title: Dialysis enrollment patterns in Guatemala: evidence of the chronic kidney disease of non-traditional causes epidemic in Mesoamerica.
abstract: BACKGROUND
  In western Nicaragua and El Salvador, chronic kidney disease (CKD) is highly prevalent and generally affects young, male, agricultural (usually sugar cane) workers without the established CKD risk factors. It is yet unknown if the prevalence of this CKD of Non-Traditional causes (CKDnT) extends to the northernmost Central American country, Guatemala. Therefore, we sought to compare dialysis enrollment rates by region, municipality, sex, daily temperature, and agricultural production in Guatemala and assess if there is a similar CKDnT distribution pattern as in Nicaragua and El Salvador.
  
  
  METHODS
  The National Center for Chronic Kidney Disease Treatment (Unidad Nacional de Atención al Enfermo Renal Crónico) is the largest provider of dialysis in Guatemala. We used population, Human Development Index, literacy, and agricultural databases to assess the geographic, economic, and educational correlations with the National Center for Chronic Kidney Disease Treatment's hemodialysis and peritoneal dialysis enrollment database. Enrollment rates (per 100 000) inhabitants were compared by region and mapped for comparison to regional agricultural and daytime temperature data. The distribution of men and women enrolled in dialysis were compared by region using Fisher's exact tests. Spearman's rank correlation coefficients were calculated.
  
  
  RESULTS
  Dialysis enrollment is higher in the Southwest compared to the rest of the country where enrollees are more likely (p < 0.01) to be male (57.8%) compared to the rest of the country (49.3%). Dialysis enrollment positively correlates with Human Development Index and literacy rates. These correlations are weaker in the agricultural regions (predominantly sugar cane) of Southwest Guatemala.
  
  
  CONCLUSIONS
  In Guatemala, CKDnT incidence may have a similar geographic distribution as Nicaragua and El Salvador (higher in the high temperature and sugar cane growing regions). Therefore, it is likely that the CKNnT epidemic extends throughout the Mesoamerican region.
authors.affiliation: Barnes-Jewish Hospital Department of Internal Medicine, St. Louis, MO, USA.|Department of Medicine, Division of Medical Education, Washington University School of Medicine, 660 South Euclid Avenue, Box 8121, St Louis, MO, 63110, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Laux
authors.affiliation: Washington University in St Louis Division of Public Health Sciences, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA. barnoyaj@wudosis.wustl.edu.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Barnoya
authors.affiliation: Unidad Nacional de Atención al Enfermo Renal Crónico, 9a. Avenida 3-40 Zona 1, Ciudad de Guatemala, 01001, Guatemala, Guatemala.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Guerrero
authors.affiliation: Division of Renal Diseases, Washington University in St. Louis, St. Louis, MO, USA.|Washington University School of Medicine, Division of Renal Diseases, 660 South Euclid Avenue, Campus Box 8126, St. Louis, MO, 63110, USA.
authors.forename: Marcos
authors.initials: M
authors.lastname: Rothstein
mesh_terms: D000328:Adult; D017677:Age Distribution; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006166:Guatemala; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult