Epidemiological characteristics of chronic kidney disease of non-traditional causes in women of agricultural communities of El Salvador.
BACKGROUND
In El Salvador end-stage renal disease (ESRD) was the first cause of hospital mortality overall, the first cause of hospital deaths in men, and the fifth cause of hospital mortality in women in 2013. In agricultural communities, chronic kidney disease (CKD) occurs predominantly in male agricultural workers, but it also affects women to a lesser degree, even those who are not involved in agricultural work. Internationally, most epidemiological CKD studies emphasize men and no epidemiological studies focused exclusively on women.


OBJECTIVE
To describe the epidemiological characteristics of CKD in females in agricultural communities of El Salvador.


METHODS
A cross-sectional epidemiological study was carried out in 2009 - 2011 based on active screening for CKD and risk factors in women aged ≥ 18 years in 3 disadvantaged populations of El Salvador: Bajo Lempa (Usulután Department), Guayapa Abajo (Ahuachapán Department), and Las Brisas (San Miguel Department). Epidemiological and clinical data were gathered through personal history, as well as urinalysis for renal damage markers, determinations of serum creatinine and glucose, and estimation of glomerular filtration rates. CKD cases were confirmed at 3 months.


RESULTS
Prevalence of CKD was 13.9% in 1,412 women from 1,306 families studied. Chronic kidney disease of nontraditional causes (CKDu), not attributed to diabetes mellitus, hypertension, or proteinuric primary glomerulopathy (proteinuria > 1 g/L) was 6.6%. Prevalence of chronic renal failure was 6.8%. Prevalence of renal damage markers was 9.8% (microalbuminuria (30 - 300 mg/L) 5.7%; macroalbuminuria (> 300 mg/L) 2%; and hematuria, 2.1%. Prevalence of chronic kidney disease risk factors was: diabetes mellitus, 9.3%; hypertension, 23%; family history of CKD, 16%; family history of diabetes mellitus (DM), 18.7%; family history of hypertension (HT), 31.9%; obesity, 21%; central obesity, 30.7%; NSAID use, 84.3%; agricultural occupation, 15.2%; and contact with agrochemicals, 33.1%.


CONCLUSIONS
CKD in women of Salvadoran agricultural communities is associated with disadvantaged populations, traditional (DM, HT, obesity) and non-traditional causes (environmental and occupational exposure to toxic agents and inadequate working conditions). Our results reinforce the hypotheses emerging from other studies, suggesting a multifactorial etiopathology including environmental and occupational nephrotoxic exposure.
National Health Institute, Ministry of Health (MINSAL), San Salvador, El Salvador, Nephrology Institute, Havana, Cuba, Bajo Lempa's Monseñor Romero Specialized Family Community Health Unit (UCSF-E), Usulután Department, El Salvador, San Miguel UCSF-E, San Miguel, El Salvador, and Western Health Region, MINSAL, Santa Ana, El Salvador.
Carlos M
CM
Orantes Navarro
Raúl
R
Herrera Valdés
Miguel Almaguer
MA
López
Denis J
DJ
Calero
Jackeline
J
Fuentes de Morales
Nelly P
NP
Alvarado Ascencio
Xavier F
XF
Vela Parada
Susana M
SM
Zelaya Quezada
Delmy V
DV
Granados Castro
Patricia
P
Orellana de Figueroa
D000328:Adult; D000383:Agriculture; D016573:Agrochemicals / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004544:El Salvador / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced / Q000453:epidemiology*; D012307:Risk Factors
D016573:Agrochemicals