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Butler-Dawson J, Johnson RJ, Krisher L, Jaramillo D, Cruz A, Pilloni D, Brindley S, Rodriguez-Iturbe B, Sanchez-Lozada LG, Dally M, Newman LS. A longitudinal assessment of heat exposure and biomarkers of kidney function on heat shock protein 70 and antibodies among agricultural workers. BMC Nephrol 2024; 25:277. [PMID: 39198762 PMCID: PMC11351828 DOI: 10.1186/s12882-024-03706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Exposure to extreme heat impacts millions of people worldwide and outdoor workers are among the populations most affected by hot temperatures. Heat stress induces several biological responses in humans, including the production of heat shock proteins (HSP) and antibodies against HSP (anti-HSP) which may play a central role in the body's cellular response to a hot environment. OBJECTIVE This longitudinal study investigated the impact of elevated temperatures and humidity on the presence of HSP70 and anti-HSP70 and examined relationships with markers of kidney function in an at-risk workforce under conditions of extreme heat and exertion in Guatemala. METHODS We collected ambient temperature and relative humidity data as well as biomarkers and clinical data from 40 sugarcane workers at the start and the end of a 6-month harvest. We used generalized mixed-effects models to estimate temperature effects on HSP70 and anti-HSP70 levels. In addition, we examined trends between HSP70 and anti-HSP70 levels and markers of kidney function across the harvest. RESULTS At the end of the harvest, temperatures were higher, and workers had, on average, higher levels of HSP70 and anti-HSP70 compared to the beginning of the season. We observed significant increasing trends with temperature indices, heat index, and HSP70 levels. Maximum temperature was associated with HSP70 increments after controlling for age, systolic and diastolic blood pressure (β: 0.21, 95% Confidence Interval: 0.09, 0.33). Kidney function decline across the harvest was associated with both higher levels of anti-HSP70 levels at the end of the harvest as well as greater increases in anti-HSP70 levels across the harvest. CONCLUSIONS These results suggest that workplace heat exposure may increase the production of HSP70 and anti-HSP70 levels and that there may be a relationship between increasing anti-HSP70 antibodies and the development of renal injury. HSP70 holds promise as a biomarker of heat stress in exposed populations.
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Affiliation(s)
- Jaime Butler-Dawson
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, 13001 E 17th Pl B119, Aurora, CO, 80045, USA.
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Lyndsay Krisher
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, 13001 E 17th Pl B119, Aurora, CO, 80045, USA
| | - Diana Jaramillo
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Alex Cruz
- Grupo Pantaleón, Guatemala, Guatemala
| | | | - Stephen Brindley
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, 13001 E 17th Pl B119, Aurora, CO, 80045, USA
| | - Bernardo Rodriguez-Iturbe
- Department of Nephrology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, 14080, México
| | - Laura Gabriela Sanchez-Lozada
- Department of Cardio-Renal Physiopathology, National Institute of Cardiology Ignacio Chávez, Mexico City, 14080, Mexico
| | - Miranda Dally
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, 13001 E 17th Pl B119, Aurora, CO, 80045, USA
| | - Lee S Newman
- Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, 13001 E 17th Pl B119, Aurora, CO, 80045, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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Alatorre-Moreno EV, Saldaña-Cruz AM, Pérez-Guerrero EE, Morán-Moguel MC, Contreras-Haro B, López-de La Mora DA, Dávalos-Rodríguez IP, Marín-Medina A, Rivera-Cameras A, Balderas-Peña LMA, Gómez-Ramos JJ, Cortés-Sanabria L, Salazar-Páramo M. Association of CYP3A4-392A/G, CYP3A5-6986A/G, and ABCB1-3435C/T Polymorphisms with Tacrolimus Dose, Serum Concentration, and Biochemical Parameters in Mexican Patients with Kidney Transplant. Genes (Basel) 2024; 15:497. [PMID: 38674430 PMCID: PMC11049954 DOI: 10.3390/genes15040497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Tacrolimus (TAC) is an immunosuppressant drug that prevents organ rejection after transplantation. This drug is transported from cells via P-glycoprotein (ABCB1) and is a metabolic substrate for cytochrome P450 (CYP) 3A enzymes, particularly CYP3A4 and CYP3A5. Several single-nucleotide polymorphisms (SNPs) have been identified in the genes encoding CYP3A4, CYP3A5, and ABCB1, including CYP3A4-392A/G (rs2740574), CYP3A5 6986A/G (rs776746), and ABCB1 3435C/T (rs1045642). This study aims to evaluate the association among CYP3A4-392A/G, CYP3A5-6986A/G, and ABCB1-3435C/T polymorphisms and TAC, serum concentration, and biochemical parameters that may affect TAC pharmacokinetics in Mexican kidney transplant (KT) patients. METHODS Forty-six kidney transplant recipients (KTR) receiving immunosuppressive treatment with TAC in different combinations were included. CYP3A4, CYP3A5, and ABCB1 gene polymorphisms were genotyped using qPCR TaqMan. Serum TAC concentration (as measured) and intervening variables were assessed. Logistic regression analyses were performed at baseline and after one month to assess the extent of the association between the polymorphisms, intervening variables, and TAC concentration. RESULTS The GG genotype of CYP3A5-6986 A/G polymorphism is associated with TAC pharmacokinetic variability OR 4.35 (95%CI: 1.13-21.9; p = 0.0458) at one month of evolution; in multivariate logistic regression, CYP3A5-6986GG genotype OR 9.32 (95%CI: 1.54-93.08; p = 0.028) and the use of medications or drugs that increase serum TAC concentration OR 9.52 (95%CI: 1.79-88.23; p = 0.018) were strongly associated with TAC pharmacokinetic variability. CONCLUSION The findings of this study of the Mexican population showed that CYP3A5-6986 A/G GG genotype is associated with a four-fold increase in the likelihood of encountering a TAC concentration of more than 15 ng/dL. The co-occurrence of the CYP3A5-6986GG genotype and the use of drugs that increase TAC concentration correlates with a nine-fold increased risk of experiencing a TAC at a level above 15 ng/mL. Therefore, these patients have an increased susceptibility to TAC-associated toxicity.
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Affiliation(s)
- Edith Viridiana Alatorre-Moreno
- Centro Universitario de Ciencias de la Salud, Departamento de Nefrología, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Ana Miriam Saldaña-Cruz
- Centro Universitario de Ciencias de la Salud, Departamento de Fisiología, Instituto de Terapéutica Experimental y Clínica, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Edsaúl Emilio Pérez-Guerrero
- Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Ciencias Biomédicas, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - María Cristina Morán-Moguel
- Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (M.C.M.-M.); (A.M.-M.)
| | - Betsabé Contreras-Haro
- Departamento de Ciencias Biomédicas, Centro Universitario de Tonalá, UIB02, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | | | - Ingrid Patricia Dávalos-Rodríguez
- Departamento de Biología Molecular y Genómica, División de Genética, Centro de Investigación Biomédica de Occidente, Centro Universitario de Ciencias de la Salud, Instituto Mexicano del Seguro Social, Universidad de Guadalajara; Guadalajara 44340, Mexico; (I.P.D.-R.); (A.R.-C.)
| | - Alejandro Marín-Medina
- Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (M.C.M.-M.); (A.M.-M.)
| | - Alicia Rivera-Cameras
- Departamento de Biología Molecular y Genómica, División de Genética, Centro de Investigación Biomédica de Occidente, Centro Universitario de Ciencias de la Salud, Instituto Mexicano del Seguro Social, Universidad de Guadalajara; Guadalajara 44340, Mexico; (I.P.D.-R.); (A.R.-C.)
| | - Luz-Ma Adriana Balderas-Peña
- Departamento de Morfología, Centro Universitario de Ciencias de la Salud, UIB02, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - José Juan Gómez-Ramos
- Departamento de Urgencias, Hospital General de Zona 89, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico;
| | - Laura Cortés-Sanabria
- Centro Médico Nacional de Occidente, Hospital de Especialidades, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico;
| | - Mario Salazar-Páramo
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Academia de Inmunología, Universidad de Guadalajara, Guadalajara 44340, Mexico
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Ponsonby W, Di Corleto R. Climate change and heat stress. Occup Med (Lond) 2024; 74:138-139. [PMID: 38569113 DOI: 10.1093/occmed/kqad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Climate change is increasing the incidences of extreme weather. Record high temperatures are being experienced more frequently and for extended periods. Subsequently, there is an increased risk of occupational exposures resulting in heat-related illnesses, both acute and chronic. The editorial reviews the processes and tools that are available to assess heat exposure and develop effective controls to help address current and future exposures.
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Affiliation(s)
- Will Ponsonby
- Centre for Occupational and Environmental Health, University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester M13 9PL, UK
| | - Ross Di Corleto
- School of the Environment, The University of Queensland, St Lucia, Queensland, 4072, Australia
- School of Medicine and Health Sciences, Edith Cowan University, Joondalup, Western Australia, 6027, Australia
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Butler-Dawson J, Johnson RJ, Krisher L, Jaramillo D, Cruz A, Pilloni D, Brindley S, Rodriguez-Iturbe B, Sanchez-Lozada LG, Dally M, Newman LS. A longitudinal assessment of heat exposure and biomarkers of kidney function on heat shock protein 70 and antibodies among agricultural workers. RESEARCH SQUARE 2024:rs.3.rs-3887323. [PMID: 38343868 PMCID: PMC10854298 DOI: 10.21203/rs.3.rs-3887323/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background Exposure to extreme heat impacts millions of people worldwide and outdoor workers are among the populations most affected by high temperatures. Heat stress induces several biological responses in humans, including the production of heat shock proteins (HSP) and antibodies against HSP (anti-HSP) which may play a central role in the body's cellular response to a hot environment. Objective This longitudinal study investigated the impact of high temperatures and humidity on the presence of HSP70 and anti-HSP70 and examined relationships with markers of kidney function in an at-risk workforce under conditions of extreme heat and exertion in Guatemala. Methods We collected ambient temperature and relative humidity data as well as biomarkers and clinical data from 40 sugarcane workers at the start and the end of a 6-month harvest. We used generalized mixed-effects models to estimate temperature effects on HSP70 and anti-HSP70 levels. In addition, we examined trends between HSP70 and anti-HSP70 levels and markers of kidney function across the harvest. Results At the end of the harvest, temperatures were higher, and workers had, on average, higher levels of HSP70 and anti-HSP70 compared to the beginning of the season. We observed significant increasing trends with temperature indices and HSP70 levels. Maximum temperature was associated with HSP70 increments after controlling for age, systolic and diastolic blood pressure (β: 0.21, 95% Confidence Interval: 0.09, 0.33). Kidney function decline across the harvest was associated with both higher levels of anti-HSP70 levels at the end of the harvest as well as greater increases in anti-HSP70 levels across the harvest. Conclusions These results suggest that workplace heat exposure may increase the production of HSP70 and anti-HSP70 levels and that there may be a relationship between increasing anti-HSP70 antibodies and the development of renal injury. HSP70 holds promise as a biomarker of heat stress in exposed populations.
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Dorlach T, Gunasekara S. The politics of glyphosate regulation: lessons from Sri Lanka's short-lived ban. Global Health 2023; 19:84. [PMID: 37957659 PMCID: PMC10644602 DOI: 10.1186/s12992-023-00981-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Glyphosate is the world's most used herbicide and a central component of modern industrial agriculture. It has also been linked to a variety of negative health and environmental effects. For instance, the International Agency for Research on Cancer classified glyphosate as "probably carcinogenic to humans" in 2015. This has motivated widespread political demands for stricter glyphosate regulation but so far few governments have followed through. METHODS We conduct a case study of Sri Lanka, which in 2015 became the first and so far only country in the world to adopt and implement a complete glyphosate ban. But this ban proved to be short-lived, as it was partially reversed in 2018 (and later fully revoked in 2022). To explain the political causes of Sri Lanka's pioneering glyphosate ban and its subsequent reversal, we employ process tracing methods drawing on publicly available documents. Our analysis is theoretically guided by the multiple streams framework and the concept of self-undermining policy feedback. RESULTS Glyphosate regulation rose to the top of the Sri Lankan political agenda in 2014 when a local scientist linked glyphosate exposure to an epidemic of Chronic Kidney Disease of Unknown Origin (CKDu). A glyphosate ban was eventually adopted in June 2015 by the newly elected government of Maithripala Sirisena. The ban was a political commitment made to the Buddhist monk Rathana Thero and his party, which had supported Sirisena during his presidential campaign. The ban's partial reversal in 2018, implemented through sectoral exceptions, was the result of continued lobbying by export-oriented plantation industries and increased political concerns about potential negative effects on the large and structurally powerful tea sector. The reversal was further aided by the scientific community's failure to corroborate the hypothesized link between glyphosate and CKDu. CONCLUSIONS The case of Sri Lanka suggests that strict glyphosate regulation becomes more likely when coupled with locally salient health risks and when decision-making authority is de-delegated from regulatory agencies back to the political executive. Meanwhile, the short-lived nature of the Sri Lankan ban suggests that strict glyphosate regulation faces political sustainability threats, as the apparent lack of cost-effective alternative herbicides motivates persistent business lobbying for regulatory reversal.
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Affiliation(s)
- Tim Dorlach
- University of Bayreuth, Fritz-Hornschuch-Str. 13, Kulmbach, 95326, Germany.
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H Hathaway M, L Patil C, Odhiambo A, Onyango D, Dorevitch S. Prevalence and predictors of chronic kidney disease of undetermined causes (CKDu) in Western Kenya's "sugar belt": a cross-sectional study. BMC Nephrol 2023; 24:157. [PMID: 37280533 DOI: 10.1186/s12882-023-03213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Epidemics of chronic kidney disease of undetermined causes (CKDu) among young male agricultural workers have been observed in many tropical regions. Western Kenya has similar climatic and occupational characteristics as many of those areas. The study objectives were to characterize prevalence and predictors of CKDu, such as, HIV, a known cause of CKD, in a sugarcane growing region of Kenya; and to estimate prevalence of CKDu across occupational categories and evaluate if physically demanding work or sugarcane work are associated with reduced eGFR. METHODS The Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol was followed in a cross-sectional study conducted in Kisumu County, Western Kenya. Multivariate logistic regression was performed to identify predictors of reduced eGFR. RESULTS Among 782 adults the prevalence of eGFR < 90 was 9.85%. Among the 612 participants without diabetes, hypertension, and heavy proteinuria the prevalence of eGFR < 90 was 8.99% (95%CI 6.8%, 11.5%) and 0.33% (95%CI 0.04%, 1.2%) had eGFR < 60. Among the 508 participants without known risk factors for reduced eGFR (including HIV), the prevalence of eGFR < 90 was 5.12% (95%CI 3.4%, 7.4%); none had eGFR < 60. Significant risk factors for reduced eGFR were sublocation, age, body mass index, and HIV. No association was found between reduced eGFR and work in the sugarcane industry, as a cane cutter, or in physically demanding occupations. CONCLUSION CKDu is not a common public health problem in this population, and possibly this region. We recommend that future studies should consider HIV to be a known cause of reduced eGFR. Factors other than equatorial climate and work in agriculture may be important determinants of CKDu epidemics.
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Affiliation(s)
- Michelle H Hathaway
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA.
| | - Crystal L Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Ave., MC 802, Chicago, IL, 60612, USA
| | - Aloyce Odhiambo
- Safe Water and AIDS Project, Behind Royal City Garden Hotel, Milimani Estate, Off Aga Khan Road, P.O. Box, Kisumu, 3323-40100, Kenya
| | - Dickens Onyango
- County Department of Health, County Government of Kisumu, Kisumu, Kenya
| | - Samuel Dorevitch
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA
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Marín-Medina A, Gómez-Ramos JJ, Mendoza-Morales N, Figuera-Villanueva LE. Association between the Polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 Gene with Chronic Kidney Disease of Uncertain or Non-Traditional Etiology in Mexican Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:829. [PMID: 37241060 PMCID: PMC10221284 DOI: 10.3390/medicina59050829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Chronic Kidney Disease of uncertain or non-traditional etiology (CKDnT) is a form of chronic kidney disease of undetermined etiology (CKDu) and is not associated with traditional risk factors. The aim of this study was to investigate the association of polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 gene with CKDnT in Mexican patients. Materials and Methods: We included 105 patients with CKDnT and 90 controls. Genotyping was performed by PCR-RFLP's, genotypic and allelic frequencies were determined and compared between the two groups using χ2 analysis, and differences were expressed as odd ratios with 95% confidence intervals (CI). Values of p < 0.05 were considered statistically significant. Results: Overall, 80% of patients were male. The rs1799983 polymorphism in NOS3 was found to be associated with CKDnT in the Mexican population (p = 0.006) (OR = 0.397; 95% CI, 0.192-0.817) under a dominant model. The genotype frequency was significantly different between the CKDnT and control groups (χ2 = 8.298, p = 0.016). Conclusions: The results of this study indicate that there is an association between the rs2070744 polymorphism and CKDnT in the Mexican population. This polymorphism can play an important role in the pathophysiology of CKDnT whenever there is previous endothelial dysfunction.
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Affiliation(s)
- Alejandro Marín-Medina
- Departamento de Biología Molecular y Genómicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdeG), Guadalajara 44100, Jalisco, Mexico
| | - José Juan Gómez-Ramos
- Departamento de Urgencias, Hospital General de Zona No. 89, Instituto Mexicano del Seguro Social, Guadalajara 44100, Jalisco, Mexico
| | - Norberto Mendoza-Morales
- Departamento de Urgencias, Hospital General de Zona No. 89, Instituto Mexicano del Seguro Social, Guadalajara 44100, Jalisco, Mexico
- Programa de Especialización en Medicina de Urgencias, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdeG), Guadalajara 44100, Jalisco, Mexico
| | - Luis Eduardo Figuera-Villanueva
- Departamento de Biología Molecular y Genómicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdeG), Guadalajara 44100, Jalisco, Mexico
- Centro de Investigación Biomédica de Occidente (CIBO), Instituto Mexicano del Seguro Social, Guadalajara 44100, Jalisco, Mexico
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Figueroa-Solis E, Gimeno Ruiz de Porras D, Rojas-Garbanzo M, Whitehead L, Zhang K, Delclos GL. Prevalence and Geographic Distribution of Self-Reported Chronic Kidney Disease and Potential Risk Factors in Central America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1308. [PMID: 36674063 PMCID: PMC9859154 DOI: 10.3390/ijerph20021308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cases for chronic kidney disease of unknown etiology (CKDu) are increasing in specific disease hotspots located in rural agricultural communities over Central America. The goal of the study was to estimate the prevalence and geographic distribution of self-reported work-related CKD and associated risk factors for CKDu by industry sector in Central America. METHODS We calculated the prevalence and distribution of self-reported CKD, work-related CKD, and suspected CKDu risk factors among the 9032 workers in the Second Central American Survey of Working Conditions and Health (II ECCTS, 2018). We mapped the distribution of suspected CKDu risk factors to work-related CKDu and weather conditions using average annual temperatures. RESULTS The primary and secondary industry sectors showed the highest proportion of males, suspected CKDu risk factors, and work-related CKD. Age (30-49 years: OR = 2.38, 95% CI 1.03-5.51), ethnicity (mestizo: OR, 7.44, 95% CI: 2.14-25.82), and exposure to high physical work demands (OR = 2.45, 95% CI: 1.18-5.09) were associated with work-related CKD. The majority of work-related CKD were reported in the western parts of Honduras and Nicaragua, in hot temperature regions, and overlapped with those areas with a high density of CKDu risk factors. Finally, some areas clustered CKDu risk factors without any work-related CKD points, mainly in the western part of Guatemala. CONCLUSION Our findings supplement prior CKDu findings regarding a high prevalence of work-related CKD among 30- to 49-year-old mestizo males in the primary and secondary sectors, in hot temperature areas, in the central and western region, and overlapping with persons reporting two or more CKDu risk factors. Moreover, several geographic areas with CKDu risk factor clusters had no reported work-related CKD. These areas represent new industries and sectors to be monitored for possible future increases of CKDu cases.
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Affiliation(s)
- Erika Figueroa-Solis
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | - David Gimeno Ruiz de Porras
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX 78229, USA
| | - Marianela Rojas-Garbanzo
- Instituto Regional de Estudios en Sustancias Tóxicas (IRET), National University of Costa Rica, Heredia 40101, Costa Rica
| | - Lawrence Whitehead
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY 12144, USA
| | - George L. Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
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Lin Y, Heng S, Anand S, Deshpande SK, Small DS. Hemoglobin Levels Among Male Agricultural Workers: Analyses From the Demographic and Health Surveys to Investigate a Marker for Chronic Kidney Disease of Uncertain Etiology. J Occup Environ Med 2022; 64:e805-e810. [PMID: 36472566 PMCID: PMC9731347 DOI: 10.1097/jom.0000000000002703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Estimate agricultural work's effect on hemoglobin (Hgb) level in men. A negative effect may indicate presence of chronic kidney disease of uncertain etiology. METHODS We use Demographic and Health Surveys data from seven African and Asian countries and use matching to control for seven confounders. RESULTS On average, Hgb levels were 0.09 g/dL lower among agricultural workers compared with matched controls. Significant effects were observed in Ethiopia, India, Lesotho, and Senegal, with effects from 0.07 to 0.30 g/dL lower Hgb level among agricultural workers. The findings were robust to multiple control groups and a modest amount of unmeasured confounding. CONCLUSIONS Men engaged in agricultural work in four of the seven countries studied have modestly lower Hgb levels. Our data support integrating kidney function assessments within Demographic and Health Surveys and other population-based surveys.
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Affiliation(s)
- Yuzhou Lin
- From the Department of Statistics, Harvard University, Cambridge, Massachusetts (Mr Lin); Department of Biostatistics, School of Global Public Health, New York University, New York, New York (Dr Heng); Division of Nephrology, Stanford University, Palo Alto, California (Dr Anand); Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin (Dr Deshpande); Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
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Lou-Meda R, Alvarez-Elías AC, Bonilla-Félix M. Mesoamerican Endemic Nephropathy (MeN): A Disease Reported in Adults That May Start Since Childhood? Semin Nephrol 2022; 42:151337. [PMID: 37028147 DOI: 10.1016/j.semnephrol.2023.151337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Mesoamerican endemic nephropathy (MeN) is a type of chronic kidney disease (CKD) of uncertain etiology that occurs along the Pacific coast of the southern part of Mexico and Central America. During the past 20 years MeN has become a leading cause of death in the region, clamming close to 50,000 lives, with 40% of these deaths occurring in young people. The cause remains unknown, but most researchers believe in a multifactorial etiology that includes social determinants of poverty. Existing evidence suggests that subclinical kidney injury begins early in life and leads to a higher than expected prevalence of CKD among children in Central America. Access to health services in the region, specifically kidney replacement therapy, remains limited. We proposed a strategy to address the perceived needs and urge coordinated efforts of governments, academic organizations, and international bodies to develop a comprehensive plan of action to mitigate this situation among the vulnerable and economically disadvantaged population.
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Affiliation(s)
- Randall Lou-Meda
- Pediatric Nephrology Unit, Fundacion Para el Niño Enfermo Renal (FUNDANIER), Guatemala City, Guatemala; Department of Pediatrics, Hospital Roosevelt, Guatemala City, Guatemala.
| | - Ana Catalina Alvarez-Elías
- Nephrology Division, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy and Management, University of Toronto, Ontario, Canada; Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Melvin Bonilla-Félix
- Pediatric Nephrology Division, Hospital Pediátrico Universitario, San Juan, Puerto Rico; Universidad de Puerto Rico, San Juan, Puerto Rico
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11
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Liyanage DND, Diyabalanage S, Dunuweera SP, Rajapakse S, Rajapakse RMG, Chandrajith R. Significance of Mg-hardness and fluoride in drinking water on chronic kidney disease of unknown etiology in Monaragala, Sri Lanka. ENVIRONMENTAL RESEARCH 2022; 203:111779. [PMID: 34339700 DOI: 10.1016/j.envres.2021.111779] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
The epidemic of chronic kidney disease of unknown etiology (CKDu) that contributes significantly to morbidity and mortality rates among dry-zonal farming communities has become a public health priority in Sri Lanka. Though a large number of hypotheses were introduced as causative factors, none of them have been confirmed so far. As drinking water quality is among the most suspected causative factors for the emergence of CKDu, a detailed hydro-geochemical investigation was carried out concurrently with the population screening in the Monaragala district of Sri Lanka where high incidences of CKDu are reported. A population screening was performed selecting 46,754 people using both dipstick proteinuria test and Albumin-Creatinine Ratio (ACR). The results revealed that the disease prevalence is about 6.7 % in the district. A total of 60 groundwater samples, 30 each, were collected from CKDu-prevalent locations and control locations where there are no CKDu cases reported. The samples were analyzed to identify any possible linkage between water quality and disease prevalence. Concentrations of hardness, F-, Na+, and Mg2+ in groundwater revealed a statistically significant difference between CKDu and control wells at a confident level of p = 0.05. The study revealed that alkali (Na++K+) and alkaline earth cations (Mg2+, Ca2+, Sr2+, Ba2+) were relatively higher in drinking water sources used by CKDu patients, compared to the well waters used by healthy individuals. Nearly 87 % of the wells used by CKDu cases showed higher fluoride levels that exceed the threshold level (1.0 mg L-1). Contents of nephrotoxic trace elements such as As, Cd, and Pb were found to be comparable in both types of wells and were well below the WHO permissible levels, thus negating their prime influence on the CKDu prevalence. It is obtrusive that the elevated fluoride levels together with water hardness associated with higher Mg2+ levels have a possible relation with CKDu and may influence the disease progression.
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Affiliation(s)
- D N D Liyanage
- Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka; Postgraduate Institute of Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Saranga Diyabalanage
- Instrument Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - S P Dunuweera
- Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka; Postgraduate Institute of Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Sanath Rajapakse
- Department of Molecular Biology and Biotechnology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - R M G Rajapakse
- Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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Hettithanthri O, Sandanayake S, Magana-Arachchi D, Wanigatunge R, Rajapaksha AU, Zeng X, Shi Q, Guo H, Vithanage M. Risk factors for endemic chronic kidney disease of unknown etiology in Sri Lanka: Retrospect of water security in the dry zone. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 795:148839. [PMID: 34328928 DOI: 10.1016/j.scitotenv.2021.148839] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
The prevalence of chronic kidney disease of unknown etiology (CKDu) is receiving considerable attention due to the serious threat to human health throughout the world. However, the roles of geo-socio-environmental factors in the prevalence of the CKDu endemic areas are still unknown. Sri Lanka is one of the countries most seriously affected by CKDu, where 10 out of 25 districts have been identified as the areas with the high prevalence of CKDu (10-20%). This review summarizes the geographical distribution of CKDu and its probable geochemical, behavioral, sociological, and environmental risk factors based on research related to hydrogeochemical influences on CKDu in Sri Lanka. More than 98% of CKDu patients have consumed groundwater as their primary water source in daily life, indicating the interactions of geogenic contaminants (such as F-, total dissolved solids, Hofmeister ions) in groundwater is responsible for the disease. Apart from the hydrogeochemical factors, mycotoxins, cyanotoxins, use of some herbal medicines, dehydration, and exposure to agrochemicals were alleged as risk factors. Sociological factors, including poverty, living habits and anthropogenic activities, may also provoke the emergence of CKDu. Therefore, the interaction of geo-socio environmental risk factors should be sociologically and scientifically considered to prevent the prevalence of CKDu. Future in-depth studies are required to reveal the individual role of each of the postulated etiological factors, possibly using machine learning and advanced statistics.
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Affiliation(s)
- Oshadi Hettithanthri
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sandun Sandanayake
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Dhammika Magana-Arachchi
- Molecular Microbiology and Human Diseases, National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Rasika Wanigatunge
- Department of Plant and Molecular Biology, Faculty of Science, University of Kelaniya, Sri Lanka
| | - Anushka Upamali Rajapaksha
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Xianjiang Zeng
- School of Water Resources and Environment, China University of Geosciences, Beijing, China
| | - Qiutong Shi
- School of Water Resources and Environment, China University of Geosciences, Beijing, China
| | - Huaming Guo
- School of Water Resources and Environment, China University of Geosciences, Beijing, China.
| | - Meththika Vithanage
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
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13
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Butler-Dawson J, Barnoya J, Brindley S, Krisher L, Fan W, Asensio C, Newman LS. Cross-sectional study examining the accuracy of self-reported smoking status as compared to urinary cotinine levels among workers at risk for chronic kidney disease of unknown origin in Guatemala. BMJ Open 2021; 11:e050374. [PMID: 34697113 PMCID: PMC8547360 DOI: 10.1136/bmjopen-2021-050374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES There is a lack of information on cotinine levels in rural populations in low-income and middle-income countries like Guatemala. Therefore, there is a need to explore smoking status and biomarkers of tobacco use in epidemiological research in rural, low-income populations, in particular those at-risk for chronic kidney disease of unknown origin (CKDu). DESIGN We evaluated self-reported smoking status against urinary cotinine levels, the gold standard biomarker of tobacco smoke exposure, among agricultural workers at four separate cross-sectional time points. SETTING Guatemala. PARTICIPANTS 283 sugarcane workers. PRIMARY OUTCOME MEASURES Compared self-reported smoking status and urinary cotinine levels in two agricultural worker studies. RESULTS Self-reported smoking prevalence was 12% among workers. According to cotinine levels (≥50 ng/mL), the smoking prevalence was 34%. Self-reported smoking status had 28% sensitivity and 96% specificity. Urinary cotinine levels show that smoking prevalence is underestimated in this worker population. CONCLUSIONS According to our findings, smoking status should be objectively measured with biomarkers rather than self-reported in CKDu epidemiological research. Self-reported smoking status is likely an underestimate of the true smoking prevalence among agricultural workers. Research on the CKDu epidemic in Central America and other parts of the world might be underestimating tobacco exposure as a potential contributor to the development of CKDu.
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Affiliation(s)
- Jaime Butler-Dawson
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Joaquin Barnoya
- Integra Cancer Institute, Guatemala City, Guatemala
- Unit for Cardiovascular Surgery, Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Stephen Brindley
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Wenyi Fan
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | | | - Lee S Newman
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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14
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Petropoulos ZE, Ramirez-Rubio O, Scammell MK, Laws RL, Lopez-Pilarte D, Amador JJ, Ballester J, O’Callaghan-Gordo C, Brooks DR. Climate Trends at a Hotspot of Chronic Kidney Disease of Unknown Causes in Nicaragua, 1973-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5418. [PMID: 34069421 PMCID: PMC8159092 DOI: 10.3390/ijerph18105418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022]
Abstract
An ongoing epidemic of chronic kidney disease of uncertain etiology (CKDu) afflicts large parts of Central America and is hypothesized to be linked to heat stress at work. Mortality rates from CKDu appear to have increased dramatically since the 1970s. To explore this relationship, we assessed trends in maximum and minimum temperatures during harvest months between 1973 and 2014 as well as in the number of days during the harvest season for which the maximum temperature surpassed 35 °C. Data were collected at a weather station at a Nicaraguan sugar company where large numbers of workers have been affected by CKDu. Monthly averages of the daily maximum temperatures between 1996 and 2014 were also compared to concurrent weather data from eight Automated Surface Observing System Network weather stations across Nicaragua. Our objectives were to assess changes in temperature across harvest seasons, estimate the number of days that workers were at risk of heat-related illness and compare daily maximum temperatures across various sites in Nicaragua. The monthly average daily maximum temperature during the harvest season increased by 0.7 °C per decade between 1973 and 1990. The number of days per harvest season with a maximum temperature over 35 °C increased by approximately five days per year between 1974 and 1990, from 32 days to 114 days. Between 1991 and 2013, the number of harvest days with a maximum temperature over 35 °C decreased by two days per year, and the monthly average daily maximum temperature decreased by 0.3 °C per decade. Comparisons with weather stations across Nicaragua demonstrate that this company is located in one of the consistently hottest regions of the country.
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Affiliation(s)
- Zoe E. Petropoulos
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (M.K.S.); (R.L.L.)
| | - Oriana Ramirez-Rubio
- ISGlobal, 08003 Barcelona, Spain; (O.R.-R.); (J.B.); (C.O.-G.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA; (D.L.-P.); (J.J.A.); (D.R.B.)
| | - Madeleine K. Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (M.K.S.); (R.L.L.)
| | - Rebecca L. Laws
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (M.K.S.); (R.L.L.)
| | - Damaris Lopez-Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA; (D.L.-P.); (J.J.A.); (D.R.B.)
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA; (D.L.-P.); (J.J.A.); (D.R.B.)
| | - Joan Ballester
- ISGlobal, 08003 Barcelona, Spain; (O.R.-R.); (J.B.); (C.O.-G.)
| | - Cristina O’Callaghan-Gordo
- ISGlobal, 08003 Barcelona, Spain; (O.R.-R.); (J.B.); (C.O.-G.)
- Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Faculty of Health Sciences, Universitat Oberta de Catalunya, 08018 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA; (D.L.-P.); (J.J.A.); (D.R.B.)
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15
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Hansson E, Mansourian A, Farnaghi M, Petzold M, Jakobsson K. An ecological study of chronic kidney disease in five Mesoamerican countries: associations with crop and heat. BMC Public Health 2021; 21:840. [PMID: 33933045 PMCID: PMC8088703 DOI: 10.1186/s12889-021-10822-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mesoamerica is severely affected by an epidemic of Chronic Kidney Disease of non-traditional origin (CKDnt), an epidemic with a marked variation within countries. We sought to describe the spatial distribution of CKDnt in Mesoamerica and examine area-level crop and climate risk factors. METHODS CKD mortality or hospital admissions data was available for five countries: Mexico, Guatemala, El Salvador, Nicaragua and Costa Rica and linked to demographic, crop and climate data. Maps were developed using Bayesian spatial regression models. Regression models were used to analyze the association between area-level CKD burden and heat and cultivation of four crops: sugarcane, banana, rice and coffee. RESULTS There are regions within each of the five countries with elevated CKD burden. Municipalities in hot areas and much sugarcane cultivation had higher CKD burden, both compared to equally hot municipalities with lower intensity of sugarcane cultivation and to less hot areas with equally intense sugarcane cultivation, but associations with other crops at different intensity and heat levels were not consistent across countries. CONCLUSION Mapping routinely collected, already available data could be a first step to identify areas with high CKD burden. The finding of higher CKD burden in hot regions with intense sugarcane cultivation which was repeated in all five countries agree with individual-level studies identifying heavy physical labor in heat as a key CKDnt risk factor. In contrast, no associations between CKD burden and other crops were observed.
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Affiliation(s)
- Erik Hansson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. .,La Isla Network, Washington, D.C., USA.
| | - Ali Mansourian
- GIS Centre, Department of Physical Geography and Ecosystem Science, Lund University, Lund, Sweden
| | - Mahdi Farnaghi
- GIS Centre, Department of Physical Geography and Ecosystem Science, Lund University, Lund, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,La Isla Network, Washington, D.C., USA.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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16
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Diniz CO, McKenna Z, Canuto L, Magalhães F, Machado-Moreira CA, Shibuya E, da Cunha I, Maia PA, Roscani RC, Rocha-Vieira E, Santiago de Moraes Barros TM, Bitencourt D, Souza E Silva de Almeida F, Amorim FT. A Preliminary Evaluation of the Kidney Function of Sugarcane Cutters From Brazil. J Occup Environ Med 2021; 63:e53-e58. [PMID: 33229906 DOI: 10.1097/jom.0000000000002090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate clinical parameters, markers of kidney function, and skeletal muscle damage in a group of sugarcane cutters during harvesting season. METHODS Seventeen volunteers were assessed for anthropometrics and cardiorespiratory fitness. Blood and urine samples were collected 48-hours after the last work session. Blood was analyzed for glucose, creatine kinase, cholesterol, and a complete hemogram. Urine and blood samples were also analyzed for markers related to kidney function. RESULTS Volunteers were young (26 ± 6 y), had low body fat (13 ± 5%), and good cardiorespiratory fitness (41 ± 6 mL/kg/min). Classical markers of kidney function (eGFR, creatinine, cystatin C) were within the normal range. However, ten volunteers presented elevated resting serum creatine kinase (221 ± 68 U/L). CONCLUSION Manual sugarcane harvesting is associated with sustained skeletal muscle damage which may increase the risk for kidney injury in Brazilian sugarcane cutters.
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Affiliation(s)
- Caíque Olegário Diniz
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil (Mr Diniz, Mr Canuto, Dr Magalhães, Dr Rocha-Vieira, Dr Amorim); Departamento de Educação Física, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil (Dr Machado-Moreira); Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho, São Paulo, São Paulo, Brazil (Dr Shibuya, Dr da Cunha, Dr Maia, Dr Roscani, Dr Santiago de Moraes Barros, Dr Bitencourt); Faculdade de Ciências Médicas da Santa Casa, São Paulo, São Paulo, Brazil (Dr Souza e Silva de Almeida); University of New Mexico, Albuquerque, New Mexico (Mr McKenna, Dr Amorim)
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Abstract
Evolutionary processes, including mutation, migration and natural selection, have influenced the prevalence and distribution of various disorders in humans. However, despite a few well-known examples, such as the APOL1 variants - which have undergone positive genetic selection for their ability to confer resistance to Trypanosoma brucei infection but confer a higher risk of chronic kidney disease - little is known about the effects of evolutionary processes that have shaped genetic variation on kidney disease. An understanding of basic concepts in evolutionary genetics provides an opportunity to consider how findings from ancient and archaic genomes could inform our knowledge of evolution and provide insights into how population migration and genetic admixture have shaped the current distribution and landscape of human kidney-associated diseases. Differences in exposures to infectious agents, environmental toxins, dietary components and climate also have the potential to influence the evolutionary genetics of kidneys. Of note, selective pressure on loci associated with kidney disease is often from non-kidney diseases, and thus it is important to understand how the link between genome-wide selected loci and kidney disease occurs in relation to secondary nephropathies.
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18
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Lartey D, Greenwood M, Linse G, Moyce S, Curl C, Spivak M, Johnson EC. Estimating Differences in Risk of Chronic Kidney Disease Based on Water Intake in a National Sample. ANNALS OF NUTRITION AND METABOLISM 2021. [PMID: 35226910 DOI: 10.1159/000520666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In agricultural communities in Central and South America, Egypt, India, and Sri Lanka, an unexplained form of chronic kidney disease affects agricultural workers. Termed chronic kidney disease of unknown origin (CKDu), it disproportionately affects young men in their 30s-40s and is unrelated to the traditional risk factors of diabetes, hypertension, and obesity [1-3]. Recent investigations suggest that agricultural work in the USA carries similar risks, as reduced kidney function has been found among those working in US agriculture [4-5]. However, researchers are yet to determine the etiology of the disease [6-8]. Central to the hypotheses of CKDu is the reduced blood flow to the kidneys due to inadequate hydration during periods of intense physical labor. OBJECTIVES The primary aim of the current investigation was to identify if a relationship between hydration and kidney function exists among the general population by using the data from the National Health and Nutrition Examination Survey (NHANES). We hypothesize that reduced hydration will be associated with reduced kidney function. METHODS Data were retrieved from the NHANES dataset from 3 sample years 2005/2006, 2007/2008, and 2011/2012. Data were merged across all 3 periods with survey weights adjusted for combining across multiple years. Participants were excluded if they had missing data for hydration or kidney function, or if they were <19 year. Kidney function was categorized low risk, moderate risk, or high risk for impaired function based on estimated glomerular filtration rate and albumin creatinine ratio according to the National Kidney Foundation [9]. Hydration was classified based on total water intake (TWI) extracted from plain water intake and water from food. Participants were labeled as high if they met or exceeded sex-specific water recommendations, 3.7 and 2.7 L/day for men and women, respectively; otherwise they were labeled as low. A survey-weighted proportional odds logistic regression model was fitted to assess the association between water intake and kidney function, while controlling for other demographic, socio-economic, behavioral, and socio-economic risk factors [10-12]. RESULTS Of the 13,056 participants initially sampled, 10,651 participants are included in the analysis after cleaning and including survey weights. 9,125 (85.67%) of participants were in the low-risk group, 1,128 (10.59%) were classified as medium-risk, while the remaining 398 (3.74%) were high risk (Fig. 1). Adjusting for survey weights, results suggest that the estimated rate of high-risk kidney function was 5% more for low water drinkers compared to high water drinkers (Fig. 2). There is strong evidence of a difference in CKD risk categories based on TWI (χ2(1) = 13.1, p value <0.0001) from a survey-weighted proportional odds logistic regression model, but only moderate evidence of a difference when controlled for sodium/potassium ratio, education, age, gender, ethnicity, income, BMI, blood pressure, diabetes, smoking, and alcohol consumption (χ2(1) = 3.3, p value = 0.067). CONCLUSIONS Not meeting recommended daily TWI was associated increased presentation of high-risk kidney function. Even though the NHANES data are not focused on areas where chronic kidney disease is prevalent, results from this are an indication that hydration does play a role in kidney function.
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Affiliation(s)
- David Lartey
- Department of Mathematical Science, Montana State University, Bozeman, Montana, USA
| | - Mark Greenwood
- Department of Mathematical Science, Montana State University, Bozeman, Montana, USA.,Department of Mathematical Sciences, Statistical Consulting and Research Services, Montana State University, Bozeman, Montana, USA
| | - Greta Linse
- Department of Mathematical Sciences, Statistical Consulting and Research Services, Montana State University, Bozeman, Montana, USA
| | - Sally Moyce
- College of Nursing, Montana State University, Bozeman, Montana, USA
| | - Cynthia Curl
- Center for Excellence in Environmental Health and Safety, Boise State University, Boise, Idaho, USA
| | - Meredith Spivak
- Center for Excellence in Environmental Health and Safety, Boise State University, Boise, Idaho, USA
| | - Evan C Johnson
- Division of Kinesiology & Health, University of Wyoming, Laramie, Wyoming, USA
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A Pilot Study to Assess Inhalation Exposures among Sugarcane Workers in Guatemala: Implications for Chronic Kidney Disease of Unknown Origin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165708. [PMID: 32784623 PMCID: PMC7459472 DOI: 10.3390/ijerph17165708] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 12/16/2022]
Abstract
Background: Sugarcane workers in Central America experience a heavy burden of chronic kidney disease of unknown origin. We conducted a pilot study among worker proxies in Guatemala to characterize exposures to particulate matter, silica, heavy metals, and glyphosate, as well as to examine potential nephrotoxic exposures. Methods: Air, soil, and ash samples were collected and analyzed using scanning electron microscopy, X-ray diffraction, inductively coupled plasma mass spectrometry, and an enzyme-linked immunosorbent assay. Results: The average mass concentration for particulate matter (PM)2.5 and PM100 exposures were 360 µg/m3 (range: 32 to 1500 µg/m3) and 555 µg/m3 (range: 229 to 1170 µg/m3), respectively. The elemental composition of particles was largely silicon. The amount of crystalline silica was below 5 μg, yet the percentage of total silica was ~17% by weight. Putatively, the silica was in the amorphous form. Concentrations of aluminum and calcium ranged from 2–7 μg/m3. Glyphosate was not detectable in analyzed air samples but was detectable at concentrations ranging from 81–165 ppb in soil samples. Conclusion: Sugarcane workers are exposed to high concentrations of particulate matter. Future studies should investigate the potential role of silica, heavy metals, and agrochemicals in the etiology of chronic kidney disease in this population.
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Geck MS, Cristians S, Berger-González M, Casu L, Heinrich M, Leonti M. Traditional Herbal Medicine in Mesoamerica: Toward Its Evidence Base for Improving Universal Health Coverage. Front Pharmacol 2020; 11:1160. [PMID: 32848768 PMCID: PMC7411306 DOI: 10.3389/fphar.2020.01160] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/16/2020] [Indexed: 01/28/2023] Open
Abstract
The quality of health care in Mesoamerica is influenced by its rich cultural diversity and characterized by social inequalities. Especially indigenous and rural communities confront diverse barriers to accessing formal health services, leading to often conflicting plurimedical systems. Fostering integrative medicine is a fundamental pillar for achieving universal health coverage (UHC) for marginalized populations. Recent developments toward health sovereignty in the region are concerned with assessing the role of traditional medicines, and particularly herbal medicines, to foster accessible and culturally pertinent healthcare provision models. In Mesoamerica, as in most regions of the world, a wealth of information on traditional and complementary medicine has been recorded. Yet these data are often scattered, making it difficult for policy makers to regulate and integrate traditionally used botanical products into primary health care. This critical review is based on a quantitative analysis of 28 survey papers focusing on the traditional use of botanical drugs in Mesoamerica used for the compilation of the "Mesoamerican Medicinal Plant Database" (MAMPDB), which includes a total of 12,537 use-records for 2188 plant taxa. Our approach presents a fundamental step toward UHC by presenting a pharmacological and toxicological review of the cross-culturally salient plant taxa and associated botanical drugs used in traditional medicine in Mesoamerica. Especially for native herbal drugs, data about safety and effectiveness are limited. Commonly used cross-culturally salient botanical drugs, which are considered safe but for which data on effectiveness is lacking constitute ideal candidates for treatment outcome studies.
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Affiliation(s)
- Matthias S. Geck
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
- Biovision – Foundation for Ecological Development, Zurich, Switzerland
| | - Sol Cristians
- Botanical Garden, Institute of Biology, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Mónica Berger-González
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala, Guatemala
- Department of Epidemiology and Public Heath, Swiss TPH, University of Basel, Basel, Switzerland
| | - Laura Casu
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Michael Heinrich
- Pharmacognosy and Phytotherapy, UCL School of Pharmacy, London, United Kingdom
| | - Marco Leonti
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
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21
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Ferguson R, Leatherman S, Fiore M, Minnings K, Mosco M, Kaufman J, Kerns E, Amador JJ, Brooks DR, Fiore M, Parekh RS, Fiore L. Prevalence and Risk Factors for CKD in the General Population of Southwestern Nicaragua. J Am Soc Nephrol 2020; 31:1585-1593. [PMID: 32471819 DOI: 10.1681/asn.2019050521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 03/24/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Studies have described Mesoamerican nephropathy among agricultural workers of El Salvador and northwestern Nicaragua. Data on prevalence and risk factors for CKD beyond agricultural workers and in other regions in Nicaragua are sparse. METHODS We recruited participants from 32 randomly selected communities in the Department of Rivas's ten municipalities in two phases. In phase 1, we screened participants using a field-based capillary creatinine measuring system and collected self-reported information on lifestyle and occupational, exposure, and health histories. Two years later, in phase 2, we enrolled 222 new participants, performing serum creatinine testing in these participants and confirmatory serum creatinine testing in phase 1 participants. RESULTS We enrolled 1242 of 1397 adults (89%) living in 533 households (median age 41 years; 43% male). We confirmed CKD (eGFR<60 ml/min per 1.73 m2) in 53 of 1227 (4.3%) evaluable participants. In multivariable testing, risk factors for prevalent CKD included age (odds ratio [OR], 1.92; 95% confidence interval [95% CI], 1.89 to 1.96) and self-reported history of hypertension (OR, 1.95; 95% CI, 1.04 to 3.64), diabetes (OR, 2.88; 95% CI, 1.40 to 5.93), or current or past work in the sugarcane industry (OR 2.92; 95% CI, 1.36 to 6.27). CONCLUSIONS Adjusted CKD prevalence was about 5% with repeat confirmatory testing in southwest Nicaragua, lower than in the northwest region. Risk factors included diabetes, hypertension, and current or prior work in the sugarcane industry but not in other forms of agricultural work. Formal CKD surveillance programs in Nicaragua are needed to assess the overall burden of CKD nationally, with a focus on agricultural workers.
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Affiliation(s)
- Ryan Ferguson
- Boston University, School of Public Health, Boston, Massachusetts
| | - Sarah Leatherman
- Boston Cooperative Studies Program Coordinating Center, Veterans Affairs, Boston Healthcare System, Boston, Massachusetts
| | - Madeline Fiore
- University of Massachusetts, School of Medicine, Worcester, Massachusetts
| | - Kailey Minnings
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Martha Mosco
- New York Presbyterian Hospital, Weill Cornell, New York, New York
| | - James Kaufman
- Division of Nephrology, Veterans Affairs New York Harbor Healthcare System and New York University School of Medicine, New York, New York
| | - Eric Kerns
- Division of Nephrology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Juan Jose Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Rulan S Parekh
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.,Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada
| | - Louis Fiore
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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22
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Fernando WBNT, Nanayakkara N, Gunarathne L, Chandrajith R. Serum and urine fluoride levels in populations of high environmental fluoride exposure with endemic CKDu: a case-control study from Sri Lanka. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2020; 42:1497-1504. [PMID: 31641912 DOI: 10.1007/s10653-019-00444-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/09/2019] [Indexed: 05/24/2023]
Abstract
Chronic kidney disease of uncertain etiology (CKDu) is a common health issue among farming communities in the dry zone of Sri Lanka where groundwater fluoride is known to be higher than recommended levels. Excessive environmental ingestion of fluoride is widely considered as a possible factor for the onset of CKDu. This study was carried out to evaluate the serum and urine fluoride levels in biopsy-proven, non-dialysis CKDu patients. Control subjects were selected from the same area without any deteriorated kidney functions. Serum and urine fluoride levels were determined by ion-selective electrode method. Higher content of serum and urine fluoride levels were observed in patients with chronic renal failures. In CKDu cases, the serum fluoride concentrations ranged between 0.47 and 9.58 mg/L (mean 1.39 ± 1.1 mg/L), while urine levels were varied between 0.45 and 6.92 mg/L (mean 1.53 ± 0.8 mg/L). In patients, urine fluoride levels showed a significant difference with the CKDu stage; however, no difference was obtained between genders and age. In endemic controls, serum and urine fluoride levels ranged between 0.51 and 1.92 mg/L (mean = 1.07 ± 0.3 mg/L) and 0.36 and 3.80 mg/L (mean = 1.26 ± 0.6 mg/L), respectively. Significantly higher fluoride in serum and urine was noted in CKDu patients compared to endemic control groups. Higher fluoride exposure via drinking water is possibly the reason for higher fluoride in serum, while excessive urinary excretion would be due to deterioration of the kidney, suggesting a possible nephrotoxic role of environmental fluoride exposure.
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Affiliation(s)
- W B N T Fernando
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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23
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Abstract
Mesoamerican endemic nephropathy is a type of chronic kidney disease of unknown origin, present in pockets of high prevalence along the Pacific Ocean coast of the Mesoamerican region, from southwest Mexico to Costa Rica. The disease is common in young adult men, most often yet not exclusively from agricultural communities, and with a high mortality rate. Kidney biopsy specimens show primarily tubular atrophy and interstitial fibrosis with some glomerular changes attributed to ischemia. Exposure to agrochemicals, heavy metals or metalloids, intense physical activity under heat stress with dehydration, infections, among other possible causes have been hypothesized as the culprit of the disease. Hypokalemia and hyperuricemia are frequent clinical features. Early diagnosis is key to initiate timely treatment and slow down the progression to end-stage kidney disease. At present, our knowledge about the magnitude of the disease burden imposed by Mesoamerican endemic nephropathy is clearly incomplete and its cause has not been determined. There is a need to implement epidemiologic and mechanistic research projects as well as formal chronic kidney disease and end-stage kidney disease registries in the Mesoamerican region to better understand the real extent of the epidemic, delimit risk populations, and to construct sound public health policy decisions.
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Affiliation(s)
- Ricardo Correa-Rotter
- Departament of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Ramón García-Trabanino
- Hemodialisis Center, San Salvador, El Salvador; Fondo Social de Emergencia para la Salud de Tierra Blanca, Usulután, El Salvador
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24
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Hansson E, Glaser J, Weiss I, Ekström U, Apelqvist J, Hogstedt C, Peraza S, Lucas R, Jakobsson K, Wesseling C, Wegman DH. Workload and cross-harvest kidney injury in a Nicaraguan sugarcane worker cohort. Occup Environ Med 2020; 76:818-826. [PMID: 31611303 PMCID: PMC6839725 DOI: 10.1136/oemed-2019-105986] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/20/2019] [Accepted: 09/18/2019] [Indexed: 12/29/2022]
Abstract
Objectives To examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury. Methods Biological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), drip irrigation workers (moderate), seed cutters (high) and burned sugarcane cutters (very high). Dropouts were contacted (87%) and reported the reason for leaving work. Cross-harvest incident kidney injury (IKI) was defined as serum creatinine increase ≥0.30 mg/dL or ≥1.5 times the baseline value, or among dropouts reporting kidney injury leading to leaving work. Results Mean cross-harvest estimated glomerular filtration rate change was significantly associated with workload, increasing from 0 mL/min/1.73 m2 in the low-moderate category to −5 mL/min/1.73 m2 in the high and −9 mL/min/1.73 m2 in the very high workload group. A similar pattern occurred with IKI, where low-moderate workload had 2% compared with 27% in the very high workload category. A healthy worker selection effect was detected, with 32% of dropouts reporting kidney injury. Fever and C reactive protein elevation were associated with kidney injury. Conclusions Workers considered to have the highest workload had more cross-harvest kidney damage than workers with less workload. Work practices preventing heat stress should be strengthened and their role in preventing kidney damage examined further. Future occupational studies on chronic kidney disease of unknown aetiology should account for a healthy worker effect by pursuing those lost to follow-up.
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Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, District of Columbia, USA.,School of Public Health, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Jason Glaser
- La Isla Network, Washington, District of Columbia, USA .,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ilana Weiss
- La Isla Network, Washington, District of Columbia, USA
| | - Ulf Ekström
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University Faculty of Medicine, Lund, Sweden
| | - Jenny Apelqvist
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University Faculty of Medicine, Lund, Sweden
| | - Christer Hogstedt
- La Isla Network, Washington, District of Columbia, USA.,Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sandra Peraza
- La Isla Network, Washington, District of Columbia, USA.,Facultad de Quimica y Farmacia, Universidad de El Salvador, San Salvador, El Salvador.,Programa SALTRA/ES, San Salvador, El Salvador
| | - Rebekah Lucas
- La Isla Network, Washington, District of Columbia, USA.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Kristina Jakobsson
- La Isla Network, Washington, District of Columbia, USA.,School of Public Health, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Catharina Wesseling
- La Isla Network, Washington, District of Columbia, USA.,Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - David H Wegman
- La Isla Network, Washington, District of Columbia, USA.,University of Massachusetts Lowell, Lowell, Massachusetts, USA
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25
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Rojas-Valverde D, Olcina G, Gutiérrez-Vargas R, Crowe J. Heat Strain, External Workload, and Chronic Kidney Disease in Tropical Settings: Are Endurance Athletes Exposed? Front Physiol 2019; 10:1403. [PMID: 31824329 PMCID: PMC6881241 DOI: 10.3389/fphys.2019.01403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica.,Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
| | - Guillermo Olcina
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
| | - Randall Gutiérrez-Vargas
- Centro de Investigación y Diagnóstico en Salud y Deporte, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica
| | - Jennifer Crowe
- Instituto Regional de Estudios en Sustancias Tóxicas (IRET), Universidad Nacional, Heredia, Costa Rica
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26
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Lee CJ, Gardiner BS, Evans RG, Smith DW. Analysis of the critical determinants of renal medullary oxygenation. Am J Physiol Renal Physiol 2019; 317:F1483-F1502. [DOI: 10.1152/ajprenal.00315.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We have previously developed a three-dimensional computational model of oxygen transport in the renal medulla. In the present study, we used this model to quantify the sensitivity of renal medullary oxygenation to four of its major known determinants: medullary blood flow (MBF), medullary oxygen consumption rate (V̇o2,M), hemoglobin (Hb) concentration in the blood, and renal perfusion pressure. We also examined medullary oxygenation under special conditions of hydropenia, extracellular fluid volume expansion by infusion of isotonic saline, and hemodilution during cardiopulmonary bypass. Under baseline (normal) conditions, the average medullary tissue Po2 predicted for the whole renal medulla was ~30 mmHg. The periphery of the interbundle region in the outer medulla was identified as the most hypoxic region in the renal medulla, which demonstrates that the model prediction is qualitatively accurate. Medullary oxygenation was most sensitive to changes in renal perfusion pressure followed by Hb, MBF, and V̇o2,M, in that order. The medullary oxygenation also became sensitized by prohypoxic changes in other parameters, leading to a greater fall in medullary tissue Po2 when multiple parameters changed simultaneously. Hydropenia did not induce a significant change in medullary oxygenation compared with the baseline state, while volume expansion resulted in a large increase in inner medulla tissue Po2 (by ~15 mmHg). Under conditions of cardiopulmonary bypass, the renal medulla became severely hypoxic, due to hemodilution, with one-third of the outer stripe of outer medulla tissue having a Po2 of <5 mmHg.
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Affiliation(s)
- Chang-Joon Lee
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
- Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Bruce S. Gardiner
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
- Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Roger G. Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - David W. Smith
- Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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27
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Abstract
Objectives: To characterize kidney function of sugarcane workers in Guatemala over the 6-month harvest and identify risk factors associated with changes in kidney function. Methods: Demographic and biological data were collected for 330 sugarcane cutters at the beginning and end of the harvest. Multivariable regression analyses were used to assess factors related to kidney function. Results: A decline in kidney function across the harvest was observed in 36% of the participants. Risk factors associated with this decline included working at a particular plantation mill, local area workers compared with highland workers, and current smokers. Conclusion: Results showed both occupational and behavioral factors play significant roles in declines in kidney function. These results underline the need for a comprehensive approach to the epidemic as well as further investigation of risk factors to guide research and interventions.
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28
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Smpokou ET, González-Quiroz M, Martins C, Alvito P, Le Blond J, Glaser J, Aragón A, Wesseling C, Nitsch D, Pearce N, Norman J, Lindh CH, Morton J, Caplin B. Environmental exposures in young adults with declining kidney function in a population at risk of Mesoamerican nephropathy. Occup Environ Med 2019; 76:920-926. [PMID: 31562235 DOI: 10.1136/oemed-2019-105772] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/28/2019] [Accepted: 09/01/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES There is an epidemic of Mesoamerican nephropathy (MeN) in Central America, where sugarcane production is prominent. Numerous causes are proposed, but to date limited evidence supports any one hypothesis. A nested case-control study using biosamples from a rural, community-based follow-up study of 350 young adults from Northwest Nicaragua at risk of MeN was conducted with the aim of characterising the associations between urinary concentrations of metals, pesticides and mycotoxins from samples collected in the first 6 months and decline in kidney function over 2 years. METHODS Urine samples collected at baseline (pre-sugarcane harvest) and the first 6 month follow-up (post-sugarcane harvest) visit were tested. Twelve metals and metalloids (aluminium, total arsenic, cadmium, chromium, cobalt, copper, lead, manganese, mercury, selenium, silicon and strontium) were analysed by inductively coupled plasma-mass spectrometry. Twelve pesticides or their metabolites (2,4-dichlorophenoxyacetic acid, 3-phenoxybenzoic acid, 4-fluoro-3-phenoxybenzoic acid, chloro-3,3,3-trifluoro-1-propen-1-yl-2,2-dimethylcyclopropanecarboxylic acid, cis/trans 3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, ethylenethiourea, glyphosate, 4-chloro-2-methylphenoxy acetic acid, 3-hydroxy-pyrimetanil, 5-hydroxytiabendazole, hydroxy-tebuconazole and 3,5,6-trichloro-2-pyridinol) and two mycotoxins (ochratoxin A (OTA) and citrinin (CIT)) were analysed by liquid chromatography coupled-mass spectrometry. Differences in the creatinine-corrected urinary concentrations of the measured exposures between outcome groups (participants with stable vs declining kidney function) were examined. RESULTS Elevated levels of aluminium and total arsenic as well as metabolites of several pesticides were detected across the population. No differences were identified between the declining and stable groups in the levels of metals or pesticides tested. OTA and CIT were below the limit of detection. CONCLUSIONS The tested metals, metalloids, pesticides and mycotoxins were not associated with loss of kidney function in participants at-risk of MeN.
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Affiliation(s)
| | - Marvin González-Quiroz
- Department of Renal Medicine, University College London, London, UK.,Research Centre on Health, Work and Environment, National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua
| | - Carla Martins
- Department of Food and Nutrition, National Institute of Health Dr Ricardo Jorge (INSA), Lisboa, Portugal.,Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | - Paula Alvito
- Department of Food and Nutrition, National Institute of Health Dr Ricardo Jorge (INSA), Lisboa, Portugal.,Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | | | - Jason Glaser
- Executive, La Isla Network, Ada, Michigan, USA.,Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurora Aragón
- Research Centre on Health, Work and Environment, National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua
| | - Catharina Wesseling
- Executive, La Isla Network, Ada, Michigan, USA.,Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Medical Statistics, Faculty of Epidemiology and Population Health, Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Jill Norman
- Department of Renal Medicine, University College London, London, UK
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Jackie Morton
- HSE Science and Research Centre, Health and Safety Executive, Buxton, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
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29
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Gonzalez-Quiroz M, Nitsch D, Hamilton S, O'Callaghan Gordo C, Saran R, Glaser J, Correa-Rotter R, Jakobsson K, Singh A, Gunawardena N, Levin A, Remuzzi G, Caplin B, Pearce N. Rationale and population-based prospective cohort protocol for the disadvantaged populations at risk of decline in eGFR (CO-DEGREE). BMJ Open 2019; 9:e031169. [PMID: 31551387 PMCID: PMC6773312 DOI: 10.1136/bmjopen-2019-031169] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A recently recognised form of chronic kidney disease (CKD) of unknown origin (CKDu) is afflicting communities, mostly in rural areas in several regions of the world. Prevalence studies are being conducted in a number of countries, using a standardised protocol, to estimate the distribution of estimated glomerular filtration rate (eGFR), and thus identify communities with a high prevalence of reduced glomerular filtration rate (GFR). In this paper, we propose a standardised minimum protocol for cohort studies in high-risk communities aimed at investigating the incidence of, and risk factors for, early kidney dysfunction. METHODS AND ANALYSIS This generic cohort protocol provides the information to establish a prospective population-based cohort study in low-income settings with a high prevalence of CKDu. This involves a baseline survey that included key elements from the DEGREE survey (eg, using the previously published DEGREE methodology) of a population-representative sample, and subsequent follow-up visits in young adults (without a pre-existing diagnosis of CKD (eGFR<60 mL/min/1.73m2), proteinuria or risk factors for CKD at baseline) over several years. Each visit involves a core questionnaire, and collection and storage of biological samples. Local capacity to measure serum creatinine will be required so that immediate feedback on kidney function can be provided to participants. After completion of follow-up, repeat measures of creatinine should be conducted in a central laboratory, using reference standards traceable to isotope dilution mass spectrometry (IDMS) quality control material to quantify the main outcome of eGFR decline over time, alongside a description of the early evolution of disease and risk factors for eGFR decline. ETHICS AND DISSEMINATION Ethical approval will be obtained by local researchers, and participants will provide informed consent before the study commences. Participants will typically receive feedback and advice on their laboratory results, and referral to a local health system where appropriate.
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Affiliation(s)
- Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
- Centre for Nephrology, University College London, London, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Hamilton
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Cristina O'Callaghan Gordo
- Campus Mar, Instituto de Salud Global Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Rajiv Saran
- Division of Nephrology, Department of Internal Medicine & Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Kristina Jakobsson
- Department of Public Health and Community Medicine, Insitute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Ajay Singh
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Adeera Levin
- Division of Nepohrology UBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Giuseppe Remuzzi
- Instituto di Ricerche Farmacologiche Mario Negri - IRCCS, Milan, Italy
| | - Ben Caplin
- Centre for Nephrology, University College London, London, UK
| | - Neil Pearce
- Deparment of Medical Statistics and Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
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30
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31
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Hosokawa Y, Casa DJ, Trtanj JM, Belval LN, Deuster PA, Giltz SM, Grundstein AJ, Hawkins MD, Huggins RA, Jacklitsch B, Jardine JF, Jones H, Kazman JB, Reynolds ME, Stearns RL, Vanos JK, Williams AL, Williams WJ. Activity modification in heat: critical assessment of guidelines across athletic, occupational, and military settings in the USA. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:405-427. [PMID: 30710251 PMCID: PMC10041407 DOI: 10.1007/s00484-019-01673-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 05/04/2023]
Abstract
Exertional heat illness (EHI) risk is a serious concern among athletes, laborers, and warfighters. US Governing organizations have established various activity modification guidelines (AMGs) and other risk mitigation plans to help ensure the health and safety of their workers. The extent of metabolic heat production and heat gain that ensue from their work are the core reasons for EHI in the aforementioned population. Therefore, the major focus of AMGs in all settings is to modulate the work intensity and duration with additional modification in adjustable extrinsic risk factors (e.g., clothing, equipment) and intrinsic risk factors (e.g., heat acclimatization, fitness, hydration status). Future studies should continue to integrate more physiological (e.g., valid body fluid balance, internal body temperature) and biometeorological factors (e.g., cumulative heat stress) to the existing heat risk assessment models to reduce the assumptions and limitations in them. Future interagency collaboration to advance heat mitigation plans among physically active population is desired to maximize the existing resources and data to facilitate advancement in AMGs for environmental heat.
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Affiliation(s)
- Yuri Hosokawa
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA.
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan.
| | - Douglas J Casa
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Juli M Trtanj
- National Oceanic and Atmospheric Administration, Washington DC, USA
| | - Luke N Belval
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sarah M Giltz
- National Oceanic and Atmospheric Administration, Washington DC, USA
- Louisiana Sea Grant, Louisiana State University, Baton Rouge, LA, USA
| | | | | | - Robert A Huggins
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Brenda Jacklitsch
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - John F Jardine
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Hunter Jones
- National Oceanic and Atmospheric Administration, Washington DC, USA
- University Corporation for Atmospheric Research, Boulder, CO, USA
| | - Josh B Kazman
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Mark E Reynolds
- U.S. Army Public Health Center, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Rebecca L Stearns
- Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | - Jennifer K Vanos
- Scripps Institution of Oceanography Department, University of California San Diego, La Jolla, CA, USA
| | - Alan L Williams
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - W Jon Williams
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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LUNDGREN-KOWNACKI K, DAHL M, GAO C, JAKOBSSON K, LINNINGE C, SONG D, KUKLANE K. Exploring how a traditional diluted yoghurt drink may mitigate heat strain during medium-intensity intermittent work: a multidisciplinary study of occupational heat strain. INDUSTRIAL HEALTH 2018; 56:106-121. [PMID: 29057769 PMCID: PMC5889929 DOI: 10.2486/indhealth.2017-0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
It is common practice in India to consume the dairy drink buttermilk as a way of mitigating occupational heat strain. This paper explores the thermoregulatory and hydration benefits of drinking buttermilk but also the impacts of work in a hot environment on the gut microbiota, renal and cognitive function. Twelve healthy participants were subjected to a 3-h period of medium load physical intermittent work in a climatic chamber (34°C, 60% RH). The subjects were given water, buttermilk (700 ml) or no rehydration at random. Mean body temperatures when no rehydration was given were significantly higher (p≤0.001). When subjects drank water or buttermilk they had a lower sweat rate than with no rehydration (p≤0.05) and the perception of feeling hot, uncomfortable, thirsty and physically exerted was significantly reduced (p≤0.05). A hormonal stress response at the end of the exposure was seen when not drinking (p≤0.05). No differences in cognitive abilities and gut microbiota were found. The exposure lowered the renal blood flow suggesting an acute impact of short term heat exposure. It was also found that buttermilk has a protective effect on this impact. Our results demonstrated that keeping hydrated by water/buttermilk consumption mitigates heat strain in well-nourished subjects.
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Affiliation(s)
- Karin LUNDGREN-KOWNACKI
- Thermal Environment Laboratory, Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Sweden
- *To whom correspondence should be addressed. E-mail:
| | - Mats DAHL
- Department of Psychology, Lund University, Sweden
| | - Chuansi GAO
- Thermal Environment Laboratory, Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Sweden
| | - Kristina JAKOBSSON
- Department of Laboratory Medicine Lund, Unit of Occupational and Environmental Medicine, Lund University
- Department of Public Health and Community Medicine, Unit of Occupational and Environmental Medicine Sahlgrenska Academy, University of Gothenburg
| | - Caroline LINNINGE
- Department of Food Technology, Engineering and Nutrition, Lund University, Sweden
| | - Danping SONG
- Department of Food Technology, Engineering and Nutrition, Lund University, Sweden
| | - Kalev KUKLANE
- Thermal Environment Laboratory, Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Sweden
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Obrador GT, Schultheiss UT, Kretzler M, Langham RG, Nangaku M, Pecoits-Filho R, Pollock C, Rossert J, Correa-Rotter R, Stenvinkel P, Walker R, Yang CW, Fox CS, Köttgen A. Genetic and environmental risk factors for chronic kidney disease. Kidney Int Suppl (2011) 2017; 7:88-106. [PMID: 30675423 DOI: 10.1016/j.kisu.2017.07.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In order to change the current state of chronic kidney disease knowledge and therapeutics, a fundamental improvement in the understanding of genetic and environmental causes of chronic kidney disease is essential. This article first provides an overview of the existing knowledge gaps in our understanding of the genetic and environmental causes of chronic kidney disease, as well as their interactions. The second part of the article formulates goals that should be achieved in order to close these gaps, along with suggested timelines and stakeholders that are to be involved. A better understanding of genetic and environmental factors and their interactions that influence kidney function in healthy and diseased conditions can provide novel insights into renal physiology and pathophysiology and result in the identification of novel therapeutic or preventive targets to tackle the global public health care problem of chronic kidney disease.
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Affiliation(s)
- Gregorio T Obrador
- Department of Epidemiology, Biostatistics and Public Health, Universidad Panamericana School of Medicine, Mexico City, Mexico
| | - Ulla T Schultheiss
- Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany.,Renal Division, Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Matthias Kretzler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Robyn G Langham
- Monash Rural Health, Monash University, Clayton VIC, Australia
| | - Masaomi Nangaku
- Department of Hemodialysis and Apheresis, Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Roberto Pecoits-Filho
- Department of Internal Medicine, School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil
| | - Carol Pollock
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zuibrán, Mexico City, Mexico
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Caroline S Fox
- Genetics and Pharmacogenomics, Merck Research Laboratories, Boston, Massachusetts, USA
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
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Ratnayake S, Badurdeen Z, Nanayakkara N, Abeysekara T, Ratnatunga N, Kumarasiri R. Screening for chronic kidney disease of uncertain aetiology in Sri Lanka: usability of surrogate biomarkers over dipstick proteinuria. BMC Nephrol 2017. [PMID: 28629425 PMCID: PMC5477244 DOI: 10.1186/s12882-017-0610-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The use of dipstick proteinuria to screen Chronic Kidney Disease of uncertain aetiology (CKDu) in Sri Lanka is a recently debated matter of dispute. The aim of this study was to assess the suitability of biomarkers: serum creatinine, cystatin C and urine albumin to creatinine ratio (ACR) for screening CKDu in Sri Lanka. Methods Forty-four male CKDu patients and 49 healthy males from a CKDu-endemic region were selected. Meanwhile, 25 healthy males from a non-endemic region were selected as an absolute control. The diagnostic accuracy of each marker was compared using the above three study groups. Results In receiver operating characteristics (ROC) plots for creatinine, cystatin C and ACR, values of area under the curve (AUC) were 0.926, 0.920 and 0.737 respectively when CKDu was compared to non-endemic control. When CKDu was compared to endemic control, AUCs of above three analytes were distinctly lower as 0.718, 0.808 and 0.678 respectively. Cystatin C exhibited the highest sensitivity for CKDu when analyzed against both control groups where respective sensitivities were 0.75 against endemic control and 0.89 against non-endemic control. ROC-optimal cutoff limits of creatinine, cystatin C and ACR in CKDu vs non-endemic control were 89.0 μmol/L, 1.01 mg/L and 6.06 mg/g-Cr respectively, whereas in CKDu vs endemic control the respective values were 111.5 μmol/L, 1.22 mg/L and 12.66 mg/g-Cr. Conclusions Amongst the three biomarkers evaluated in this study, our data suggest that Cystatin C is the most accurate functional marker in detecting CKDu in endemic regions, yet the high cost hinders its usability on general population. Creatinine is favorable over dipstick proteinuria owing to its apparent accuracy and cost efficiency, while having the ability to complement the kidney damage marker (ACR) in screening. ACR may not be favorable as a standalone screening marker in place of dipstick proteinuria due to its significant decline in sensitivity against the CKDu-endemic population. However, creatinine and ACR in a complementary manner could overcome current shortcomings of dipstick proteinuria and such a dual marker tool could be commodious in screening CKDu-type tubulointerstital diseases. Furthermore, use of ACR may also increase the ability to clinically discriminate CKDu from other glomerular nephropathies.
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Affiliation(s)
- Samantha Ratnayake
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. .,Sri Lanka Institute of Nanotechnology (SLINTEC), Homagama, Sri Lanka.
| | - Zeid Badurdeen
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Tilak Abeysekara
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ranjith Kumarasiri
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Zoccali C. Causal mechanism and component causes in Mesoamerican-Sri Lankan nephropathy: the moderator's view. Nephrol Dial Transplant 2017; 32:607-610. [PMID: 28407132 DOI: 10.1093/ndt/gfx030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 11/14/2022] Open
Abstract
Inspired by Conan Doyle's novels, the pro contender of this Polar View undertakes an elegant exercise in territory common to epidemiology and police investigation and concludes that cyclic episodes of dehydration in individuals exposed to heavy work in very hot climates is the cause of Mesoamerican and Sri Lankan nephropathy. The contender in the opposite camp accepts the idea that dehydration may play a key role in this condition but highlights a different explanation, that it is contaminated water used for rehydration that is the eventual cause of the disease.Causal mechanisms result from the combination of many components, i.e. conditions or events that are needed for the occurrence of the disease. If we adopt a global, extended approach to the problem, it is unlikely that cyclic dehydration is a key component in all cases. While credible in most cases in Central America, the cyclic dehydration hypothesis fails to explain most cases in Sri Lanka, where agrochemicals have been implicated as the most likely cause of this disease. The experience with Balkan nephropathy is an enduring lesson that full clarification of the causal mechanisms behind endemic nephropathies can be a decades-long process. Therefore, action to control Mesoamerican and Sri Lankan nephropathy should not be deferred. Deployable interventions include the provision of uncontaminated water sources, prevention of dehydration at work sites and the application of safety procedures for agrochemicals. The joint application of these interventions will most likely benefit the populations plagued by this endemic disease.
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Affiliation(s)
- Carmine Zoccali
- CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
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Valcke M, Levasseur ME, Soares da Silva A, Wesseling C. Pesticide exposures and chronic kidney disease of unknown etiology: an epidemiologic review. Environ Health 2017; 16:49. [PMID: 28535811 PMCID: PMC5442867 DOI: 10.1186/s12940-017-0254-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 05/08/2017] [Indexed: 05/20/2023]
Abstract
The main causes of chronic kidney disease (CKD) globally are diabetes and hypertension but epidemics of chronic kidney disease of unknown etiology (CKDu) occur in Central America, Sri Lanka, India and beyond. Althoug also being observed in women, CKDu concentrates among men in agricultural sectors. Therefore, suspicions fell initially on pesticide exposure, but currently chronic heat stress and dehydration are considered key etiologic factors. Responding to persistent community and scientific concerns about the role of pesticides, we performed a systematic review of epidemiologic studies that addressed associations between any indicator of pesticide exposure and any outcome measure of CKD. Of the 21 analytical studies we identified, seven were categorized as with low, ten with medium and four with relatively high explanation value. Thirteen (62%) studies reported one or more positive associations, but four had a low explanation value and three presented equivocal results. The main limitations of both positive and negative studies were unspecific and unquantified exposure measurement ('pesticides'), the cross-sectional nature of most studies, confounding and selection bias. The four studies with stronger designs and better exposure assessment (from Sri Lanka, India and USA) all showed exposure-responses or clear associations, but for different pesticides in each study, and three of these studies were conducted in areas without CKDu epidemics. No study investigated interactions between pesticides and other concommittant exposures in agricultural occupations, in particular heat stress and dehydration. In conclusion, existing studies provide scarce evidence for an association between pesticides and regional CKDu epidemics but, given the poor pesticide exposure assessment in the majority, a role of nephrotoxic agrochemicals cannot be conclusively discarded. Future research should procure assessment of lifetime exposures to relevant specific pesticides and enough power to look into interactions with other major risk factors, in particular heat stress.
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Affiliation(s)
- Mathieu Valcke
- WHO-PAHO Collaborating Centre on Environmental and Occupational Health Impact Assessment and Surveillance INSPQ-CHUQ-DSPQ, 945, Avenue Wolfe, Québec, G1V 5B3 Canada
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, C.P. 6128 Succursale Centre-Ville, Montreal, H3C 3J7 Canada
| | - Marie-Eve Levasseur
- WHO-PAHO Collaborating Centre on Environmental and Occupational Health Impact Assessment and Surveillance INSPQ-CHUQ-DSPQ, 945, Avenue Wolfe, Québec, G1V 5B3 Canada
| | - Agnes Soares da Silva
- Pan American Health Organization (PAHO), 525 Twenty-third Street, N.W, Washington DC, 20037 USA
| | - Catharina Wesseling
- Department of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, 171 77 Stockholm, SE Sweden
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Bundschuh J, Maity JP, Mushtaq S, Vithanage M, Seneweera S, Schneider J, Bhattacharya P, Khan NI, Hamawand I, Guilherme LRG, Reardon-Smith K, Parvez F, Morales-Simfors N, Ghaze S, Pudmenzky C, Kouadio L, Chen CY. Medical geology in the framework of the sustainable development goals. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 581-582:87-104. [PMID: 28062106 DOI: 10.1016/j.scitotenv.2016.11.208] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 05/23/2023]
Abstract
Exposure to geogenic contaminants (GCs) such as metal(loid)s, radioactive metals and isotopes as well as transuraniums occurring naturally in geogenic sources (rocks, minerals) can negatively impact on environmental and human health. The GCs are released into the environment by natural biogeochemical processes within the near-surface environments and/or by anthropogenic activities such as mining and hydrocarbon exploitation as well as exploitation of geothermal resources. They can contaminate soil, water, air and biota and subsequently enter the food chain with often serious health impacts which are mostly underestimated and poorly recognized. Global population explosion and economic growth and the associated increase in demand for water, energy, food, and mineral resources result in accelerated release of GCs globally. The emerging science of "medical geology" assesses the complex relationships between geo-environmental factors and their impacts on humans and environments and is related to the majority of the 17 Sustainable Development Goals in the 2030 Agenda of the United Nations for Sustainable Development. In this paper, we identify multiple lines of evidence for the role of GCs in the incidence of diseases with as yet unknown etiology (causation). Integrated medical geology promises a more holistic understanding of the occurrence, mobility, bioavailability, bio-accessibility, exposure and transfer mechanisms of GCs to the food-chain and humans, and the related ecotoxicological impacts and health effects. Scientific evidence based on this approach will support adaptive solutions for prevention, preparedness and response regarding human and environmental health impacts originating from exposure to GCs.
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Affiliation(s)
- Jochen Bundschuh
- Deputy Vice-Chancellor's Office (Research and Innovation), University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; Faculty of Health, Engineering and Sciences, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; KTH-International Groundwater Arsenic Research Group, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 76, SE-10044 Stockholm, Sweden.
| | - Jyoti Prakash Maity
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Min-Hsiung, Chiayi County 62102, Taiwan.
| | - Shahbaz Mushtaq
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Meththika Vithanage
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; Chemical and Environmental Systems Modeling Research Group, National Institute of Fundamental Studies, Kandy 20000, Sri Lanka.
| | - Saman Seneweera
- Centre for Crop Health, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Jerusa Schneider
- Sanitation and Environment Dept., School of Civil Engineering, Architecture and Urban Design, State University of Campinas, 113083-889 Campinas, (SP), Brazil.
| | - Prosun Bhattacharya
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; KTH-International Groundwater Arsenic Research Group, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 76, SE-10044 Stockholm, Sweden.
| | - Nasreen Islam Khan
- College of Medicine, Biology and Environment, Australian National University, Canberra, ACT 0200, Australia; GIS Social Science Division, International Rice Research Institute (IRRI), Los Banos, Laguna 4031, Philippines.
| | - Ihsan Hamawand
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Luiz R G Guilherme
- Soil Science Department, Federal University of Lavras (UFLA), Campus Universitário, Caixa Postal 3037, CEP: 37200-000 Lavras, Minas Gerais, Brazil.
| | - Kathryn Reardon-Smith
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Faruque Parvez
- Department of Environmental Health Sciences, Mailman, School of Public Health, Columbia University, 722 West 168th St., 10032 NewYork, NY, USA.
| | | | - Sara Ghaze
- Faculty of Health, Engineering and Sciences, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Christa Pudmenzky
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Louis Kouadio
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Chien-Yen Chen
- Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Min-Hsiung, Chiayi County 62102, Taiwan.
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Moyce S, Mitchell D, Armitage T, Tancredi D, Joseph J, Schenker M. Heat strain, volume depletion and kidney function in California agricultural workers. Occup Environ Med 2017; 74:402-409. [PMID: 28093502 DOI: 10.1136/oemed-2016-103848] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/23/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Agricultural work can expose workers to increased risk of heat strain and volume depletion due to repeated exposures to high ambient temperatures, arduous physical exertion and limited rehydration. These risk factors may result in acute kidney injury (AKI). METHODS We estimated AKI cumulative incidence in a convenience sample of 283 agricultural workers based on elevations of serum creatinine between preshift and postshift blood samples. Heat strain was assessed based on changes in core body temperature and heart rate. Volume depletion was assessed using changes in body mass over the work shift. Logistic regression models were used to estimate the associations of AKI with traditional risk factors (age, diabetes, hypertension and history of kidney disease) as well as with occupational risk factors (years in farm work, method of payment and farm task). RESULTS 35 participants were characterised with incident AKI over the course of a work shift (12.3%). Workers who experienced heat strain had increased adjusted odds of AKI (1.34, 95% CI 1.04 to 1.74). Piece rate work was associated with 4.24 odds of AKI (95% CI 1.56 to 11.52). Females paid by the piece had 102.81 adjusted odds of AKI (95% CI 7.32 to 1443.20). DISCUSSION Heat strain and piece rate work are associated with incident AKI after a single shift of agricultural work, though gender differences exist. Modifications to payment structures may help prevent AKI.
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Affiliation(s)
- Sally Moyce
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California, USA
| | - Diane Mitchell
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Tracey Armitage
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Daniel Tancredi
- Department of Pediatrics, University of California, Davis, Davis, California, USA
| | - Jill Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California, USA
| | - Marc Schenker
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
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González-Quiroz M, Camacho A, Faber D, Aragón A, Wesseling C, Glaser J, Le Blond J, Smeeth L, Nitsch D, Pearce N, Caplin B. Rationale, description and baseline findings of a community-based prospective cohort study of kidney function amongst the young rural population of Northwest Nicaragua. BMC Nephrol 2017; 18:16. [PMID: 28086816 PMCID: PMC5237152 DOI: 10.1186/s12882-016-0422-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/20/2016] [Indexed: 12/16/2022] Open
Abstract
Background An epidemic of Mesoamerican Nephropathy (MeN) is killing thousands of agricultural workers along the Pacific coast of Central America, but the natural history and aetiology of the disease remain poorly understood. We have recently commenced a community-based longitudinal study to investigate Chronic Kidney Disease (CKD) in Nicaragua. Although logistically challenging, study designs of this type have the potential to provide important insights that other study designs cannot. In this paper we discuss the rationale for conducting this study and summarize the findings of the baseline visit. Methods The baseline visit of the community-based cohort study was conducted in 9 communities in the North Western Nicaragua in October and November 2014. All of the young men, and a random sample of young women (aged 18–30) without a pre-existing diagnosis of CKD were invited to participate. Glomerular filtration rate (eGFR) was estimated with CKD-EPI equation, along with clinical measurements, questionnaires, biological and environmental samples to evaluate participants’ exposures to proposed risk factors for MeN. Results We identified 520 young adults (286 males and 234 females) in the 9 different communities. Of these, 16 males with self-reported CKD and 5 females with diagnoses of either diabetes or hypertension were excluded from the study population. All remaining 270 men and 90 women, selected at random, were then invited to participate in the study; 350 (97%) agreed to participate. At baseline, 29 (11%) men and 1 (1%) woman had an eGFR <90 mL/min/1.73 m2. Conclusion Conducting a community based study of this type requires active the involvement of communities and commitment from local leaders. Furthermore, a research team with strong links to the area and broad understanding of the context of the problem being studied is essential. The key findings will arise from follow-up, but it is striking that 5% of males under aged 30 had to be excluded because of pre-existing kidney disease, and that despite doing so 11% of males had an eGFR <90 mL/min/1.73 m2 at baseline. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0422-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marvin González-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), Campus Médico, Facultad de Ciencias Médica, Edificio C (CISTA), León, Nicaragua. .,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for Nephrology, University College London Medical School, London, UK.
| | - Armando Camacho
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), Campus Médico, Facultad de Ciencias Médica, Edificio C (CISTA), León, Nicaragua
| | | | - Aurora Aragón
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), Campus Médico, Facultad de Ciencias Médica, Edificio C (CISTA), León, Nicaragua
| | - Catharina Wesseling
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Centre for Nephrology, University College London Medical School, London, UK
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Riefkohl A, Ramírez-Rubio O, Laws RL, McClean MD, Weiner DE, Kaufman JS, Galloway RL, Shadomy SV, Guerra M, Amador JJ, Sánchez JM, López-Pilarte D, Parikh CR, Leibler JH, Brooks DR. Leptospira seropositivity as a risk factor for Mesoamerican Nephropathy. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2017; 23:1-10. [PMID: 28209095 PMCID: PMC6060841 DOI: 10.1080/10773525.2016.1275462] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Leptospirosis is postulated as a possible cause of Mesoamerican Nephropathy (MeN) in Central American workers. OBJECTIVES Investigate job-specific Leptospira seroprevalence and its association with kidney disease biomarkers. METHODS In 282 sugarcane workers, 47 sugarcane applicants and 160 workers in other industries, we measured anti-leptospiral antibodies, serum creatinine, and urinary injury biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and N-acetyl-D-glucosaminidase (NAG). RESULTS Leptospira seroprevalence differed among job categories and was highest among sugarcane cutters (59%). Seropositive sugarcane workers had higher NGAL concentrations (relative mean: 1.28; 95% CI: 0.94-1.75) compared to those who were seronegative, with similar findings among field and non-field workers. CONCLUSIONS Leptospira seroprevalence varied by job category. There was some indication that seropositivity was associated with elevated biomarker levels, but results were inconsistent. Additional studies may help establish whether Leptospira infection plays any role in MeN among Central American workers.
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Affiliation(s)
- Alejandro Riefkohl
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Oriana Ramírez-Rubio
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Preventive Medicine and Public Health Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rebecca L. Laws
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Michael D. McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Daniel E. Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - James S. Kaufman
- Research Service, VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY, USA
| | - Renee L. Galloway
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens & Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean V. Shadomy
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens & Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marta Guerra
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens & Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - José Marcel Sánchez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Damaris López-Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Chirag R. Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT, USA
- Program of Applied Translational Research, Department of Medicine, Yale University, New Haven, CT, USA
| | - Jessica H. Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Abstract
Changes in atmosphere and temperature are affecting multiple environmental indicators from extreme heat events to global air quality. Workers will be uniquely affected by climate change, and the occupational impacts of major shifts in atmospheric and weather conditions need greater attention. Climate change-related exposures most likely to differentially affect workers in the USA and globally include heat, ozone, polycyclic aromatic hydrocarbons, other chemicals, pathogenic microorganisms, vector-borne diseases, violence, and wildfires. Epidemiologic evidence documents a U-, J-, or V-shaped relationship between temperature and mortality. Whereas heat-related morbidity and mortality risks are most evident in agriculture, many other outdoor occupational sectors are also at risk, including construction, transportation, landscaping, firefighting, and other emergency response operations. The toxicity of chemicals change under hyperthermic conditions, particularly for pesticides and ozone. Combined with climate-related changes in chemical transport and distribution, these interactions represent unique health risks specifically to workers. Links between heat and interpersonal conflict including violence require attention because they pose threats to the safety of emergency medicine, peacekeeping and humanitarian relief, and public safety professionals. Recommendations for anticipating how US workers will be most susceptible to climate change include formal monitoring systems for agricultural workers; modeling scenarios focusing on occupational impacts of extreme climate events including floods, wildfires, and chemical spills; and national research agenda setting focusing on control and mitigation of occupational susceptibility to climate change.
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Wesseling C, Aragón A, González M, Weiss I, Glaser J, Rivard CJ, Roncal-Jiménez C, Correa-Rotter R, Johnson RJ. Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua. BMJ Open 2016; 6:e011034. [PMID: 27932336 PMCID: PMC5168614 DOI: 10.1136/bmjopen-2016-011034] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To study Mesoamerican nephropathy (MeN) and its risk factors in three hot occupations. DESIGN Cross-sectional. SETTING Chinandega and León municipalities, a MeN hotspot on the Nicaraguan Pacific coast, January-February 2013. PARTICIPANTS 194 male workers aged 17-39 years: 86 sugarcane cutters, 56 construction workers, 52 small-scale farmers. OUTCOME MEASURES (1) Differences between the three occupational groups in prevalences/levels of socioeconomic, occupational, lifestyle and health risk factors for chronic kidney disease (CKD) and in biomarkers of kidney function and hydration; (2) differences in prevalences/levels of CKD risk factors between workers with reduced estimated glomerular filtration rate (eGFRCKD-EPI <80 mL/min/1.73 m2) and workers with normal kidney function (eGFRCKD-EPI ≥80 mL/min/1.73 m2). RESULTS Sugarcane cutters were more exposed to heat and consumed more fluid on workdays and had less obesity, lower blood sugar, lower blood pressure and a better lipid profile. Reduced eGFR occurred in 16%, 9% and 2% of sugarcane cutters, construction workers and farmers, respectively (trend cane > construction > farming, p=0.003). Significant trends (cane > construction > farming) were also observed for high serum urea nitrogen (blood urea nitrogen (BUN) >20 mg/dL), high serum creatinine (SCr >1.2 mg/dL), low urinary pH (≤5.5) and high BUN/SCr ratio (>20) but not for high urinary specific gravity (≥1.030). Sugarcane cutters also more often had proteinuria and blood and leucocytes in the urine. Workers with eGFR <80 mL/min/1.73 m2 reported a higher intake of water and lower intake of sugary beverages. Serum uric acid levels related strongly and inversely to eGFR levels (adj β -10.4 mL/min/1.73 m2, 95% CI -12.2 to -8.5, p<0.001). No associations were observed for other metabolic risk factors, pesticides, non-steroidal anti-inflammatory drugs or alcohol. Among cane cutters, consumption of electrolyte hydration solution appeared preventive (adj β 8.1 mL/min/1.73 m2, p=0.09). CONCLUSIONS Heat stress, dehydration and kidney dysfunction were most common among sugarcane cutters. Kidney dysfunction also occurred to a lesser extent among construction workers, but hardly at all among small-scale farmers. High serum uric acid was associated with reduced kidney function.
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Affiliation(s)
- Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Aurora Aragón
- Research Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
| | - Marvin González
- Research Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jason Glaser
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- La Isla Foundation, Chicago, Illinois, USA
| | - Christopher J Rivard
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado,USA
| | - Carlos Roncal-Jiménez
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado,USA
| | - Ricardo Correa-Rotter
- Department Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado,USA
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McInnes JA, MacFarlane EM, Sim MR, Smith P. Working in hot weather: a review of policies and guidelines to minimise the risk of harm to Australian workers. Inj Prev 2016; 23:334-339. [DOI: 10.1136/injuryprev-2016-042204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/08/2016] [Accepted: 10/24/2016] [Indexed: 11/04/2022]
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Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H, Cahuana-Hurtado L, Darney B, Avila-Burgos L, Correa-Rotter R, Rivera JA, Barquera S, González-Pier E, Aburto-Soto T, de Castro EFA, Barrientos-Gutiérrez T, Basto-Abreu AC, Batis C, Borges G, Campos-Nonato I, Campuzano-Rincón JC, de Jesús Cantoral-Preciado A, Contreras-Manzano AG, Cuevas-Nasu L, de la Cruz-Gongora VV, Diaz-Ortega JL, de Lourdes García-García M, Garcia-Guerra A, de Cossío TG, González-Castell LD, Heredia-Pi I, Hijar-Medina MC, Jauregui A, Jimenez-Corona A, Lopez-Olmedo N, Magis-Rodríguez C, Medina-Garcia C, Medina-Mora ME, Mejia-Rodriguez F, Montañez JC, Montero P, Montoya A, Moreno-Banda GL, Pedroza-Tobías A, Pérez-Padilla R, Quezada AD, Richardson-López-Collada VL, Riojas-Rodríguez H, Ríos Blancas MJ, Razo-Garcia C, Mendoza MPR, Sánchez-Pimienta TG, Sánchez-Romero LM, Schilmann A, Servan-Mori E, Shamah-Levy T, Téllez-Rojo MM, Texcalac-Sangrador JL, Wang H, Vos T, Forouzanfar MH, Naghavi M, Lopez AD, Murray CJL, Lozano R. Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2016; 388:2386-2402. [PMID: 27720260 DOI: 10.1016/s0140-6736(16)31773-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.
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Affiliation(s)
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - Blair Darney
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan A Rivera
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | | | | | | | | | | | - Guilherme Borges
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Maria E Medina-Mora
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | - Pablo Montero
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Rafael Lozano
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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Cusumano AM, Rosa-Diez GJ, Gonzalez-Bedat MC. Latin American Dialysis and Transplant Registry: Experience and contributions to end-stage renal disease epidemiology. World J Nephrol 2016; 5:389-397. [PMID: 27648403 PMCID: PMC5011246 DOI: 10.5527/wjn.v5.i5.389] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/29/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
In 2015, 634387 million people (9% of the world’s population) resided in Latin America (LA), with half of those populating Brazil and Mexico. The LA Dialysis and Transplant Registry was initiated in 1991, with the aim of collecting data on renal replacement therapy (RRT) from the 20 LA-affiliated countries. Since then, the Registry has revealed a trend of increasing prevalence and incidence of end-stage kidney disease on RRT, which is ongoing and is correlated with gross national income, life expectancy at birth, and percentage of population that is older than 65 years. In addition, the rate of kidney transplantation has increased yearly, with > 70% being performed from deceased donors. According to the numbers reported for 2013, the rates of prevalence, incidence and transplantation were (in patients per million population) 669, 149 and 19.4, respectively. Hemodialysis was the treatment of choice (90%), and 43% of the patients undergoing this treatment was located in Brazil; in contrast, peritoneal dialysis prevailed in Costa Rica, El Salvador and Guatemala. To date, the Registry remains the only source of RRT data available to healthcare authorities in many LA countries. It not only serves to promote knowledge regarding epidemiology of end-stage renal disease and the related RRT but also for training of nephrologists and renal researchers, to improve understanding and clinical application of dialysis and transplantation services. In LA, accessibility to RRT is still limited and it remains necessary to develop effective programs that will reduce risk factors, promote early diagnosis and treatment of chronic kidney disease, and strengthen transplantation programs.
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Ganguli A. Uddanam Nephropathy/Regional Nephropathy in India: Preliminary Findings and a Plea for Further Research. Am J Kidney Dis 2016; 68:344-8. [DOI: 10.1053/j.ajkd.2016.04.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/04/2016] [Indexed: 02/08/2023]
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Bodin T, García-Trabanino R, Weiss I, Jarquín E, Glaser J, Jakobsson K, Lucas RAI, Wesseling C, Hogstedt C, Wegman DH. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1. Occup Environ Med 2016; 73:409-16. [PMID: 27073211 PMCID: PMC4893112 DOI: 10.1136/oemed-2016-103555] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/24/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic heat stress and dehydration from strenuous work in hot environments is considered an essential component of the epidemic of chronic kidney disease in Central America. OBJECTIVE (1) To assess feasibility of providing an intervention modelled on OSHA's Water.Rest.Shade programme (WRS) during sugarcane cutting and (2) to prevent heat stress and dehydration without decreasing productivity. METHODS Midway through the 6-month harvest, the intervention introduced WRS practices. A 60-person cutting group was provided water supplied in individual backpacks, mobile shaded rest areas and scheduled rest periods. Ergonomically improved machetes and efficiency strategies were also implemented. Health data (anthropometric, blood, urine, questionnaires) were collected preharvest, preintervention, mid-intervention and at the end of harvest. A subsample participated in focus group discussions. Daily wet bulb globe temperatures (WBGT) were recorded. The employer provided individual production records. RESULTS Over the harvest WBGT was >26°C from 9:00 onwards reaching average maximum of 29.3±1.7°C, around 13:00. Postintervention self-reported water consumption increased 25%. Symptoms associated with heat stress and with dehydration decreased. Individual daily production increased from 5.1 to a high of 7.3 tons/person/day postintervention. This increase was greater than in other cutting groups at the company. Focus groups reported a positive perception of components of the WRS, and the new machete and cutting programmes. CONCLUSIONS A WRS intervention is feasible in sugarcane fields, and appears to markedly reduce the impact of the heat stress conditions for the workforce. With proper attention to work practices, production can be maintained with less impact on worker health.
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Affiliation(s)
- T Bodin
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - R García-Trabanino
- Association of Nephrology and Hypertension of El Salvador, San Salvador, El Salvador
| | - I Weiss
- La Isla Foundation, Ada, Michigan, USA
| | - E Jarquín
- Agency for Development and Agricultural Health (AGDYSA), San Salvador, El Salvador
| | - J Glaser
- La Isla Foundation, Ada, Michigan, USA
| | - K Jakobsson
- Department of Public Health and Community Medicine, Gothenburg University, Gothenburg, Sweden
| | - R A I Lucas
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - C Wesseling
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - C Hogstedt
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - D H Wegman
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Moyce S, Joseph J, Tancredi D, Mitchell D, Schenker M. Cumulative Incidence of Acute Kidney Injury in California's Agricultural Workers. J Occup Environ Med 2016; 58:391-7. [DOI: 10.1097/jom.0000000000000668] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Wesseling C, García-Trabanino R, Wegman DH. Mesoamerican Nephropathy: Do Novel Biomarkers of Kidney Damage Have a Role to Play? Am J Kidney Dis 2016; 67:173-5. [PMID: 26802327 DOI: 10.1053/j.ajkd.2015.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 01/30/2023]
Affiliation(s)
| | | | - David H Wegman
- University of Massachusetts Lowell, Lowell, Massachusetts
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Harhay MN, Harhay MO, Coto-Yglesias F, Rosero Bixby L. Altitude and regional gradients in chronic kidney disease prevalence in Costa Rica: Data from the Costa Rican Longevity and Healthy Aging Study. Trop Med Int Health 2016; 21:41-51. [PMID: 26466575 PMCID: PMC4718874 DOI: 10.1111/tmi.12622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Recent studies in Central America indicate that mortality attributable to chronic kidney disease (CKD) is rising rapidly. We sought to determine the prevalence and regional variation of CKD and the relationship of biologic and socio-economic factors to CKD risk in the older-adult population of Costa Rica. METHODS We used data from the Costa Rican Longevity and Health Aging Study (CRELES). The cohort was comprised of 2657 adults born before 1946 in Costa Rica, chosen through a sampling algorithm to represent the national population of Costa Ricans >60 years of age. Participants answered questionnaire data and completed laboratory testing. The primary outcome of this study was CKD, defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 . RESULTS The estimated prevalence of CKD for older Costa Ricans was 20% (95% CI 18.5-21.9%). In multivariable logistic regression, older age (adjusted odds ratio [aOR] 1.08 per year, 95% CI 1.07-1.10, P < 0.001) was independently associated with CKD. For every 200 m above sea level of residence, subjects' odds of CKD increased 26% (aOR 1.26 95% CI 1.15-1.38, P < 0.001). There was large regional variation in adjusted CKD prevalence, highest in Limon (40%, 95% CI 30-50%) and Guanacaste (36%, 95% CI 26-46%) provinces. Regional and altitude effects remained robust after adjustment for socio-economic status. CONCLUSIONS We observed large regional and altitude-related variations in CKD prevalence in Costa Rica, not explained by the distribution of traditional CKD risk factors. More studies are needed to explore the potential association of geographic and environmental exposures with the risk of CKD.
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Affiliation(s)
- Meera N Harhay
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Michael O Harhay
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando Coto-Yglesias
- Department of Geriatric Medicine, National Geriatrics and Gerontology Hospital, San José, Costa Rica
| | - Luis Rosero Bixby
- Central American Population Center, University of Costa Rica, San José, Costa Rica
- Department of Demography, University of California, Berkeley, CA, USA
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