoor and indoor workers who are exposed to chronic heat stress and recurrent dehydration. These changes create an urgent need for health researchers and industry to identify work practices that contribute to heat-stress nephropathy, and to test targeted, robust prevention and mitigation strategies. Preventing occupational heat stress presents a great challenge for a concerted multidisciplinary effort from employers, health authorities, engineers, researchers, and governments.
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Affiliation(s)
- Fabiana B Nerbass
- Nephrology Division, Pro-rim Foundation, Joinville, Santa Catarina, Brazil.,School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brazil
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brazil.,Renal and Metabolic Division, George Institute for Global Health, Sydney, New South Wales, Australia
| | - William F Clark
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Jessica M Sontrop
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher W McIntyre
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Louise Moist
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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105
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Ratnayake S, Badurdeen Z, Nanayakkara N, Abeysekara T, Ratnatunga N, Kumarasiri R. Screening for chronic kidney disease of uncertain aetiology in Sri Lanka: usability of surrogate biomarkers over dipstick proteinuria. BMC Nephrol 2017. [PMID: 28629425 PMCID: PMC5477244 DOI: 10.1186/s12882-017-0610-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The use of dipstick proteinuria to screen Chronic Kidney Disease of uncertain aetiology (CKDu) in Sri Lanka is a recently debated matter of dispute. The aim of this study was to assess the suitability of biomarkers: serum creatinine, cystatin C and urine albumin to creatinine ratio (ACR) for screening CKDu in Sri Lanka. Methods Forty-four male CKDu patients and 49 healthy males from a CKDu-endemic region were selected. Meanwhile, 25 healthy males from a non-endemic region were selected as an absolute control. The diagnostic accuracy of each marker was compared using the above three study groups. Results In receiver operating characteristics (ROC) plots for creatinine, cystatin C and ACR, values of area under the curve (AUC) were 0.926, 0.920 and 0.737 respectively when CKDu was compared to non-endemic control. When CKDu was compared to endemic control, AUCs of above three analytes were distinctly lower as 0.718, 0.808 and 0.678 respectively. Cystatin C exhibited the highest sensitivity for CKDu when analyzed against both control groups where respective sensitivities were 0.75 against endemic control and 0.89 against non-endemic control. ROC-optimal cutoff limits of creatinine, cystatin C and ACR in CKDu vs non-endemic control were 89.0 μmol/L, 1.01 mg/L and 6.06 mg/g-Cr respectively, whereas in CKDu vs endemic control the respective values were 111.5 μmol/L, 1.22 mg/L and 12.66 mg/g-Cr. Conclusions Amongst the three biomarkers evaluated in this study, our data suggest that Cystatin C is the most accurate functional marker in detecting CKDu in endemic regions, yet the high cost hinders its usability on general population. Creatinine is favorable over dipstick proteinuria owing to its apparent accuracy and cost efficiency, while having the ability to complement the kidney damage marker (ACR) in screening. ACR may not be favorable as a standalone screening marker in place of dipstick proteinuria due to its significant decline in sensitivity against the CKDu-endemic population. However, creatinine and ACR in a complementary manner could overcome current shortcomings of dipstick proteinuria and such a dual marker tool could be commodious in screening CKDu-type tubulointerstital diseases. Furthermore, use of ACR may also increase the ability to clinically discriminate CKDu from other glomerular nephropathies.
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Affiliation(s)
- Samantha Ratnayake
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. .,Sri Lanka Institute of Nanotechnology (SLINTEC), Homagama, Sri Lanka.
| | - Zeid Badurdeen
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Tilak Abeysekara
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ranjith Kumarasiri
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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106
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Vandenberg LN, Blumberg B, Antoniou MN, Benbrook CM, Carroll L, Colborn T, Everett LG, Hansen M, Landrigan PJ, Lanphear BP, Mesnage R, vom Saal FS, Welshons WV, Myers JP. Is it time to reassess current safety standards for glyphosate-based herbicides? J Epidemiol Community Health 2017; 71:613-618. [PMID: 28320775 PMCID: PMC5484035 DOI: 10.1136/jech-2016-208463] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 01/06/2023]
Abstract
Use of glyphosate-based herbicides (GBHs) increased ∼100-fold from 1974 to 2014. Additional increases are expected due to widespread emergence of glyphosate-resistant weeds, increased application of GBHs, and preharvest uses of GBHs as desiccants. Current safety assessments rely heavily on studies conducted over 30 years ago. We have considered information on GBH use, exposures, mechanisms of action, toxicity and epidemiology. Human exposures to glyphosate are rising, and a number of in vitro and in vivo studies challenge the basis for the current safety assessment of glyphosate and GBHs. We conclude that current safety standards for GBHs are outdated and may fail to protect public health or the environment. To improve safety standards, the following are urgently needed: (1) human biomonitoring for glyphosate and its metabolites; (2) prioritisation of glyphosate and GBHs for hazard assessments, including toxicological studies that use state-of-the-art approaches; (3) epidemiological studies, especially of occupationally exposed agricultural workers, pregnant women and their children and (4) evaluations of GBHs in commercially used formulations, recognising that herbicide mixtures likely have effects that are not predicted by studying glyphosate alone.
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Affiliation(s)
- Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts—Amherst, Amherst, Massachusetts, USA
| | - Bruce Blumberg
- Department of Developmental and Cell Biology, University of California, Irvine, California, USA
| | - Michael N Antoniou
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Charles M Benbrook
- University of Newcastle, Newcastle, UK
- Benbrook Consulting Services, Enterprise, Oregon, USA
| | - Lynn Carroll
- TEDX, The Endocrine Disruption Exchange, Paonia, Colorado, USA
| | - Theo Colborn
- TEDX, The Endocrine Disruption Exchange, Paonia, Colorado, USA
| | | | | | - Philip J Landrigan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bruce P Lanphear
- Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robin Mesnage
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Frederick S vom Saal
- Division of Biological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Wade V Welshons
- Department of Biomedical Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - John Peterson Myers
- Environmental Health Sciences, Charlottesville, Virginia, USA
- Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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107
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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.
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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
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108
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Orantes-Navarro CM, Herrera-Valdés R, Almaguer-López M, López-Marín L, Vela-Parada XF, Hernandez-Cuchillas M, Barba LM. Toward a Comprehensive Hypothesis of Chronic Interstitial Nephritis in Agricultural Communities. Adv Chronic Kidney Dis 2017; 24:101-106. [PMID: 28284375 DOI: 10.1053/j.ackd.2017.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/19/2016] [Accepted: 01/03/2017] [Indexed: 01/18/2023]
Abstract
Over the past 20 years, there has been an increase in chronic interstitial nephritis in agricultural communities (CINAC) not associated with traditional risk factors. This disease has become an important public health problem and is observed in several countries in Central America and Asia. CINAC predominantly affects young male farmers between the third and fifth decades of life with women, children, and adolescents less often affected. Clinically, CINAC behaves like a chronic tubulointerstitial nephropathy but with systemic manifestations not attributable to kidney disease. Kidney biopsy reveals chronic tubulointerstitial nephritis with variable glomerulosclerosis and mild chronic vascular damage, with the severity depending on sex, occupation, and CKD stage. The presence of toxicological, occupational, and environmental risk factors within these communities suggests a multifactorial etiology for CINAC. This may include exposure to agrochemicals, a contaminated environment, repeated episodes of dehydration with heat stress, and an underlying genetic predisposition. An understanding of these interacting factors using a multidisciplinary approach with international cooperation and the formulation of a comprehensive hypothesis are essential for the development of public health programs to prevent this devastating epidemic.
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109
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Bundschuh J, Maity JP, Mushtaq S, Vithanage M, Seneweera S, Schneider J, Bhattacharya P, Khan NI, Hamawand I, Guilherme LRG, Reardon-Smith K, Parvez F, Morales-Simfors N, Ghaze S, Pudmenzky C, Kouadio L, Chen CY. Medical geology in the framework of the sustainable development goals. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 581-582:87-104. [PMID: 28062106 DOI: 10.1016/j.scitotenv.2016.11.208] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 05/23/2023]
Abstract
Exposure to geogenic contaminants (GCs) such as metal(loid)s, radioactive metals and isotopes as well as transuraniums occurring naturally in geogenic sources (rocks, minerals) can negatively impact on environmental and human health. The GCs are released into the environment by natural biogeochemical processes within the near-surface environments and/or by anthropogenic activities such as mining and hydrocarbon exploitation as well as exploitation of geothermal resources. They can contaminate soil, water, air and biota and subsequently enter the food chain with often serious health impacts which are mostly underestimated and poorly recognized. Global population explosion and economic growth and the associated increase in demand for water, energy, food, and mineral resources result in accelerated release of GCs globally. The emerging science of "medical geology" assesses the complex relationships between geo-environmental factors and their impacts on humans and environments and is related to the majority of the 17 Sustainable Development Goals in the 2030 Agenda of the United Nations for Sustainable Development. In this paper, we identify multiple lines of evidence for the role of GCs in the incidence of diseases with as yet unknown etiology (causation). Integrated medical geology promises a more holistic understanding of the occurrence, mobility, bioavailability, bio-accessibility, exposure and transfer mechanisms of GCs to the food-chain and humans, and the related ecotoxicological impacts and health effects. Scientific evidence based on this approach will support adaptive solutions for prevention, preparedness and response regarding human and environmental health impacts originating from exposure to GCs.
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Affiliation(s)
- Jochen Bundschuh
- Deputy Vice-Chancellor's Office (Research and Innovation), University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; Faculty of Health, Engineering and Sciences, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; KTH-International Groundwater Arsenic Research Group, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 76, SE-10044 Stockholm, Sweden.
| | - Jyoti Prakash Maity
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Min-Hsiung, Chiayi County 62102, Taiwan.
| | - Shahbaz Mushtaq
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Meththika Vithanage
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; Chemical and Environmental Systems Modeling Research Group, National Institute of Fundamental Studies, Kandy 20000, Sri Lanka.
| | - Saman Seneweera
- Centre for Crop Health, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Jerusa Schneider
- Sanitation and Environment Dept., School of Civil Engineering, Architecture and Urban Design, State University of Campinas, 113083-889 Campinas, (SP), Brazil.
| | - Prosun Bhattacharya
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; KTH-International Groundwater Arsenic Research Group, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 76, SE-10044 Stockholm, Sweden.
| | - Nasreen Islam Khan
- College of Medicine, Biology and Environment, Australian National University, Canberra, ACT 0200, Australia; GIS Social Science Division, International Rice Research Institute (IRRI), Los Banos, Laguna 4031, Philippines.
| | - Ihsan Hamawand
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Luiz R G Guilherme
- Soil Science Department, Federal University of Lavras (UFLA), Campus Universitário, Caixa Postal 3037, CEP: 37200-000 Lavras, Minas Gerais, Brazil.
| | - Kathryn Reardon-Smith
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Faruque Parvez
- Department of Environmental Health Sciences, Mailman, School of Public Health, Columbia University, 722 West 168th St., 10032 NewYork, NY, USA.
| | | | - Sara Ghaze
- Faculty of Health, Engineering and Sciences, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Christa Pudmenzky
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Louis Kouadio
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Chien-Yen Chen
- Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Min-Hsiung, Chiayi County 62102, Taiwan.
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110
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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.
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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.
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111
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Moyce S, Mitchell D, Armitage T, Tancredi D, Joseph J, Schenker M. Heat strain, volume depletion and kidney function in California agricultural workers. Occup Environ Med 2017; 74:402-409. [PMID: 28093502 DOI: 10.1136/oemed-2016-103848] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/23/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Agricultural work can expose workers to increased risk of heat strain and volume depletion due to repeated exposures to high ambient temperatures, arduous physical exertion and limited rehydration. These risk factors may result in acute kidney injury (AKI). METHODS We estimated AKI cumulative incidence in a convenience sample of 283 agricultural workers based on elevations of serum creatinine between preshift and postshift blood samples. Heat strain was assessed based on changes in core body temperature and heart rate. Volume depletion was assessed using changes in body mass over the work shift. Logistic regression models were used to estimate the associations of AKI with traditional risk factors (age, diabetes, hypertension and history of kidney disease) as well as with occupational risk factors (years in farm work, method of payment and farm task). RESULTS 35 participants were characterised with incident AKI over the course of a work shift (12.3%). Workers who experienced heat strain had increased adjusted odds of AKI (1.34, 95% CI 1.04 to 1.74). Piece rate work was associated with 4.24 odds of AKI (95% CI 1.56 to 11.52). Females paid by the piece had 102.81 adjusted odds of AKI (95% CI 7.32 to 1443.20). DISCUSSION Heat strain and piece rate work are associated with incident AKI after a single shift of agricultural work, though gender differences exist. Modifications to payment structures may help prevent AKI.
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Affiliation(s)
- Sally Moyce
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California, USA
| | - Diane Mitchell
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Tracey Armitage
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Daniel Tancredi
- Department of Pediatrics, University of California, Davis, Davis, California, USA
| | - Jill Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California, USA
| | - Marc Schenker
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
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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.
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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
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García-Trabanino R, Cerdas M, Madero M, Jakobsson K, Barnoya J, Crowe J, Jarquín E, Guzmán-Quilo C, Correa-Rotter R. Nefropatía mesoamericana: revisión breve basada en el segundo taller del Consorcio para el estudio de la Epidemia de Nefropatía en Centroamérica y México (CENCAM). NEFROLOGÍA LATINOAMERICANA 2017. [DOI: 10.1016/j.nefrol.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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114
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Quinteros E, Ribó A, Mejía R, López A, Belteton W, Comandari A, Orantes CM, Pleites EB, Hernández CE, López DL. Heavy metals and pesticide exposure from agricultural activities and former agrochemical factory in a Salvadoran rural community. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:1662-1676. [PMID: 27796975 DOI: 10.1007/s11356-016-7899-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/11/2016] [Indexed: 06/06/2023]
Abstract
Pesticide handling in farming activities involves substantial hazards for the rural population and for the environment. In Latin America, it is estimated that the population at risk of being affected by heavy metals is over 4 million. This research describes the different types of exposure to pesticides and heavy metals in a rural population (Loma del Gallo), considering both environmental and occupational exposure. This study consists of an inspection in a former pesticide factory (QUIMAGRO), analysis of heavy metals in samples from surface and ground water in the community close to the factory, and a survey to the local population about their perceptions of pesticide exposures. Containers with 34.6 tons of chemicals improperly stored were identified in the former factory and removed by the government. Arsenic and cadmium were found in groundwater, and the highest values were 0.012 and 0.004 mg/l, respectively. These contaminants were also detected in most surface water samples, with maximum values of 0.026 and 0.0001 mg/l, respectively. Results of the survey show that of the 44 participants 42 % were farmers. Farmers used 19 different pesticide products containing 11 active ingredients. The most used active ingredients were paraquat (65 %), methamidophos (35 %), and atrazina (29 %). Eighty-two percent of the farmers did not use personal protective equipment. In addition to the pesticides used in the agriculture of the area, pesticide containers were removed from the QUIMAGRO area, but the pollution was still present at time of sampling and it is evident by the odor of the site. Surface water had the major concentration of heavy metals than the groundwater. Loma del Gallo population has been exposed to toxic pesticide from QUIMAGRO and agriculture for many years. The farmers carry out mishandling of pesticides and they not use PPE.
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Affiliation(s)
- Edgar Quinteros
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador.
| | - Alexandre Ribó
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Roberto Mejía
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Alejandro López
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Wilfredo Belteton
- National Reference Laboratory, Ministry of Health El Salvador, Alameda Roosvelt, Edificio Max Bloch, frente a parque Cuscatlán, San Salvador, El Salvador
| | - Aimee Comandari
- Department of General Science, College of Southern Nevada, 6375 W. Charleston Blvd, Las Vegas, NV, 89146, USA
| | - Carlos M Orantes
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Ernesto B Pleites
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Carlos E Hernández
- Ministry of Health El Salvador, Calle Gabriela Mistral Avenida del Prado, National Institute of Health, N° J-234, Col. Buenos Aires I, San Salvador, El Salvador
| | - Dina L López
- Department of Geological Sciences, Ohio University, Clippinger Laboratories 316, Athens, OH, 45701-2979, USA
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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.
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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
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Levine KE, Redmon JH, Elledge MF, Wanigasuriya KP, Smith K, Munoz B, Waduge VA, Periris-John RJ, Sathiakumar N, Harrington JM, Womack DS, Wickremasinghe R. Quest to identify geochemical risk factors associated with chronic kidney disease of unknown etiology (CKDu) in an endemic region of Sri Lanka-a multimedia laboratory analysis of biological, food, and environmental samples. ENVIRONMENTAL MONITORING AND ASSESSMENT 2016; 188:548. [PMID: 27591985 DOI: 10.1007/s10661-016-5524-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/01/2016] [Indexed: 05/09/2023]
Abstract
The emergence of a new form of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka's North Central Province (NCP) has become a catastrophic health crisis. CKDu is characterized as slowly progressing, irreversible, and asymptomatic until late stages and, importantly, not attributed to diabetes, hypertension, or other known risk factors. It is postulated that the etiology of CKDu is multifactorial, involving genetic predisposition, nutritional and dehydration status, exposure to one or more environmental nephrotoxins, and lifestyle factors. The objective of this limited geochemical laboratory analysis was to determine the concentration of a suite of heavy metals and trace element nutrients in biological samples (human whole blood and hair) and environmental samples (drinking water, rice, soil, and freshwater fish) collected from two towns within the endemic NCP region in 2012 and 2013. This broad panel, metallomics/mineralomics approach was used to shed light on potential geochemical risk factors associated with CKDu. Based on prior literature documentation of potential nephrotoxins that may play a role in the genesis and progression of CKDu, heavy metals and fluoride were selected for analysis. The geochemical concentrations in biological and environmental media areas were quantified. Basic statistical measurements were subsequently used to compare media against applicable benchmark values, such as US soil screening levels. Cadmium, lead, and mercury were detected at concentrations exceeding US reference values in many of the biological samples, suggesting that study participants are subjected to chronic, low-level exposure to these elements. Within the limited number of environmental media samples, arsenic was determined to exceed initial risk screening and background concentration values in soil, while data collected from drinking water samples reflected the unique hydrogeochemistry of the region, including the prevalence of hard or very hard water, and fluoride, iron, manganese, sodium, and lead exceeding applicable drinking water standards in some instances. Current literature suggests that the etiology of CKDu is likely multifactorial, with no single biological or hydrogeochemical parameter directly related to disease genesis and progression. This preliminary screening identified that specific constituents may be present above levels of concern, but does not compare results against specific kidney toxicity values or cumulative risk related to a multifactorial disease process. The data collected from this limited investigation are intended to be used in the subsequent study design of a comprehensive and multifactorial etiological study of CKDu risk factors that includes sample collection, individual surveys, and laboratory analyses to more fully evaluate the potential environmental, behavioral, genetic, and lifestyle risk factors associated with CKDu.
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Affiliation(s)
- Keith E Levine
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | | | - Myles F Elledge
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kristin Smith
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Breda Munoz
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Roshini J Periris-John
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nalini Sathiakumar
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Harrington
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Donna S Womack
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
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Kupferman J, Amador JJ, Lynch KE, Laws RL, López-Pilarte D, Ramírez-Rubio O, Kaufman JS, Lau JL, Weiner DE, Robles NV, Verma KP, Scammell MK, McClean MD, Brooks DR, Friedman DJ. Characterization of Mesoamerican Nephropathy in a Kidney Failure Hotspot in Nicaragua. Am J Kidney Dis 2016; 68:716-725. [PMID: 27575010 DOI: 10.1053/j.ajkd.2016.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mesoamerican nephropathy (MeN) is a kidney disease of unknown cause that mainly affects working-age men in Central America. Despite being a major cause of morbidity and mortality in this region, its clinical characteristics have not been well defined. STUDY DESIGN Cross-sectional family-based study. SETTING & PARTICIPANTS 266 members of 24 families with high chronic kidney disease (CKD) burdens in a MeN hotspot in Northwestern Nicaragua. We compared clinical and biochemical characteristics of affected individuals first with their unaffected relatives and then with NHANES (National Health and Nutrition Examination Survey) participants with CKD in order to reveal identifying features of MeN. PREDICTOR CKD defined as serum creatinine level ≥ 1.5mg/dL in men and ≥1.4mg/dL in women. OUTCOMES Clinical and biochemical parameters, including serum sodium, potassium, bicarbonate, calcium, magnesium, phosphorus, and uric acid. RESULTS Hyperuricemia, in many cases severe, was common among patients with MeN. Uric acid levels in patients with MeN were higher than those in NHANES participants (mean, 9.6 vs 7.4mg/dL for men in each group) despite more frequent use of uric acid-lowering medications in Nicaraguan individuals (71.7% vs 11.2%). In multivariable linear mixed-effects regression analysis, uric acid levels were 2.0mg/dL (95% CI, 1.0-3.0; P<0.001) higher in patients with MeN compared with their NHANES counterparts after adjusting for age, estimated glomerular filtration rate, and uric acid-lowering therapies. In contrast to prior reports, hyponatremia and hypokalemia were not common. LIMITATIONS CKD defined by single serum creatinine measurement; population likely not representative of full MeN phenotype spectrum across Central America; major differences between MeN and NHANES groups in important characteristics such as age, ancestry, and recruitment method. CONCLUSIONS Hyperuricemia out of proportion to the degree of decreased kidney function was common among Nicaraguan patients with MeN. Our results suggest that rather than being solely a consequence of CKD, hyperuricemia may play a role in MeN pathogenesis, a hypothesis that deserves further study.
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Affiliation(s)
- Joseph Kupferman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Katherine E Lynch
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Rebecca L Laws
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | | | - Oriana Ramírez-Rubio
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - James S Kaufman
- Research Service, VA New York Harbor Healthcare System and Department of Medicine, New York University School of Medicine, New York, NY
| | - Jorge Luis Lau
- Universidad Nacional Autónoma de Nicaragua, León, Nicaragua
| | - Daniel E Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Ninoska Violeta Robles
- Centro Nacional de Diagnóstico y Referencia, Nicaraguan Ministry of Health, Managua, Nicaragua
| | - Karina P Verma
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.
| | - David J Friedman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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118
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Glaser J, Lemery J, Rajagopalan B, Diaz HF, García-Trabanino R, Taduri G, Madero M, Amarasinghe M, Abraham G, Anutrakulchai S, Jha V, Stenvinkel P, Roncal-Jimenez C, Lanaspa MA, Correa-Rotter R, Sheikh-Hamad D, Burdmann EA, Andres-Hernando A, Milagres T, Weiss I, Kanbay M, Wesseling C, Sánchez-Lozada LG, Johnson RJ. Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy. Clin J Am Soc Nephrol 2016; 11:1472-1483. [PMID: 27151892 PMCID: PMC4974898 DOI: 10.2215/cjn.13841215] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Climate change has led to significant rise of 0.8°C-0.9°C in global mean temperature over the last century and has been linked with significant increases in the frequency and severity of heat waves (extreme heat events). Climate change has also been increasingly connected to detrimental human health. One of the consequences of climate-related extreme heat exposure is dehydration and volume loss, leading to acute mortality from exacerbations of pre-existing chronic disease, as well as from outright heat exhaustion and heat stroke. Recent studies have also shown that recurrent heat exposure with physical exertion and inadequate hydration can lead to CKD that is distinct from that caused by diabetes, hypertension, or GN. Epidemics of CKD consistent with heat stress nephropathy are now occurring across the world. Here, we describe this disease, discuss the locations where it appears to be manifesting, link it with increasing temperatures, and discuss ongoing attempts to prevent the disease. Heat stress nephropathy may represent one of the first epidemics due to global warming. Government, industry, and health policy makers in the impacted regions should place greater emphasis on occupational and community interventions.
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Affiliation(s)
- Jason Glaser
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Wimalawansa SA, Wimalawansa SJ. Environmentally induced, occupational diseases with emphasis on chronic kidney disease of multifactorial origin affecting tropical countries. Ann Occup Environ Med 2016; 28:33. [PMID: 27499855 PMCID: PMC4974668 DOI: 10.1186/s40557-016-0119-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/26/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Environmentally induced, occupational diseases are increasing worldwide, especially in rural agricultural communities. Poverty-associated malnutrition, environmental hazards and pollution, and lack of access to clean water, safe sanitation, and modern healthcare facilities are often associated with these chronic illnesses. METHOD The authors systematically reviewed occupational public health issues that have been related to the environment. General interpretations of results were included as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Pertinent publications from research databases were reviewed on (A) the risk-benefits, (B) the prevalence of risk factors for various diseases, (C) the benefits of not ignoring the risk factors (i.e., broader evidence), and (D) the risks, effects, and outcomes of different types of interventions. The authors used chronic kidney disease of multifactorial origin (CKDmfo) as an example to explore the theme. Emphasis was given to the regions with emerging economies and developing countries located in the vicinity of the equator. FINDINGS Geographical, socio-economic and aetiological similarities exist for many chronic non-communicable diseases that are affecting tropical countries around the equator. The authors identified manufacturing, mining, and agriculture as the biggest polluters of the environment. In addition, deforestation and associated soil erosion, overuse of agrochemicals, and irresponsible factory discharge (e.g., chemicals and paint, from rubber and textile factories, etc.), all contribute to pollution. To decrease the escalating incidences of environmentally induced diseases, governments should work proactively to protect the environment, especially watersheds, and take steps to minimise harmful occupational exposures and strictly enforce environmental regulations. CONCLUSION Creating public awareness of environmental issues and their relationship to public health is essential. This includes regular monitoring and periodic publication of the quality of water, air and soil; preventing deforestation and man-made soil erosion, increasing forest and ground cover, preventing occupational injuries, judicious and safe use of agrochemicals, sustainable agriculture and development programs, and implementing legislation to protect and conserve water heriage and the environment. These actions are essential both for a healthier environment and for the health of the people who live in that environment. Such measures would also decrease public health threats from such, including global-warming-related erratic environmental changes and the occurrence and the spread of non-communicable diseases, such as CKDmfo.
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Minnings K, Fiore M, Mosco M, Ferguson R, Leatherman S, Kerns E, Kaufman J, Fiore M, Brooks D, Amador JJ, Paulsen H, Ernstberger Z, Trejo B, Sullivan E, Lichtman A, Nobil K, Lawlor M, Parker C, Parekh R, Fiore L. The Rivas Cohort Study: design and baseline characteristics of a Nicaraguan cohort. BMC Nephrol 2016; 17:93. [PMID: 27456863 PMCID: PMC4959050 DOI: 10.1186/s12882-016-0320-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/20/2016] [Indexed: 12/01/2022] Open
Abstract
Background A lack of advanced healthcare information systems and validated scientific cohorts in Nicaragua makes it difficult to estimate disease prevalences and other public health statistics. Although there is concern of an “epidemic” of chronic kidney disease (CKD) in this country, statistics regarding its magnitude are derived from only a small number of non-representative studies. Budgetary constraints and the logistical problems of maintaining a study cohort make longitudinal studies difficult. The Rivas Cohort was created to measure disease burden of CKD and other public health priorities in the Department of Rivas, Nicaragua. Using primarily volunteer research students and technologic innovation including GPS, digital photography and point of care biochemical analysis, the ability to establish a longitudinal chronic disease cohort is demonstrated. Methods Subjects were recruited from consecutive adjacent households in thirty-two randomly selected communities in the ten municipalities that comprise the Department of Rivas in southern Pacific coastal Nicaragua. The study was conducted in two phases. In the first phase, subjects were enrolled into the cohort and consented for future re-contact. In Phase II, conducted two years later, attempts were made to re-contact 400 of these subjects for additional data collection. Demographic, lifestyle, occupational, exposure and health data was collected for both phases of the study. Blood and urine testing and height, weight and blood pressure measurements were also performed. GPS coordinates of homes were recorded and maps of remote communities created. Results Of 1397 adults living in 533 households approached for participation a total of 1242 (89 %) were enrolled in the cohort. The median age is 41 years and 43 % are male, demographics in agreement with Nicaraguan census data for the Department of Rivas. During Phase II we attempted to re-contact 400 subjects for a follow-up study of CKD. It was possible to re-contact 84 % of these participants and of those re-contacted 95 % agreed to participate in the follow-up study. Of subjects that were not successfully re-contacted the majority had either moved (32) or were not at home (22) at the time of the study team visits. Conclusion The Rivas Cohort Study enrolled a representative sample of 1242 adults living in the Department of Rivas, Nicaragua. The high re-contact and participation rates at two years suggests that the cohort is suitable for long-term studies and presents opportunities for investigations of disease prevalence, incidence, treatment and other public health matters. GPS coordinates and maps are available for future researchers who wish to use the cohort for additional studies. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0320-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kailey Minnings
- University of Toronto Faculty of Medicine, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Madeline Fiore
- UMass Medical School, 55 N Lake Ave, Chestnut St. Apt 21, Worcester, MA 01604 34, UK.,UMass Medical School, 55 N Lake Ave, Chestnut St. Apt 21, Worcester, MA 01609, UK
| | - Martha Mosco
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.,Beth Israel Deaconess Medical Center, 16 Oak Manor Dr. Barrington, Barrington, RI, 02806, USA
| | - Ryan Ferguson
- Massachusetts Veterans Epidemiology Research and Information Center Health, 150 South Huntington Avenue, Boston, MA, 02130, USA
| | - Sarah Leatherman
- VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
| | - Eric Kerns
- Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 9, Providence, RI, 02903, USA
| | - James Kaufman
- VA New York Healthcare System, 423 East 23rd Street, New York, NY, 10010, USA
| | - Melissa Fiore
- Athena Health, 311 Arsenal Street, Watertown, MA, 02472, USA.,Athena Health, 18 Parker Street, Cambridge, MA, 02138, USA
| | - Daniel Brooks
- Boston University School of Public Health, 715 Albany Street, T317E, Boston, MA, 02118, USA
| | - Juan Jose Amador
- Boston University, 715 Albany St., Talbot 3 East, Boston, MA, 02118, USA
| | - Hillary Paulsen
- Boston Children's Hospital, 401 Park Dr., 6th Floor, Landmark Center, Boston, MA, 02115, USA.,Boston Children's Hospital, 12 Greenway Ct. Apt. 3, Brookline, MA, 02446, USA
| | - Zachary Ernstberger
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, 1547 N. College Ave, Indianapolis, IN, 46202, USA
| | - Bricia Trejo
- Boston University School of Public Health, 801 Massachusetts Avenue 4th Floor, Boston, MA, 02118, USA.,Boston University School of Public Health, 60 Parkway Road, Newton, MA, 02460, USA
| | - Elyse Sullivan
- Northeastern University, 350 Huntington Ave, Boston, MA, 02115, USA.,Northeastern University, 255 Newbury Street, Apr1R, Boston, MA, 02116, USA
| | - Amos Lichtman
- UMass Medical School, 55 N Lake Ave, Worcester, MA, 01604, USA.,UMass Medical School, 60 Parkway Rd., Newton, MA, 02460, USA
| | - Keriann Nobil
- University of Massachusetts Medical School, 55 N. Lake Ave, Worcester, MA, 01605, USA.,University of Massachusetts Medical School, 285 Plantation St Apt 522, Worcester, MA, 01604, USA
| | - Matthew Lawlor
- Boston University Schools of Medicine and Public Health, 72 E. Concord Street, Boston, MA, 02118, USA.,Boston University Schools of Medicine and Public Health, 255 Newbury St 1R, Boston, MA, 02116, USA
| | - Cassandra Parker
- Boston University Schools of Medicine and Public Health, 160 E Berkeley St. Apt 304, Boston, MA, 02118, USA
| | - Rulan Parekh
- Hospital for Sick Children, University Health Network and University of Toronto, 555 University Ave, Toronto, ON, M5G1X8, Canada
| | - Louis Fiore
- Boston University Schools of Medicine and Public Health, 72 E. Concord Street, Boston, MA, 02118, USA.
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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).
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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
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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.
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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
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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.
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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.
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Bodin T, García-Trabanino R, Weiss I, Jarquín E, Glaser J, Jakobsson K, Lucas RAI, Wesseling C, Hogstedt C, Wegman DH. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1. Occup Environ Med 2016; 73:409-16. [PMID: 27073211 PMCID: PMC4893112 DOI: 10.1136/oemed-2016-103555] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/24/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic heat stress and dehydration from strenuous work in hot environments is considered an essential component of the epidemic of chronic kidney disease in Central America. OBJECTIVE (1) To assess feasibility of providing an intervention modelled on OSHA's Water.Rest.Shade programme (WRS) during sugarcane cutting and (2) to prevent heat stress and dehydration without decreasing productivity. METHODS Midway through the 6-month harvest, the intervention introduced WRS practices. A 60-person cutting group was provided water supplied in individual backpacks, mobile shaded rest areas and scheduled rest periods. Ergonomically improved machetes and efficiency strategies were also implemented. Health data (anthropometric, blood, urine, questionnaires) were collected preharvest, preintervention, mid-intervention and at the end of harvest. A subsample participated in focus group discussions. Daily wet bulb globe temperatures (WBGT) were recorded. The employer provided individual production records. RESULTS Over the harvest WBGT was >26°C from 9:00 onwards reaching average maximum of 29.3±1.7°C, around 13:00. Postintervention self-reported water consumption increased 25%. Symptoms associated with heat stress and with dehydration decreased. Individual daily production increased from 5.1 to a high of 7.3 tons/person/day postintervention. This increase was greater than in other cutting groups at the company. Focus groups reported a positive perception of components of the WRS, and the new machete and cutting programmes. CONCLUSIONS A WRS intervention is feasible in sugarcane fields, and appears to markedly reduce the impact of the heat stress conditions for the workforce. With proper attention to work practices, production can be maintained with less impact on worker health.
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Affiliation(s)
- T Bodin
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - R García-Trabanino
- Association of Nephrology and Hypertension of El Salvador, San Salvador, El Salvador
| | - I Weiss
- La Isla Foundation, Ada, Michigan, USA
| | - E Jarquín
- Agency for Development and Agricultural Health (AGDYSA), San Salvador, El Salvador
| | - J Glaser
- La Isla Foundation, Ada, Michigan, USA
| | - K Jakobsson
- Department of Public Health and Community Medicine, Gothenburg University, Gothenburg, Sweden
| | - R A I Lucas
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - C Wesseling
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - C Hogstedt
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - D H Wegman
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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García-Arroyo FE, Cristóbal M, Arellano-Buendía AS, Osorio H, Tapia E, Soto V, Madero M, Lanaspa MA, Roncal-Jiménez C, Bankir L, Johnson RJ, Sánchez-Lozada LG. Rehydration with soft drink-like beverages exacerbates dehydration and worsens dehydration-associated renal injury. Am J Physiol Regul Integr Comp Physiol 2016; 311:R57-65. [PMID: 27053647 DOI: 10.1152/ajpregu.00354.2015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 03/31/2016] [Indexed: 12/18/2022]
Abstract
Recurrent dehydration, such as commonly occurs with manual labor in tropical environments, has been recently shown to result in chronic kidney injury, likely through the effects of hyperosmolarity to activate both vasopressin and aldose reductase-fructokinase pathways. The observation that the latter pathway can be directly engaged by simple sugars (glucose and fructose) leads to the hypothesis that soft drinks (which contain these sugars) might worsen rather than benefit dehydration associated kidney disease. Recurrent dehydration was induced in rats by exposure to heat (36°C) for 1 h/24 h followed by access for 2 h to plain water (W), a 11% fructose-glucose solution (FG, same composition as typical soft drinks), or water sweetened with noncaloric stevia (ST). After 4 wk plasma and urine samples were collected, and kidneys were examined for oxidative stress, inflammation, and injury. Recurrent heat-induced dehydration with ad libitum water repletion resulted in plasma and urinary hyperosmolarity with stimulation of the vasopressin (copeptin) levels and resulted in mild tubular injury and renal oxidative stress. Rehydration with 11% FG solution, despite larger total fluid intake, resulted in greater dehydration (higher osmolarity and copeptin levels) and worse renal injury, with activation of aldose reductase and fructokinase, whereas rehydration with stevia water had opposite effects. In animals that are dehydrated, rehydration acutely with soft drinks worsens dehydration and exacerbates dehydration associated renal damage. These studies emphasize the danger of drinking soft drink-like beverages as an attempt to rehydrate following dehydration.
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Affiliation(s)
- Fernando E García-Arroyo
- Laboratory of Renal Physiopathology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico; Department of Nephrology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico
| | - Magdalena Cristóbal
- Laboratory of Renal Physiopathology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico; Department of Nephrology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico
| | - Abraham S Arellano-Buendía
- Laboratory of Renal Physiopathology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico; Department of Nephrology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico
| | - Horacio Osorio
- Laboratory of Renal Physiopathology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico; Department of Nephrology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico
| | - Edilia Tapia
- Laboratory of Renal Physiopathology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico; Department of Nephrology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico
| | - Virgilia Soto
- Department of Pathology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico
| | - Magdalena Madero
- Department of Nephrology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado; and
| | - Carlos Roncal-Jiménez
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado; and
| | - Lise Bankir
- INSERM, Centre de Recherche des Cordeliers, Paris, France
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado; and
| | - Laura-Gabriela Sánchez-Lozada
- Laboratory of Renal Physiopathology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico; Department of Nephrology, Instituto Nacional de Cardiología-Ignacio Chávez, Mexico City, Mexico;
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Harhay MN, Harhay MO, Coto-Yglesias F, Rosero Bixby L. Altitude and regional gradients in chronic kidney disease prevalence in Costa Rica: Data from the Costa Rican Longevity and Healthy Aging Study. Trop Med Int Health 2016; 21:41-51. [PMID: 26466575 PMCID: PMC4718874 DOI: 10.1111/tmi.12622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Recent studies in Central America indicate that mortality attributable to chronic kidney disease (CKD) is rising rapidly. We sought to determine the prevalence and regional variation of CKD and the relationship of biologic and socio-economic factors to CKD risk in the older-adult population of Costa Rica. METHODS We used data from the Costa Rican Longevity and Health Aging Study (CRELES). The cohort was comprised of 2657 adults born before 1946 in Costa Rica, chosen through a sampling algorithm to represent the national population of Costa Ricans >60 years of age. Participants answered questionnaire data and completed laboratory testing. The primary outcome of this study was CKD, defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 . RESULTS The estimated prevalence of CKD for older Costa Ricans was 20% (95% CI 18.5-21.9%). In multivariable logistic regression, older age (adjusted odds ratio [aOR] 1.08 per year, 95% CI 1.07-1.10, P < 0.001) was independently associated with CKD. For every 200 m above sea level of residence, subjects' odds of CKD increased 26% (aOR 1.26 95% CI 1.15-1.38, P < 0.001). There was large regional variation in adjusted CKD prevalence, highest in Limon (40%, 95% CI 30-50%) and Guanacaste (36%, 95% CI 26-46%) provinces. Regional and altitude effects remained robust after adjustment for socio-economic status. CONCLUSIONS We observed large regional and altitude-related variations in CKD prevalence in Costa Rica, not explained by the distribution of traditional CKD risk factors. More studies are needed to explore the potential association of geographic and environmental exposures with the risk of CKD.
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Affiliation(s)
- Meera N Harhay
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Michael O Harhay
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando Coto-Yglesias
- Department of Geriatric Medicine, National Geriatrics and Gerontology Hospital, San José, Costa Rica
| | - Luis Rosero Bixby
- Central American Population Center, University of Costa Rica, San José, Costa Rica
- Department of Demography, University of California, Berkeley, CA, USA
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Lunyera J, Mohottige D, Von Isenburg M, Jeuland M, Patel UD, Stanifer JW. CKD of Uncertain Etiology: A Systematic Review. Clin J Am Soc Nephrol 2015; 11:379-85. [PMID: 26712810 DOI: 10.2215/cjn.07500715] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/12/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Epidemics of CKD of uncertain etiology (CKDu) are emerging around the world. Highlighting common risk factors for CKD of uncertain etiology across various regions and populations may be important for health policy and public health responses. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We searched PubMed, Embase, Scopus and Web of Science databases to identify published studies on CKDu. The search was generated in January of 2015; no language or date limits were used. We used a vote-counting method to evaluate exposures across all studies. RESULTS We identified 1607 articles, of which 26 met inclusion criteria. Eighteen (69%) were conducted in known CKDu-endemic countries: Sri Lanka (38%), Nicaragua (19%), and El Salvador (12%). The other studies were from India, Japan, Australia, Mexico, Sweden, Tunisia, Tanzania, and the United States. Heavy metals, heat stress, and dietary exposures were reported across all geographic regions. In south Asia, family history, agrochemical use, and heavy metal exposures were reported most frequently, whereas altitude and temperature were reported only in studies from Central America. Across all regions, CKDu was most frequently associated with a family history of CKDu, agricultural occupation, men, middle age, snake bite, and heavy metal exposure. CONCLUSIONS Studies examining etiologies of CKDu have reported many exposures that are heterogeneous and vary by region. To identify etiologies of CKDu, designing consistent and comparative multisite studies across high-risk populations may help elucidate the importance of region-specific versus global risk factors.
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Affiliation(s)
| | | | | | - Marc Jeuland
- Duke Global Health Institute, Sanford School of Public Policy, and Institute of Water Policy, Lee Kwan Yew School of Public Policy, National University of Singapore, Singapore
| | - Uptal D Patel
- Duke Global Health Institute, Departments of Medicine and Pediatrics, Duke Clinical Research Institute, Duke University, Durham, North Carolina; and
| | - John W Stanifer
- Duke Global Health Institute, Departments of Medicine and Duke Clinical Research Institute, Duke University, Durham, North Carolina; and
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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.
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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
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129
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Roncal-Jimenez C, García-Trabanino R, Barregard L, Lanaspa MA, Wesseling C, Harra T, Aragón A, Grases F, Jarquin ER, González MA, Weiss I, Glaser J, Sánchez-Lozada LG, Johnson RJ. Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy. Am J Kidney Dis 2015; 67:20-30. [PMID: 26455995 DOI: 10.1053/j.ajkd.2015.08.021] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 08/07/2015] [Indexed: 11/11/2022]
Abstract
Mesoamerican nephropathy (MeN), an epidemic in Central America, is a chronic kidney disease of unknown cause. In this article, we argue that MeN may be a uric acid disorder. Individuals at risk for developing the disease are primarily male workers exposed to heat stress and physical exertion that predisposes to recurrent water and volume depletion, often accompanied by urinary concentration and acidification. Uric acid is generated during heat stress, in part consequent to nucleotide release from muscles. We hypothesize that working in the sugarcane fields may result in cyclic uricosuria in which uric acid concentrations exceed solubility, leading to the formation of dihydrate urate crystals and local injury. Consistent with this hypothesis, we present pilot data documenting the common presence of urate crystals in the urine of sugarcane workers from El Salvador. High end-of-workday urinary uric acid concentrations were common in a pilot study, particularly if urine pH was corrected to 7. Hyperuricemia may induce glomerular hypertension, whereas the increased urinary uric acid may directly injure renal tubules. Thus, MeN may result from exercise and heat stress associated with dehydration-induced hyperuricemia and uricosuria. Increased hydration with water and salt, urinary alkalinization, reduction in sugary beverage intake, and inhibitors of uric acid synthesis should be tested for disease prevention.
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Affiliation(s)
| | - Ramón García-Trabanino
- Scientific Board, Department of Investigation, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Miguel A Lanaspa
- Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO
| | - Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Tamara Harra
- Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO
| | - Aurora Aragón
- Research Center on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua
| | - Felix Grases
- University of Balearic Islands, Palma de Mallorca, Spain
| | - Emmanuel R Jarquin
- Agencia para el Desarrollo y la Salud Agropecuaria, San Salvador, El Salvador
| | - Marvin A González
- Research Center 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, United Kingdom
| | - Ilana Weiss
- La Isla Foundation, San Salvador, El Salvador
| | | | - Laura G Sánchez-Lozada
- Laboratory of Renal Physiopathology and Nephrology Department, INC Ignacio Chavez, Mexico City, Mexico
| | - Richard J Johnson
- Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO; Division of Nephrology, Eastern Colorado Health Care System, Department of Veteran Affairs, Denver, CO.
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130
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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.
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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.
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131
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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.
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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
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132
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Weaver VM, Fadrowski JJ, Jaar BG. Global dimensions of chronic kidney disease of unknown etiology (CKDu): a modern era environmental and/or occupational nephropathy? BMC Nephrol 2015; 16:145. [PMID: 26282933 PMCID: PMC4539684 DOI: 10.1186/s12882-015-0105-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/15/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Virginia M Weaver
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. .,Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Jeffrey J Fadrowski
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
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133
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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.
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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
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134
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Lebov JF, Engel LS, Richardson D, Hogan SL, Hoppin JA, Sandler DP. Pesticide use and risk of end-stage renal disease among licensed pesticide applicators in the Agricultural Health Study. Occup Environ Med 2015; 73:3-12. [PMID: 26177651 DOI: 10.1136/oemed-2014-102615] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 06/22/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Experimental studies suggest a relationship between pesticide exposure and renal impairment, but epidemiological evidence is limited. We evaluated the association between exposure to 39 specific pesticides and end-stage renal disease (ESRD) incidence in the Agricultural Health Study, a prospective cohort study of licensed pesticide applicators in Iowa and North Carolina. METHODS Via linkage to the US Renal Data System, we identified 320 ESRD cases diagnosed between enrolment (1993-1997) and December 2011 among 55 580 male licensed pesticide applicators. Participants provided information on use of pesticides via self-administered questionnaires. Lifetime pesticide use was defined as the product of duration and frequency of use and then modified by an intensity factor to account for differences in pesticide application practices. Cox proportional hazards models, adjusted for age and state, were used to estimate associations between ESRD and: (1) ordinal categories of intensity-weighted lifetime use of 39 pesticides, (2) poisoning and high-level pesticide exposures and (3) pesticide exposure resulting in a medical visit or hospitalisation. RESULTS Positive exposure-response trends were observed for the herbicides alachlor, atrazine, metolachlor, paraquat, and pendimethalin, and the insecticide permethrin. More than one medical visit due to pesticide use (HR=2.13; 95% CI 1.17 to 3.89) and hospitalisation due to pesticide use (HR=3.05; 95% CI 1.67 to 5.58) were significantly associated with ESRD. CONCLUSIONS Our findings support an association between ESRD and chronic exposure to specific pesticides, and suggest pesticide exposures resulting in medical visits may increase the risk of ESRD. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT00352924.
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Affiliation(s)
- Jill F Lebov
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lawrence S Engel
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan L Hogan
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jane A Hoppin
- Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA
| | - Dale P Sandler
- Epidemiology Branch/Chronic Disease Epidemiology Group, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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135
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Rango T, Jeuland M, Manthrithilake H, McCornick P. Nephrotoxic contaminants in drinking water and urine, and chronic kidney disease in rural Sri Lanka. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 518-519:574-85. [PMID: 25782025 DOI: 10.1016/j.scitotenv.2015.02.097] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 05/08/2023]
Abstract
Chronic kidney disease of unknown ("u") cause (CKDu) is a growing public health concern in Sri Lanka. Prior research has hypothesized a link with drinking water quality, but rigorous studies are lacking. This study assesses the relationship between nephrotoxic elements (namely arsenic (As), cadmium (Cd), lead (Pb), and uranium (U)) in drinking water, and urine samples collected from individuals with and/or without CKDu in endemic areas, and from individuals without CKDu in nonendemic areas. All water samples - from a variety of source types (i.e. shallow and deep wells, springs, piped and surface water) - contained extremely low concentrations of nephrotoxic elements, and all were well below drinking water guideline values. Concentrations in individual urine samples were higher than, and uncorrelated with, those measured in drinking water, suggesting potential exposure from other sources. Mean urinary concentrations of these elements for individuals with clinically diagnosed CKDu were consistently lower than individuals without CKDu both in endemic and nonendemic areas. This likely stems from the inability of the kidney to excrete these toxic elements via urine in CKDu patients. Urinary concentrations of individuals were also found to be within the range of reference values measured in urine of healthy unexposed individuals from international biomonitoring studies, though these reference levels may not be safe for the Sri Lankan population. The results suggest that CKDu cannot be clearly linked with the presence of these contaminants in drinking water. There remains a need to investigate potential interactions of low doses of these elements (particularly Cd and As) with other risk factors that appear linked to CKDu, prior to developing public health strategies to address this illness.
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Affiliation(s)
- Tewodros Rango
- Division of Earth and Ocean Sciences, Nicholas School of the Environment, Duke University, Durham, NC, USA.
| | - Marc Jeuland
- Sanford School of Public Policy and Duke Global Health Institute, Duke University, Durham, NC, USA; Institute of Water Policy, National University of Singapore, Singapore
| | | | - Peter McCornick
- International Water Management Institute, Colombo, Sri Lanka
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136
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Laux TS, Barnoya J, Guerrero DR, Rothstein M. Dialysis enrollment patterns in Guatemala: evidence of the chronic kidney disease of non-traditional causes epidemic in Mesoamerica. BMC Nephrol 2015; 16:54. [PMID: 25881146 PMCID: PMC4406024 DOI: 10.1186/s12882-015-0049-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 04/01/2015] [Indexed: 12/15/2022] Open
Abstract
Background In western Nicaragua and El Salvador, chronic kidney disease (CKD) is highly prevalent and generally affects young, male, agricultural (usually sugar cane) workers without the established CKD risk factors. It is yet unknown if the prevalence of this CKD of Non-Traditional causes (CKDnT) extends to the northernmost Central American country, Guatemala. Therefore, we sought to compare dialysis enrollment rates by region, municipality, sex, daily temperature, and agricultural production in Guatemala and assess if there is a similar CKDnT distribution pattern as in Nicaragua and El Salvador. Methods The National Center for Chronic Kidney Disease Treatment (Unidad Nacional de Atención al Enfermo Renal Crónico) is the largest provider of dialysis in Guatemala. We used population, Human Development Index, literacy, and agricultural databases to assess the geographic, economic, and educational correlations with the National Center for Chronic Kidney Disease Treatment’s hemodialysis and peritoneal dialysis enrollment database. Enrollment rates (per 100 000) inhabitants were compared by region and mapped for comparison to regional agricultural and daytime temperature data. The distribution of men and women enrolled in dialysis were compared by region using Fisher’s exact tests. Spearman’s rank correlation coefficients were calculated. Results Dialysis enrollment is higher in the Southwest compared to the rest of the country where enrollees are more likely (p < 0.01) to be male (57.8%) compared to the rest of the country (49.3%). Dialysis enrollment positively correlates with Human Development Index and literacy rates. These correlations are weaker in the agricultural regions (predominantly sugar cane) of Southwest Guatemala. Conclusions In Guatemala, CKDnT incidence may have a similar geographic distribution as Nicaragua and El Salvador (higher in the high temperature and sugar cane growing regions). Therefore, it is likely that the CKNnT epidemic extends throughout the Mesoamerican region.
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Affiliation(s)
- Timothy S Laux
- Barnes-Jewish Hospital Department of Internal Medicine, St. Louis, MO, USA.,Department of Medicine, Division of Medical Education, Washington University School of Medicine, 660 South Euclid Avenue, Box 8121, St Louis, MO, 63110, USA
| | - Joaquin Barnoya
- Washington University in St Louis Division of Public Health Sciences, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Douglas R Guerrero
- Unidad Nacional de Atención al Enfermo Renal Crónico, 9a. Avenida 3-40 Zona 1, Ciudad de Guatemala, 01001, Guatemala, Guatemala
| | - Marcos Rothstein
- Division of Renal Diseases, Washington University in St. Louis, St. Louis, MO, USA.,Washington University School of Medicine, Division of Renal Diseases, 660 South Euclid Avenue, Campus Box 8126, St. Louis, MO, 63110, USA
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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.
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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
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138
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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.
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139
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Minnings K, Kerns E, Fiore M, Fiore M, Parekh RS, DuBois J, Isbell TS, Ferguson R, Fiore L. Chronic kidney disease prevalence in Rivas, Nicaragua: use of a field device for creatinine measurement. Clin Biochem 2015; 48:456-8. [PMID: 25617662 DOI: 10.1016/j.clinbiochem.2015.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/17/2014] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE An epidemic of chronic kidney disease (CKD) has been identified in Pacific coastal regions of Central America, and screening in the field in these low income countries remains logistically problematic. We tested the performance characteristics of a point of care creatinine analyzer compared to standardized serum creatinine measurements. METHODS Measurements were conducted in 100 persons from a local health center (n=34) and hospital (n=66) in Rivas, Nicaragua using both a point-of-care analyzer (StatSensor Xpress, Nova Biomedical) and serum creatinine by Jaffe kinetic method with a Roche Cobas Integra 400 analyzer. Percent coefficient of variation, sensitivity and specificity of the StatSensor Xpress were determined. RESULTS The average coefficient of variation (CV) was 1.28% for the serum creatinine and CV for the StatSensor Xpress analyzer was 6.8%. The median intra-individual creatinine results obtained with the StatSensor Xpress device were 0.32 mg/dL higher than those by serum creatinine by Jaffe kinetic method. The sensitivity and specificity of the StatSensor Xpress device for identifying subjects with abnormal creatinine (defined as >1.2 mg/dL) was 100% and 79%, respectively. CONCLUSIONS Point of care testing for creatinine demonstrated acceptable repeatability, excellent sensitivity (100%) and modest specificity (79%). Using the point of care testing will allow for generalized screening in the field in low income countries; however, confirmation for elevated levels >1.2 mg/dL will require a second laboratory test confirmation.
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Affiliation(s)
- Kailey Minnings
- University of Toronto Faculty of Medicine, 1 King's College Circle, Toronto, ON M52 1A8, Canada.
| | - Eric Kerns
- Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
| | - Melissa Fiore
- Boston VA Healthcare System, 150 S. Huntington Avenue, Boston, MA 02458, USA.
| | - Madeline Fiore
- University of Massachusetts School of Medicine, 55 N. Lake Avenue, Worcester, MA 01655, USA.
| | - Rulan S Parekh
- Hospital for Sick Children, University Health Network, University of Toronto, 555 University Ave., Toronto, ON M5G 1X8, Canada.
| | - Jeff DuBois
- Nova Biomedical, 200 Prospect Street, Waltham, MA 02453, USA.
| | - T Scott Isbell
- Saint Louis University School of Medicine, 1402 South Grand Boulevard, St. Louis, MO 63104, USA.
| | - Ryan Ferguson
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
| | - Louis Fiore
- Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
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140
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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.
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141
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Habib RR, Hojeij S, Elzein K. Gender in occupational health research of farmworkers: a systematic review. Am J Ind Med 2014; 57:1344-67. [PMID: 25227724 PMCID: PMC4257096 DOI: 10.1002/ajim.22375] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 01/06/2023]
Abstract
Background Farmwork is one of the most hazardous occupations for men and women. Research suggests sex/gender shapes hazardous workplace exposures and outcomes for farmworkers. This paper reviews the occupational health literature on farmworkers, assessing how gender is treated and interpreted in exposure-outcome studies. Methods The paper evaluates peer-reviewed articles on men and women farmworkers' health published between 2000 and 2012 in PubMed or SCOPUS. Articles were identified and analyzed for approaches toward sampling, data analysis, and use of exposure indicators in relation to sex/gender. Results 18% of articles reported on and interpreted sex/gender differences in health outcomes and exposures. Sex/gender dynamics often shaped health outcomes, yet adequate data was not collected on established sex/gender risk factors relating to study outcomes. Conclusion Research can better incorporate sex/gender analysis into design, analytical and interpretive approaches to better explore its mediation of health outcomes in light of emerging calls to mainstream gender research. Am. J. Ind. Med. 57:1344–1367, 2014. © 2014 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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Affiliation(s)
- Rima R. Habib
- Faculty of Health SciencesAmerican University of BeirutP.O.Box: 11‐0236 Riad El Solh1107 2020BeirutLebanon
| | - Safa Hojeij
- Faculty of Health SciencesAmerican University of BeirutP.O.Box: 11‐0236 Riad El Solh1107 2020BeirutLebanon
| | - Kareem Elzein
- Faculty of Health SciencesAmerican University of BeirutP.O.Box: 11‐0236 Riad El Solh1107 2020BeirutLebanon
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142
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Kong X, Ma X, Yao J, Zheng S, Cui M, Xu D. Hypovolaemia was associated with clustering of major cardiovascular risk factors in general population. BMC Cardiovasc Disord 2014; 14:151. [PMID: 25361538 PMCID: PMC4223830 DOI: 10.1186/1471-2261-14-151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/21/2014] [Indexed: 12/20/2022] Open
Abstract
Background Previous studies indicated that the clustering of major cardiovascular disease (CVD) risk factors is common, and multiple unhealthy lifestyles are responsible for the clustering of CVD risk factors. However, little is known about the direct association between the volume load and the clustering of CVD risk factors in general population. Methods We investigated the association of the clustering of CVD risk factors (defined as two or more of the following factors: hypertension, diabetes, dyslipidemia and overweight) with volume load, which was evaluated by bioelectrical impedance analysis. Hypovolaemia was defined as extracellular water/total body water (ECW/TBW) at and under the 10th percentile for the normal population. Results Among the 7900 adults, only 29.3% were free of any pre-defined CVD risk factors and 40.8% had clustering of CVD risk factors. Hypovolaemia in clustering group was statistically higher than that either in the single or in the none risk factor group, which was 23.7% vs. 17.0% and 10.0%, respectively (P <0.001). As a categorical outcome, the percentage of the lowest quartiles of ECW/TBW and TBW/TBWwatson in clustering group were statistically higher than either those in the single or in the none risk factor group, which were 44.9% vs. 36.9% and 25.1% (P <0.001), 36.2% vs. 32.2% and 25.0%, respectively (P <0.001). After adjusting of potential confounders, hypovolaemia was significantly associated with clustering of CVD risk factors, with an OR of 1.66 (95% CI, 1.45-1.90). Conclusions Hypovolaemia was associated with clustering of major CVD risk factors, which further confirms the importance of lifestyle for the development of CVD.
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Affiliation(s)
| | | | | | | | | | - Dongmei Xu
- Department of Nephrology, Qianfoshan Hospital, Shandong University, No,16766, Jingshi Road, Jinan 250014, PR China.
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143
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Correa-Rotter R, Wesseling C, Johnson RJ. In reply to 'Pesticides and the epidemic of CKD in Central America'. Am J Kidney Dis 2014; 64:477-8. [PMID: 25150855 DOI: 10.1053/j.ajkd.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ricardo Correa-Rotter
- National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
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Paula Santos U, Zanetta DMT, Terra-Filho M, Burdmann EA. Burnt sugarcane harvesting is associated with acute renal dysfunction. Kidney Int 2014; 87:792-9. [PMID: 25229334 DOI: 10.1038/ki.2014.306] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 12/18/2022]
Abstract
Sugarcane harvesting has been associated with an epidemic of chronic kidney disease in Central America mainly affecting previously healthy young workers. Repeated episodes of acute kidney dysfunction are hypothesized to be one of the possible mechanisms for this phenomenon. Therefore, this exploratory study aimed to assess the acute effects of burnt sugarcane harvesting on renal function among 28 healthy non-African Brazilian workers. Urine and blood samples were collected at the beginning and at the end of the harvesting season and before and at the end of a harvesting workday. All individuals decreased their estimated glomerular filtration rate by ∼20% at the end of the daily shift, and 18.5% presented with serum creatinine increases consistent with acute kidney injury. Those changes were associated with increased serum creatine phosphokinase (a known marker for exertional rhabdomyolysis) and oxidative stress-associated malondialdehyde levels, increased peripheral blood white cell counts, decreased urinary and serum sodium, decreased calculated fractional sodium excretion, and increased urine density. Thus, burnt sugarcane harvesting caused acute renal dysfunction in previously healthy workers. This was associated with a combination of dehydration, systemic inflammation, oxidative stress, and rhabdomyolysis.
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Affiliation(s)
- Ubiratan Paula Santos
- Pulmonary Division, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Dirce Maria T Zanetta
- Department of Epidemiology, University of São Paulo Public Health School, São Paulo, Brazil
| | - Mário Terra-Filho
- Pulmonary Division, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Emmanuel A Burdmann
- Medical Investigation Laboratory 12 (LIM-12), Division of Nephrology, University of São Paulo Medical School, São Paulo, Brazil
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145
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Cyclical dehydration-induced renal injury and Mesoamerican nephropathy: as sweet by any other name? Kidney Int 2014; 86:226-9. [DOI: 10.1038/ki.2014.47] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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146
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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.
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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
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148
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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.
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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
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149
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Affiliation(s)
- Nadine Bouby
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
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150
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Clark WF, Sontrop JM, Huang SH, Gallo K, Moist L, House AA, Weir MA, Garg AX. The chronic kidney disease Water Intake Trial (WIT): results from the pilot randomised controlled trial. BMJ Open 2013; 3:e003666. [PMID: 24362012 PMCID: PMC3884598 DOI: 10.1136/bmjopen-2013-003666] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Increased water intake may benefit kidney function. Prior to initiating a larger randomised controlled trial (RCT), we examined the safety and feasibility of asking adults with chronic kidney disease (CKD) to increase their water intake. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS Beginning in October 2012, we randomly assigned 29 adults with stage 3 CKD (estimated glomerular filtration rate (eGFR) 30-60 mL/min/1.73 m(2) and albuminuria) to one of the two groups of water intake: hydration (n=18) or standard (n=11). We asked the hydration group to increase their water intake by 1.0-1.5 L/day (in addition to usual intake, depending on sex and weight) for 6 weeks, while the control group carried on with their usual intake. Participants collected a 24 h urine sample at baseline and at 2 and 6 weeks after randomisation. Our primary outcome was the between-group difference in change in 24 h urine volume from baseline to 6 weeks. RESULTS (63%)of participants were men, 81% were Caucasians and the average age was 61 years (SD 14 years). The average baseline eGFR was 40 mL/min/1.73 m(2) (SD 11 mL/min/1.73 m(2)); the median albumin to creatinine ratio was 19 mg/mmol (IQR 6-74 mg/mmol). Between baseline and 6-week follow-up, the hydration group's average 24 h urine volume increased by 0.7 L/day (from 2.3 to 3.0 L/day) and the control group's 24 h urine decreased by 0.3 L/day (from 2.0 to 1.7 L/day; between-group difference in change: 0.9 L/day (95% CI 0.4 to 1.5; p=0.002)). We found no significant changes in urine, serum osmolality or electrolyte concentrations, or eGFR. No serious adverse events or changes in quality of life were reported. CONCLUSIONS A pilot RCT indicates adults with stage 3 CKD can successfully and safely increase water intake by up to 0.7 L/day in addition to usual fluid intake. TRIAL REGISTRATION REGISTERED WITH CLINICAL TRIALSGOVERNMENT IDENTIFIER: NCT01753466.
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Affiliation(s)
- William F Clark
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jessica M Sontrop
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Shih-Han Huang
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Kerri Gallo
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Louise Moist
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Andrew A House
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Matthew A Weir
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
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