title: Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is found at epidemic levels in certain populations of the Pacific Coast in northwestern Nicaragua especially in younger men. There are knowledge gaps concerning CKD's prevalence in regions at higher altitudes.
  
  
  METHODS
  A cross-sectional study of adults between the ages of 20 and 60 years in 1 coffee-growing village in Nicaragua located at 1,000 m above sea level (MASL) altitude was performed. Predictors included participant sex, age, occupation, conventional CKD risk factors and other factors associated with CKD suggested by previous surveys in Central America. Outcomes included serum creatinine (SCr) values >1.2 mg/dL for men and >0.9 mg/dL for women, estimated glomerular filtration rate (GFR) <60 ml/min per 1.73 m2, dipstick proteinuria stratified as microalbuminuria (30-300 mg/dL) and macroalbuminuria (>300 mg/dL), hypertension and body mass index.
  
  
  RESULTS
  Of 324 eligible participants, 293 were interviewed (90.4%), and 267 of those received the physical exam (82.4% overall). Of the sample, 45% were men. Prevalence rate of estimated GFR <60 ml/min per 1.73 m2 was 0 for men (0%) and 2 for women (1.4%). The prevalence of at least microalbuminuria was significantly higher among men compared with women (27.5% vs. 21.4%, respectively; p=0.02).
  
  
  CONCLUSIONS
  The CKD prevalence in this village is comparable to a previously studied Nicaraguan coffee-farming region and much lower than previously screened portions of northwestern Nicaragua. There is heterogeneity in CKD prevalence across Nicaragua. At this time, screenings should target individuals living in previously identified, higher risk regions. More work is needed to understand determinants of CKD in this resource-poor nation.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. TL1174@hotmail.com
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Laux
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Bert
authors.forename: Gerardo M
authors.initials: GM
authors.lastname: Barreto Ruiz
authors.forename: Marvin
authors.initials: M
authors.lastname: González
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
authors.forename: Aurora
authors.initials: A
authors.lastname: Aragon
authors.forename: Cecilia
authors.initials: C
authors.lastname: Torres Lacourt
mesh_terms: D000328:Adult; D000383:Agriculture; D000419:Albuminuria / Q000453:epidemiology; D000531:Altitude; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002908:Chronic Disease; D040503:Coffea; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006306:Health Surveys; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009527:Nicaragua / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health; D012737:Sex Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003404:Creatinine