title: Chronic kidney disease of nontraditional etiology in Central America: a provisional epidemiologic case definition for surveillance and epidemiologic studies.
abstract: SYNOPSIS Over the last two decades, experts have reported a rising number of deaths caused by chronic kidney disease (CKD) along the Pacific coast of Central America, from southern Mexico to Costa Rica. However, this specific disease is not associated with traditional causes of CKD, such as aging, diabetes, or hypertension. Rather, this disease is a chronic interstitial nephritis termed chronic kidney disease of nontraditional etiology (CKDnT). According to the Pan American Health Organization (PAHO) mortality database, there are elevated rates of deaths related to kidney disease in many of these countries, with the highest rates being reported in El Salvador and Nicaragua. This condition has been identified in certain agricultural communities, predominantly among male farmworkers. Since CKD surveillance systems in Central America are under development or nonexistent, experts and governmental bodies have recommended creating standardized case definitions for surveillance purposes to monitor and characterize this epidemiological situation. A group of experts from Central American ministries of health, the U.S. Centers for Disease Control and Prevention (CDC), and PAHO held a workshop in Guatemala to discuss CKDnT epidemiologic case definitions. In this paper, we propose that CKD in general be identified by the standard definition internationally accepted and that a suspect case of CKDnT be defined as a person age < 60 years with CKD, without type 1 diabetes mellitus, hypertensive diseases, and other well-known causes of CKD. A probable case of CKDnT is defined as a suspect case with the same findings confirmed three or more months later.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for Environmental Health, Air Pollution and Respiratory Health Branch, Atlanta, Georgia, United States of America.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lozier
authors.affiliation: Centers for Disease Control and Prevention, Center for Global Health, Division of Global Health Protection, Central American Regional Office, Guatemala City, Guatemala.
authors.forename: Reina Maria
authors.initials: RM
authors.lastname: Turcios-Ruiz
authors.affiliation: Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Atlanta, Georgia, United States of America.
authors.forename: Gary
authors.initials: G
authors.lastname: Noonan
authors.affiliation: Pan American Health Organization/World Health Organization, Noncommunicable Diseases Unit, Washington, D.C., United States of America.
authors.forename: Pedro
authors.initials: P
authors.lastname: Ordunez
mesh_terms: D002489:Central America / Q000453:epidemiology; D003364:Costa Rica / Q000453:epidemiology; D004544:El Salvador / Q000453:epidemiology; D016021:Epidemiologic Studies; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D011159:Population Surveillance; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000401:mortality