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Hora M, Pontzer H, Wall-Scheffler CM, Sládek V. Dehydration and persistence hunting in Homo erectus. J Hum Evol 2020; 138:102682. [DOI: 10.1016/j.jhevol.2019.102682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 09/06/2019] [Accepted: 09/16/2019] [Indexed: 12/19/2022]
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O’Callaghan-Gordo C, Shivashankar R, Anand S, Ghosh S, Glaser J, Gupta R, Jakobsson K, Kondal D, Krishnan A, Mohan S, Mohan V, Nitsch D, P A P, Tandon N, Narayan KMV, Pearce N, Caplin B, Prabhakaran D. Prevalence of and risk factors for chronic kidney disease of unknown aetiology in India: secondary data analysis of three population-based cross-sectional studies. BMJ Open 2019; 9:e023353. [PMID: 30850400 PMCID: PMC6429742 DOI: 10.1136/bmjopen-2018-023353] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/26/2018] [Accepted: 01/04/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To assess whether chronic kidney disease of unknown aetiology (CKDu) is present in India and to identify risk factors for it using population-based data and standardised methods. DESIGN Secondary data analysis of three population-based cross-sectional studies conducted between 2010 and 2014. SETTING Urban and rural areas of Northern India (states of Delhi and Haryana) and Southern India (states of Tamil Nadu and Andhra Pradesh). PARTICIPANTS 12 500 individuals without diabetes, hypertension or heavy proteinuria. OUTCOME MEASURES Mean estimated glomerular filtration rate (eGFR) and prevalence of eGFR below 60 mL/min per 1.73 m2 (eGFR <60) in individuals without diabetes, hypertension or heavy proteinuria (proxy definition of CKDu). RESULTS The mean eGFR was 105.0±17.8 mL/min per 1.73 m2. The prevalence of eGFR <60 was 1.6% (95% CI=1.4 to 1.7), but this figure varied markedly between areas, being highest in rural areas of Southern Indian (4.8% (3.8 to 5.8)). In Northern India, older age was the only risk factor associated with lower mean eGFR and eGFR <60 (regression coefficient (95% CI)=-0.94 (0.97 to 0.91); OR (95% CI)=1.10 (1.08 to 1.11)). In Southern India, risk factors for lower mean eGFR and eGFR <60, respectively, were residence in a rural area (-7.78 (-8.69 to -6.86); 4.95 (2.61 to 9.39)), older age (-0.90 (-0.93 to -0.86); 1.06 (1.04 to 1.08)) and less education (-0.94 (-1.32 to -0.56); 0.67 (0.50 to 0.90) for each 5 years at school). CONCLUSIONS CKDu is present in India and is not confined to Central America and Sri Lanka. Identified risk factors are consistent with risk factors previously reported for CKDu in Central America and Sri Lanka.
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Affiliation(s)
- Cristina O’Callaghan-Gordo
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Roopa Shivashankar
- Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
| | - Shuchi Anand
- StanfordUniversity School of Medicine, Stanford, CA, USA
| | | | - Jason Glaser
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- LaIsla Network, Ada, Michigan, USA
| | - Ruby Gupta
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Kristina Jakobsson
- Occupationaland Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Occupationaland Environmental Medicine, Lund University, Lund, Sweden
| | - Dimple Kondal
- Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
| | - Anand Krishnan
- Centrefor Community Medicine, All India Institute of Medical Sciences, New Delhi, Haryana, India
| | - Sailesh Mohan
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Viswanathan Mohan
- Diabetes Research, Madras Diabetes Research Foundation, Chennai, India
- Dr.Mohan’s Diabetes Specialities Centre, Chennai, India
| | - Dorothea Nitsch
- Departmentof Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Praveen P A
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
- Departmentof Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Departmentof Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - K M Venkat Narayan
- EmoryGlobal Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Centrefor Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Centrefor Nephrology, University College London Medical School, London, UK
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, Haryana, India
- Centre for Control of Chronic Conditions (4Cs), New Delhi, Haryana, India
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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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Urinary Biomarkers KIM-1 and NGAL for Detection of Chronic Kidney Disease of Uncertain Etiology (CKDu) among Agricultural Communities in Sri Lanka. PLoS Negl Trop Dis 2016; 10:e0004979. [PMID: 27643785 PMCID: PMC5028052 DOI: 10.1371/journal.pntd.0004979] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/15/2016] [Indexed: 12/19/2022] Open
Abstract
Chronic Kidney Disease of uncertain etiology (CKDu) is an emerging epidemic among farming communities in rural Sri Lanka. Victims do not exhibit common causative factors, however, histopathological studies revealed that CKDu is a tubulointerstitial disease. Urine albumin or albumin-creatinine ratio is still being used as a traditional diagnostic tool to identify CKDu, but accuracy and prevalence data generated are questionable. Urinary biomarkers have been used in similar nephropathy and are widely recognised for their sensitivity, specificity and accuracy in determining CKDu and early renal injury. However, these biomarkers have never been used in diagnosing CKDu in Sri Lanka. Male farmers (n = 1734) were recruited from 4 regions in Sri Lanka i.e. Matara and Nuwara Eliya (farming locations with no CKDu prevalence) and two CKDu emerging locations from Hambantota District in Southern Sri Lanka; Angunakolapelessa (EL1) and Bandagiriya (EL2). Albuminuria (ACR ≥ 30mg/g); serum creatinine based estimation of glomerular filtration rate (eGFR); creatinine normalized urinary kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) were measured. Fourteen new CKDu cases (18%) from EL1 and nine CKDu cases (9%) from EL2 were recognized for the first time from EL1, EL2 locations, which were previously considered as non-endemic of the disease and associated with persistent albuminuria (ACR ≥ 30mg/g Cr). No CKDu cases were identified in non-endemic study locations in Matara (CM) and Nuwara Eliya (CN). Analysis of urinary biomarkers showed urinary KIM-1 and NGAL were significantly higher in new CKDu cases in EL1 and EL2. However, we also reported significantly higher KIM-1 and NGAL in apparently healthy farmers in EL 1 and EL 2 with comparison to both control groups. These observations may indicate possible early renal damage in absence of persistent albuminuria and potential capabilities of urinary KIM-1 and NGAL in early detection of renal injury among farming communities in Southern Sri Lanka.
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Ganguli A. Uddanam Nephropathy/Regional Nephropathy in India: Preliminary Findings and a Plea for Further Research. Am J Kidney Dis 2016; 68:344-8. [DOI: 10.1053/j.ajkd.2016.04.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/04/2016] [Indexed: 02/08/2023]
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Flores S, Rider AC, Alter HJ. Mesoamerican nephropathy: a novel case of kidney failure in a US ED. Am J Emerg Med 2016; 34:1323.e5-6. [DOI: 10.1016/j.ajem.2015.11.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/18/2015] [Indexed: 12/16/2022] Open
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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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Campese VM. The Mesoamerican nephropathy: a regional epidemic of chronic kidney disease? Nephrol Dial Transplant 2016; 31:335-6. [DOI: 10.1093/ndt/gfv430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/13/2022] Open
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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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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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