title: Risk factors for reduced glomerular filtration rate in a Nicaraguan community affected by Mesoamerican nephropathy.
abstract: Mesoamerican nephropathy, also known as chronic kidney disease of unknown etiology, is widespread in Pacific coastal Central America. The cause of the epidemic is unknown, but the disease may be linked to multiple factors, including diet as well as environmental and occupational exposures. As many as 50% of men in some communities have Mesoamerican nephropathy.
  
  
  
  Describe prevalence of reduced glomerular filtration rate in a region of Nicaragua suspected to harbor high rates of Mesoamerican nephropathy; and investigate potential risk factors for such reduction associated with agricultural work (such as pesticide exposure and specific agricultural tasks associated with increased heat stress); sugar consumption; and traditional factors such as age, sex, diabetes, hypertension and nephrotoxic medication use.
  
  
  
  This study uses a cross-sectional design with nested case-control analysis. Cases were individuals with estimated glomerular filtration rates of <60mL/min/1.73m2 and controls were individuals with those >90mL/min/1.73m2, estimated using serum creatinine. Data on nutrition, past medical history, medication and substance use, and agricultural behaviors and exposures were collected using medical questionnaires from June through August, 2012. Venous blood and urine samples were collected to assess hemoglobin A1c, and dipstick proteinuria, respectively; anthropometry and blood pressure measurements were made using standard techniques. Analyses were conducted using chi square, and univariate and multiple logistic regression.
  
  
  
  Of 424 individuals in the study, 151 had an occupational history in agriculture. Prevalence of glomerular filtration rate <60mL/min/1.73m2 was 9.8% among women and 41.9% among men (male to female ratio = 4.3, p<0.0001). Proteinuria =300 mg/dL was observed in <10% of participants with decreased glomerular filtration rate. Hemoglobin A1c and use of NSAIDs were not associated with decreased glomerular filtration rate. Although systolic and diastolic blood pressure was higher among participants with decreased glomerular filtration rate (p <0.001), hypertension was uncommon. Significant agricultural risk factors for reduced glomerular filtration rate included increased lifetime days cutting sugarcane during the dry season (OR 5.86, 95% CI 2.45-14.01), nondeliberate pesticide inhalation (OR 3.31, 95% CI 1.32-8.31), and sugarcane chewing (OR 3.24, 95% CI 1.39-7.58).
  
  
  
  Our findings demonstrate a high prevalence of chronic kidney disease not linked to traditional risk factors, and suggest it may be associated instead with occupational exposure to heat stress in conjunction with pesticide inhalation, sugarcane chewing and sugar intake during the workday.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, USA. nathan.raines@mssm.edu.
authors.forename: Nathan
authors.initials: N
authors.lastname: Raines
authors.forename: Marvin
authors.initials: M
authors.lastname: González
authors.forename: Christina
authors.initials: C
authors.lastname: Wyatt
authors.forename: Mark
authors.initials: M
authors.lastname: Kurzrok
authors.forename: Christopher
authors.initials: C
authors.lastname: Pool
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lemma
authors.forename: Ilana
authors.initials: I
authors.lastname: Weiss
authors.forename: Carlos
authors.initials: C
authors.lastname: Marín
authors.forename: Valerio
authors.initials: V
authors.lastname: Prado
authors.forename: Eugenia
authors.initials: E
authors.lastname: Marcas
authors.forename: Karina
authors.initials: K
authors.lastname: Mayorga
authors.forename: Jean Franco
authors.initials: JF
authors.lastname: Morales
authors.forename: Aurora
authors.initials: A
authors.lastname: Aragón
authors.forename: Perry
authors.initials: P
authors.lastname: Sheffield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000383:Agriculture; D016573:Agrochemicals / Q000506:poisoning*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D004781:Environmental Exposure / Q000009:adverse effects; D005247:Feeding Behavior; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009527:Nicaragua / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D011507:Proteinuria / Q000652:urine; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000150:complications*; D055815:Young Adult
chemical_list: D016573:Agrochemicals; D015415:Biomarkers; D003404:Creatinine