title: Positive association of renal insufficiency with agriculture employment and unregulated alcohol consumption in Nicaragua.
abstract: OBJECTIVE
  Endemic renal insufficiency (RI) of unknown etiology is a major public health issue with high mortality in the Pacific coastal regions of Central America. We studied RI in León and Chinandega, Nicaragua, evaluating associations with known risk factors and hypothesized exposures.
  
  
  METHODS
  A cross-sectional survey was conducted with assessment of medical, social, and occupational history and exposures in conjunction with measurement of serum creatinine. Cases were defined by an estimated glomerular filtration rate (eGFR) <or=60 mL/min/1.73 m(2) using the modified four-variable Modification of Diet in Renal Disease (MDRD) study equation for non-African Americans. Logistic regression models controlling for known risk factors of kidney disease were used to evaluate associations between exposures and RI.
  
  
  RESULTS
  A total of 124 RI cases were compared to 873 persons without RI. Cases had no significant differences in the odds of having a systolic blood pressure (SBP) > 140 or diastolic blood pressure (DBP) > 90 mmHg, or in reporting diabetes. Agricultural labor was associated with RI (OR = 2.48, 95%CI: 1.59, 3.89, p < 0.0001). There was no association with agricultural non-field work (OR = 0.91, 95%CI: 0.60, 1.38, p = 0.65). Consumption of unregulated alcohol ("lija") was associated with RI (OR = 2.10, 95%CI: 1.31, 3.39, p = 0.0023), as was drinking 5 L or more of water per day (OR = 3.59 vs. 1 L 95%CI: 1.52, 4.46, p = 0.0035).
  
  
  CONCLUSIONS
  Agricultural field labor and lija consumption were associated with RI in this region. Water intake may also be important. Identifying specific risk factors for RI within these exposures, such as individual pesticides or lija ingredients, may facilitate prevention in a setting where dialysis and transplantation are limited.
authors.affiliation: Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Sanoff
authors.forename: Luis
authors.initials: L
authors.lastname: Callejas
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Alonso
authors.forename: Yichun
authors.initials: Y
authors.lastname: Hu
authors.forename: Romulo E
authors.initials: RE
authors.lastname: Colindres
authors.forename: Hyunsook
authors.initials: H
authors.lastname: Chin
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Morgan
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hogan
mesh_terms: D000328:Adult; D000382:Agricultural Workers' Diseases / Q000453:epidemiology* / Q000209:etiology; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009527:Nicaragua; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000209:etiology