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Mendoza-Cano O, Lugo-Radillo A, Ríos-Silva M, Gonzalez-Curiel IE, Bricio-Barrios JA, Camacho-delaCruz AA, Romo-García MF, Cuevas-Arellano HB, Quintanilla-Montoya AL, Solano-Barajas R, Uribe-Ramos JM, García-Solórzano LA, Hilerio-López ÁG, Solano-Mendoza AA, Danis-Romero R, Murillo-Zamora E. Exploring Heavy Metal and Metalloid Exposure in Children: A Pilot Biomonitoring Study near a Sugarcane Mill. TOXICS 2024; 12:426. [PMID: 38922106 PMCID: PMC11209603 DOI: 10.3390/toxics12060426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 06/27/2024]
Abstract
Sugarcane production has been linked to the release of heavy metals and metalloids (HM/MTs) into the environment, raising concerns about potential health risks. This study aimed to assess the levels of 19 HM/MTs in children living near a sugarcane mill through a pilot biomonitoring investigation. We investigated sex-related differences in these element levels and their correlations. A cross-sectional study was conducted, analyzing data from 20 children in the latter part of 2023. Spearman correlation coefficients with 95% confidence intervals (CIs) were used to assess the relationships between urinary HM/MT levels. Detectable levels of 17 out of the 19 HM/MTs were found across the entire study sample, with arsenic and copper detectable in 95% of the children. Titanium exhibited higher levels in boys compared to girls (p = 0.017). We identified 56 statistically significant correlations, with 51 of them being positive, while the remaining coefficients indicated negative relationships. This study characterized HM/MT levels in school-aged children residing near a sugarcane mill through a pilot biomonitoring investigation. Further research employing larger sample sizes and longitudinal assessments would enhance our understanding of the dynamics and health impacts of HM/MT exposure in this vulnerable population.
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Affiliation(s)
- Oliver Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, Carretera Colima-Coquimatlán km 9, Col. Jardines del Llano, Coquimatlán 28400, Mexico
| | - Agustin Lugo-Radillo
- CONAHCyT-Facultad de Medicina y Cirugía, Universidad Autónoma Benito Juárez de Oaxaca, Ex Hacienda Aguilera S/N, Carr. a San Felipe del Agua, Oaxaca 68020, Mexico
| | - Mónica Ríos-Silva
- Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Col. Las Víboras, Colima 28040, Mexico
| | - Irma Elizabeth Gonzalez-Curiel
- Laboratorio de Inmunotoxicología, Unidad Académica de Ciencias Químicas, Universidad Autónoma de Zacatecas, Campus UAZ siglo XXI, Carretera Zacatecas-Guadalajara km 6, Col. Ejido La Escondida, Zacatecas 98160, Mexico
| | | | - Arlette A. Camacho-delaCruz
- Facultad de Ingeniería Civil, Universidad de Colima, Carretera Colima-Coquimatlán km 9, Col. Jardines del Llano, Coquimatlán 28400, Mexico
| | - María Fernanda Romo-García
- Laboratorio de Inmunotoxicología, Unidad Académica de Ciencias Químicas, Universidad Autónoma de Zacatecas, Campus UAZ siglo XXI, Carretera Zacatecas-Guadalajara km 6, Col. Ejido La Escondida, Zacatecas 98160, Mexico
| | | | - Ana Luz Quintanilla-Montoya
- Facultad de Ingeniería Civil, Universidad de Colima, Carretera Colima-Coquimatlán km 9, Col. Jardines del Llano, Coquimatlán 28400, Mexico
| | - Ramón Solano-Barajas
- Facultad de Ingeniería Civil, Universidad de Colima, Carretera Colima-Coquimatlán km 9, Col. Jardines del Llano, Coquimatlán 28400, Mexico
| | - Juan Manuel Uribe-Ramos
- Facultad de Ingeniería Civil, Universidad de Colima, Carretera Colima-Coquimatlán km 9, Col. Jardines del Llano, Coquimatlán 28400, Mexico
| | - Luis A. García-Solórzano
- Tecnológico Nacional de México, Campus Colima, Av. Tecnológico No. 1, Villa de Álvarez 28976, Mexico
| | | | - Alma Alejandra Solano-Mendoza
- Departamento de Medicina Interna, Hospital Civil de Guadalajara “Juan I. Menchaca”, Universidad de Guadalajara, Salvador Quevedo y Zubieta 750, Col. Independencia Oriente, Guadalajara 44340, Mexico
| | - Rogelio Danis-Romero
- Departamento de Pediatría, Hospital General Regional No. 1, Instituto Mexicano del Seguro Social, Av. 5 de Febrero 102, Col. Centro, Santiago de Querétaro 76000, Mexico
| | - Efrén Murillo-Zamora
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli 250, Col. El Haya, Villa de Álvarez 28984, Mexico
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Castro-Mejía MA, Saldaña-Villanueva K, Méndez-Rodríguez KB, Ortega-Romero M, Barbier OC, Pérez-Vázquez FJ. Evaluation of renal function in precarious workers exposed to heavy metals in vulnerable scenarios in the metropolitan area of San Luis Potosí, México. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2024; 106:104350. [PMID: 38154760 DOI: 10.1016/j.etap.2023.104350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
The aim of the study was to evaluate renal function in three groups of precarious workers: garbage recyclers (REC), quarry workers (CAN), and brick makers (LAD). Samples of urine and blood were collected to evaluate clinical parameters and the metal levels in urine was measured using ICP-MS. REC group had the highest concentrations of chromium in urine (36.03 ± 27.2 µg/l) compared to CAN and LAD groups. Mercury concentrations were higher in the LAD group (3.7 ± 0.8 µg/l). Additionally, arsenic was detected in both CAN and REC groups (25.4 ± 26.2 and 19.09 ± 16.7 µg/l, respectively), while arsenic concentrations in LAD were higher (47.2 ± 30.8 µg/l). In kidney biomarkers, β2-microglobulin concentrations were higher in the REC group (87867 ± 115159.5 ng/g UCr). Similarly, cystatin-C concentrations were higher in the REC group (32795.61 ± 34965.8 ng/g UCr). The data suggests that precarious workers are exposed to heavy metals and have elevated protein levels that contribute to kidney damage.
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Affiliation(s)
- Mariana Alejandra Castro-Mejía
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Kelvin Saldaña-Villanueva
- CONAHCyT Research Fellow, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, Unidad Noreste (CIATEJ), Nuevo León, México
| | - Karen Beatriz Méndez-Rodríguez
- CONAHCyT Research Fellow, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Manolo Ortega-Romero
- Unidad de Investigación en Nefrología y Metabolismo Mineral Óseo. Hospital Infantil de México Federico Gómez, Ciudad de Mexico, Mexico
| | - Olivier C Barbier
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | - Francisco Javier Pérez-Vázquez
- CONAHCyT Research Fellow, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.
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Tannor EK, Chika OU, Okpechi IG. The Impact of Low Socioeconomic Status on Progression of Chronic Kidney Disease in Low- and Lower Middle-Income Countries. Semin Nephrol 2022; 42:151338. [DOI: 10.1016/j.semnephrol.2023.151338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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El Khayat M, Halwani DA, Hneiny L, Alameddine I, Haidar MA, Habib RR. Impacts of Climate Change and Heat Stress on Farmworkers' Health: A Scoping Review. Front Public Health 2022; 10:782811. [PMID: 35211437 PMCID: PMC8861180 DOI: 10.3389/fpubh.2022.782811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/10/2022] [Indexed: 01/27/2023] Open
Abstract
Due to the continuous rise of global temperatures and heatwaves worldwide as a result of climate change, concerns for the health and safety of working populations have increased. Workers in the food production chain, particularly farmworkers, are especially vulnerable to heat stress due to the strenuous nature of their work, which is performed primarily outdoors under poor working conditions. At the cross-section of climate change and farmworkers' health, a scoping review was undertaken to summarize the existing knowledge regarding the health impacts associated with climate change and heat stress, guide future research toward better understanding current and future climate change risks, and inform policies to protect the health and safety of agricultural workers. A systematic search of 5 electronic databases and gray literature websites was conducted to identify relevant literature published up until December 2021. A total of 9045 records were retrieved from the searches, of which 92 articles were included in the final review. The majority of the reviewed articles focused on heat-related illnesses (n = 57) and kidney diseases (n = 28). The risk factors identified in the reviewed studies included gender, dehydration, heat strain, wearing inappropriate clothing, workload, piece-rate payment, job decision latitude, and hot environmental conditions. On the other hand, various protective and preventive factors were identified including drinking water, changing work hours and schedule of activities, wearing appropriate clothing, reducing soda consumption, taking breaks in shaded or air-conditioned areas, and increasing electrolyte consumption in addition to improving access to medical care. This review also identified various factors that are unique to vulnerable agricultural populations, including migrant and child farmworkers. Our findings call for an urgent need to expand future research on vulnerable agricultural communities including migrant workers so as to develop effective policies and interventions that can protect these communities from the effects of heat stress.
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Affiliation(s)
- Moussa El Khayat
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dana A. Halwani
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Layal Hneiny
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Ibrahim Alameddine
- Department of Civil and Environmental Engineering, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
| | - Mustapha A. Haidar
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima R. Habib
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Aseneh JB, Kemah BLA, Mabouna S, Njang ME, Ekane DSM, Agbor VN. Chronic kidney disease in Cameroon: a scoping review. BMC Nephrol 2020; 21:409. [PMID: 32967645 PMCID: PMC7510319 DOI: 10.1186/s12882-020-02072-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This scoping review sought to summarize available data on the prevalence, associated factors, etiology, comorbidities, treatment, cost and mortality of chronic kidney disease (CKD) in Cameroon. METHODS We searched PubMed, Scopus and African Journals Online from database inception to 31 March, 2020 to identify all studies published on the prevalence, associated factors, etiology, comorbidities, treatment, cost and mortality of CKD in Cameroon. RESULTS Thirty studies were included. The prevalence of CKD varied from 3 to 14.1 and 10.0%-14.2% in rural and urban areas, respectively. The prevalence of CKD in patients with hypertension, diabetes mellitus, and human immunodeficiency virus was 12.4-50.0, 18.5%, and 3.0-47.2%, respectively. Hypertension (22.3-59.1%), chronic glomerulonephritis (15.8-56.2%), and diabetes mellitus (15.8-56.2%) were the most common causes of CKD. The cause was unknown in 13.5-17.0% of the cases. Advanced age, hypertension, diabetes mellitus, and obesity were frequent associated factors. Hemodialysis was the main treatment modality in patients with End Stage Renal Disease (ESRD). The monthly cost of management of non-dialyzed CKD was 163 US dollars. The one-year mortality rate of ESRD was 26.8-38.6%. CONCLUSION Chronic kidney disease affects about one in 10 adults in the general population in Cameroon. Patients with hypertension, diabetes mellitus, and human immunodeficiency virus bear the greatest burden of CKD in Cameroon. Advanced age, hypertension, diabetes mellitus, and obesity are major factors associated with CKD. Chronic kidney disease in Cameroon is associated with high morbidity and mortality and huge economic cost on the patient.
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Affiliation(s)
- Jerry Brown Aseneh
- Department of Health Research, Health Education and Research Organization (HERO), Buea, Cameroon
- Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon
| | - Ben-Lawrence A. Kemah
- Department of Health Research, Health Education and Research Organization (HERO), Buea, Cameroon
- Royal Stoke University Hospital, England, UK
| | - Stephane Mabouna
- Department of Health Research, Health Education and Research Organization (HERO), Buea, Cameroon
| | - Mbeng Emmanuel Njang
- Department of Health Research, Health Education and Research Organization (HERO), Buea, Cameroon
- Fundong District Hospital, Fundong, Cameroon
| | - Domin Sone Majunda Ekane
- Department of Health Research, Health Education and Research Organization (HERO), Buea, Cameroon
- Katholieke Universiteit Leuven, School of Economics and Business, Campus Brussels, Belgium
| | - Valirie Ndip Agbor
- Department of Health Research, Health Education and Research Organization (HERO), Buea, Cameroon
- Nuffield Department of Population Health, University of Oxford, England, UK
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Abstract
Chronic kidney disease increasingly is being recognized as an important global public health problem. Interindividual susceptibility to kidney disease is high and likely is dependent on risk modulation through genetics, fetal and early childhood development, environmental circumstances, and comorbidities. Traditionally, the chronic kidney disease burden has been ascribed largely to hypertension and diabetes. Increasingly, evidence is accumulating that nontraditional risk factors may predominate in some regions and populations, contributing to epidemics of kidney disease. Such nontraditional risk factors include environmental exposures, traditional medicines, fetal and maternal factors, infections, kidney stones, and acute kidney injury. Genetic factors may predispose patients to chronic kidney disease in some populations. Chronic kidney disease of unknown origin has its epicenters in Central America and South Asia. Such clustering of CKD may represent either genetic or environmentally driven kidney disease, or combinations of both. Developmental conditions impacting kidney development often are related to poverty and structural factors that persist throughout life. In this article, we explore the possibilities that genetic and developmental factors may be important contributors to the epidemics in these regions and suggest that optimization of factors impacting kidney development hold promise to reduce the risk of kidney disease in future generations.
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Affiliation(s)
- David Friedman
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Valerie A Luyckx
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Institute for Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.
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Fabian J, George JA, Etheredge HR, van Deventer M, Kalyesubula R, Wade AN, Tomlinson LA, Tollman S, Naicker S. Methods and reporting of kidney function: a systematic review of studies from sub-Saharan Africa. Clin Kidney J 2019; 12:778-787. [PMID: 31807291 PMCID: PMC6885675 DOI: 10.1093/ckj/sfz089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 01/01/2023] Open
Abstract
Globally, chronic kidney disease (CKD) is an emerging public health challenge but accurate data on its true prevalence are scarce, particularly in poorly resourced regions such as sub-Saharan Africa (SSA). Limited funding for population-based studies, poor laboratory infrastructure and the absence of a validated estimating equation for kidney function in Africans are contributing factors. Consequently, most available studies used to estimate population prevalence are hospital-based, with small samples of participants who are at high risk for kidney disease. While serum creatinine is most commonly used to estimate glomerular filtration, there is considerable potential bias in the measurement of creatinine that might lead to inaccurate estimates of kidney disease at individual and population level. To address this, the Laboratory Working Group of the National Kidney Disease Education Program published recommendations in 2006 to standardize the laboratory measurement of creatinine. The primary objective of this review was to appraise implementation of these recommendations in studies conducted in SSA after 2006. Secondary objectives were to assess bias relating to choice of estimating equations for assessing glomerular function in Africans and to evaluate use of recommended diagnostic criteria for CKD. This study was registered with Prospero (CRD42017068151), and using PubMed, African Journals Online and Web of Science, 5845 abstracts were reviewed and 252 full-text articles included for narrative analysis. Overall, two-thirds of studies did not report laboratory methods for creatinine measurement and just over 80% did not report whether their creatinine measurement was isotope dilution mass spectroscopy (IDMS) traceable. For those reporting a method, Jaffe was the most common (93%). The four-variable Modification of Diet in Renal Disease (4-v MDRD) equation was most frequently used (42%), followed by the CKD Epidemiology Collaboration (CKD-EPI) equation for creatinine (26%). For the 4-v MDRD equation and CKD-EPI equations, respectively, one-third to one half of studies clarified use of the coefficient for African-American (AA) ethnicity. When reporting CKD prevalence, <15% of studies fulfilled Kidney Disease: Improving Global Outcomes criteria and even fewer used a population-based sample. Six studies compared performance of estimating equations to measured glomerular filtration rate (GFR) demonstrating that coefficients for AA ethnicity used in the 4-v MDRD and the CKD-EPI equations overestimated GFR in Africans. To improve on reporting in future studies, we propose an 'easy to use' checklist that will standardize reporting of kidney function and improve the quality of studies in the region. This research contributes some understanding of the factors requiring attention to ensure accurate assessment of the burden of kidney disease in SSA. Many of these factors are difficult to address and extend beyond individual researchers to health systems and governmental policy, but understanding the burden of kidney disease is a critical first step to informing an integrated public health response that would provide appropriate screening, prevention and management of kidney disease in countries from SSA. This is particularly relevant as CKD is a common pathway in both infectious and non-communicable diseases, and multimorbidity is now commonplace, and even more so when those living with severe kidney disease have limited or no access to renal replacement therapy.
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Affiliation(s)
- June Fabian
- Wits Donald Gordon Medical Centre, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Services, University of Witwatersrand, Johannesburg, South Africa
| | - Harriet R Etheredge
- Wits Donald Gordon Medical Centre, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Manuel van Deventer
- Department of Chemical Pathology, National Health Laboratory Services, University of Witwatersrand, Johannesburg, South Africa
- Lancet Laboratories, Johannesburg, South Africa
| | - Robert Kalyesubula
- Medical Research Council/UVRI, London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
- Department of Internal Medicine and Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alisha N Wade
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laurie A Tomlinson
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) Network, Accra, Ghana
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gonzalez-Quiroz M, Nitsch D, Hamilton S, O'Callaghan Gordo C, Saran R, Glaser J, Correa-Rotter R, Jakobsson K, Singh A, Gunawardena N, Levin A, Remuzzi G, Caplin B, Pearce N. Rationale and population-based prospective cohort protocol for the disadvantaged populations at risk of decline in eGFR (CO-DEGREE). BMJ Open 2019; 9:e031169. [PMID: 31551387 PMCID: PMC6773312 DOI: 10.1136/bmjopen-2019-031169] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A recently recognised form of chronic kidney disease (CKD) of unknown origin (CKDu) is afflicting communities, mostly in rural areas in several regions of the world. Prevalence studies are being conducted in a number of countries, using a standardised protocol, to estimate the distribution of estimated glomerular filtration rate (eGFR), and thus identify communities with a high prevalence of reduced glomerular filtration rate (GFR). In this paper, we propose a standardised minimum protocol for cohort studies in high-risk communities aimed at investigating the incidence of, and risk factors for, early kidney dysfunction. METHODS AND ANALYSIS This generic cohort protocol provides the information to establish a prospective population-based cohort study in low-income settings with a high prevalence of CKDu. This involves a baseline survey that included key elements from the DEGREE survey (eg, using the previously published DEGREE methodology) of a population-representative sample, and subsequent follow-up visits in young adults (without a pre-existing diagnosis of CKD (eGFR<60 mL/min/1.73m2), proteinuria or risk factors for CKD at baseline) over several years. Each visit involves a core questionnaire, and collection and storage of biological samples. Local capacity to measure serum creatinine will be required so that immediate feedback on kidney function can be provided to participants. After completion of follow-up, repeat measures of creatinine should be conducted in a central laboratory, using reference standards traceable to isotope dilution mass spectrometry (IDMS) quality control material to quantify the main outcome of eGFR decline over time, alongside a description of the early evolution of disease and risk factors for eGFR decline. ETHICS AND DISSEMINATION Ethical approval will be obtained by local researchers, and participants will provide informed consent before the study commences. Participants will typically receive feedback and advice on their laboratory results, and referral to a local health system where appropriate.
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Affiliation(s)
- Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
- Centre for Nephrology, University College London, London, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Hamilton
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Cristina O'Callaghan Gordo
- Campus Mar, Instituto de Salud Global Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Rajiv Saran
- Division of Nephrology, Department of Internal Medicine & Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Kristina Jakobsson
- Department of Public Health and Community Medicine, Insitute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Ajay Singh
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Adeera Levin
- Division of Nepohrology UBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Giuseppe Remuzzi
- Instituto di Ricerche Farmacologiche Mario Negri - IRCCS, Milan, Italy
| | - Ben Caplin
- Centre for Nephrology, University College London, London, UK
| | - Neil Pearce
- Deparment of Medical Statistics and Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
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9
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Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) can cluster in geographic locations or in people of particular genetic ancestries. We explore APOL1 nephropathy and Balkan nephropathy as examples of CKD clustering that illustrate genetics and environment conspiring to cause high rates of kidney disease. Unexplained hotspots of kidney disease in Asia and Central America are then considered from the perspective of potential gene × environment interactions. RECENT FINDINGS We report on evidence supporting both genes and environment in these CKD hotspots. Differing genetic susceptibility between populations and within populations may explain why causal environmental risk factors have been so hard to identify conclusively. Similarly, one cannot explain why these epidemics of kidney disease are happening now without invoking environmental changes. SUMMARY Approaches to these CKD hotspots are of necessity becoming more holistic. Genetic studies may help us identify the environmental triggers by teaching us about disease biology and may empower environmental risk factor studies by allowing for stratification of study participants by genetic susceptibility.
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Griffin BR, Butler-Dawson J, Dally M, Krisher L, Cruz A, Weitzenkamp D, Sorensen C, Tenney L, Johnson RJ, Newman LS. Unadjusted point of care creatinine results overestimate acute kidney injury incidence during field testing in Guatemala. PLoS One 2018; 13:e0204614. [PMID: 30261074 PMCID: PMC6160126 DOI: 10.1371/journal.pone.0204614] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/11/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Acute kidney injury (AKI) occurs at high rates among agricultural workers (12-33%) in tropical environments. Because of the remote locations affected, traditional laboratory services are often unavailable. In this study we compare point of care (POC) creatinine values to standardized laboratory values, and examine the effect of POC testing on the interpretation of AKI rates under tropical field conditions. METHODS Blood samples were collected from 104 sugarcane workers from two time points in January 2018 as a derivation cohort, and from 105 workers from February to April 2017 as a validation cohort. Finger stick and venipuncture samples were drawn at the end of a worker's shift to measure creatinine. Laboratory samples were tested in Guatemala City, Guatemala, in duplicate using the Jaffe Generation 2 method. An adjustment factor to improve agreement with serum creatinine was statistically derived and validated, and then used to determine impact on observed rates of acute kidney injury based on across shift changes in creatinine. RESULTS POC creatinine and serum creatinine measures showed that POC consistently overestimated the creatinine by an average of 22% (95% CI: 19.8%, 24.7%) and the disagreement appeared greater at higher values of serum creatinine. An adjustment factor of 0.7775 was applied, which led to significantly greater agreement between the two measures. Rates of AKI in the two combined groups fell from 72% before adjustment to 57% afterwards. CONCLUSIONS POC testing under tropical field conditions routinely overestimates creatinine compared to laboratory testing, which leads to overestimation of rates of acute kidney injury. The application of an adjustment factor significantly improved the accuracy of the POC value.
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Affiliation(s)
- Benjamin R. Griffin
- Division of Renal Diseases and Hypertension/Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Jaime Butler-Dawson
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Lyndsay Krisher
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Alex Cruz
- Pantaleon, Guatemala City, Guatemala
| | - David Weitzenkamp
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Cecilia Sorensen
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Emergency Medicine, School of Medicine, University of Colorado Denver, Aurora, CO, United States of America
| | - Liliana Tenney
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension/Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Lee S. Newman
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Colorado Consortium on Climate Change and Human Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
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11
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Selby NM. Acute kidney injury changes with the seasons. Nephrol Dial Transplant 2018; 33:1281-1283. [PMID: 29635645 DOI: 10.1093/ndt/gfy070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/03/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nicholas M Selby
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Renal Medicine, Royal Derby Hospital, Derby, UK
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