title: Prevalence of and risk factors for chronic kidney disease in rural Nicaragua.
abstract: BACKGROUND
  Mostly anecdotal reports describe a high prevalence of chronic kidney disease in northwestern Nicaragua, predominantly among younger men, resulting in substantial morbidity and mortality. The true prevalence, nature and aetiology of kidney disease in this region remain unknown.
  
  
  METHODS
  We performed a population-based prevalence study in Quezalguaque, Nicaragua to assess the frequency of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2), and compared the prevalence of reduced eGFR in Quezalguaque with the USA using the NHANES 1999-2006 data. We also conducted an embedded case-control study in a subset of participants to assess kidney disease risk factors.
  
  
  RESULTS
  From 1882 eligible households, 771 individuals from 300 households participated in the prevalence study, 98 (13%) of whom had reduced eGFR. Reduced eGFR was more common among older participants, men and participants living at lower altitudes. Among 18-29-year-old participants, 2.6% had reduced eGFR, and among 30-41-year-old participants, 7.4% had reduced eGFR; this compares with 0.2% and 0.8%, respectively, in NHANES. No individuals in these age groups were diabetic. Among cases, only 27% had dipstick proteinuria of 1+ or greater, compared with 7% of controls. Haematuria did not significantly differ between cases and controls (24% versus 18%). In age- and sex-adjusted models, hypertension and residence at lower altitude were independently associated with reduced eGFR, while occupational history was not associated with reduced eGFR.
  
  
  CONCLUSIONS
  Kidney disease appears common in residents of Quezalguaque, Nicaragua, particularly in younger men, with features most consistent with tubulointerstitial disease. Further research is needed to elucidate the causes of kidney disease in this region.
authors.affiliation: ASPH/CDC Allan Rosenfield Global Health Fellowship Program, Washington, DC, USA.
authors.forename: Julie K
authors.initials: JK
authors.lastname: O'Donnell
authors.forename: Matthew
authors.initials: M
authors.lastname: Tobey
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Stevens
authors.forename: Sarah
authors.initials: S
authors.lastname: Johnson
authors.forename: Peter
authors.initials: P
authors.lastname: Stringham
authors.forename: Bruce
authors.initials: B
authors.lastname: Cohen
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Brooks
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009527:Nicaragua / Q000453:epidemiology; D009749:Nutrition Surveys; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012423:Rural Health; D015996:Survival Rate; D055815:Young Adult