The Central American Epidemic of CKD

Weiner, Daniel E.; McClean, Michael D.; Kaufman, James S.; Brooks, Daniel R.

doi:10.2215/cjn.05050512

Cited by 97 publications

(87 citation statements)

References 27 publications

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“…Severe heat stress with accompanying water and solute loss (with repeated volume depletion) can cause ischemic kidney injury, even in healthy adults [42] . Many scientists now believe that the most probable cause of Mesoamerican nephropathy is recurrent dehydration and heat stress from extreme occupational conditions which causes subclinical kidney injury that leads to permanent kidney damage over time [37,[42][43][44] .…”

Section: The Heat Stress Hypothesismentioning

confidence: 99%

“…Many scientists now believe that the most probable cause of Mesoamerican nephropathy is recurrent dehydration and heat stress from extreme occupational conditions which causes subclinical kidney injury that leads to permanent kidney damage over time [37,[42][43][44] . As described in recent field studies, sugarcane harvesting involves 4-6 h of heavy lifting in extremely hot conditions (temperatures often exceed 35 ° C in the coastal lowlands), and workers typically lose 2.6 kg in body weight after a day of harvesting [42,[45][46][47] . Further studies have shown significant increases in levels of urinary kidney injury biomarkers (including neutrophil gelatinase-associated lipocalin and interleukin 18) in field workers compared with non-field workers before and after the harvest season [43,44] .…”

Section: The Heat Stress Hypothesismentioning

confidence: 99%

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Hydration and Chronic Kidney Disease Progression: A Critical Review of the Evidence

et al. 2016

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We performed a comprehensive literature review to examine evidence on the effects of hydration on the kidney. By reducing vasopressin secretion, increasing water intake may have a beneficial effect on renal function in patients with all forms of chronic kidney disease (CKD) and in those at risk of CKD. This potential benefit may be greater when the kidney is still able to concentrate urine (high fluid intake is contraindicated in dialysis-dependent patients). Increasing water intake is a well-accepted method for preventing renal calculi, and current evidence suggests that recurrent dehydration and heat stress from extreme occupational conditions is the most probable cause of an ongoing CKD epidemic in Mesoamerica. In polycystic kidney disease (PKD), increased water intake has been shown to slow renal cyst growth in animals via direct vasopressin suppression, and pharmacologic blockade of renal vasopressin-V2 receptors has been shown to slow cyst growth in patients. However, larger clinical trials are needed to determine if supplemental water can safely slow the loss of kidney function in PKD patients.

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Section: The Heat Stress Hypothesismentioning

confidence: 99%

Section: The Heat Stress Hypothesismentioning

confidence: 99%

Hydration and Chronic Kidney Disease Progression: A Critical Review of the Evidence

et al. 2016

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“…leptospirosis), and genetic factors. 2,6,7,22 Several papers suggest that heat stress, described as repeated exposure to heat and strenuous labor with associated repeated volume depletion and dehydration, may play an important role. 7,15,17,23,24 Most researchers believe that the causal mechanism of MeN is multifactorial, though the specific risk factors remain unknown.…”

Section: Introductionmentioning

confidence: 99%

Changes in kidney function among Nicaraguan sugarcane workers

Laws

Brooks

Amador

et al. 2015

International Journal of Occupational and Environmental Health

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101

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Background: There is an epidemic of chronic kidney disease (CKD) of unknown etiology in Central American workers. Objectives: To investigate changes and job-specific differences in kidney function over a 6-month sugarcane harvest season, explore the potential role of hydration, and measure proteinuria. Methods: We recruited 284 Nicaraguan sugarcane workers performing seven distinct tasks. We measured urine albumin and serum creatinine and estimated glomerular filtration rate (eGFR). Results: eGFR varied by job and decreased during the harvest in seed cutters (28.6 ml/min/1.73 m 2 ), irrigators (27.4 ml/min/1.73 m 2 ), and cane cutters (25.0 ml/min/1.73 m 2 ), as compared to factory workers. The number of years employed at the company was negatively associated with eGFR. Fewer than 5% of workers had albumin-to-creatinine ratio (ACR) .30 mg/g. Conclusions:The decline in kidney function during the harvest and the differences by job category and employment duration provide evidence that one or more risk factors of CKD are occupational.

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“…It is therefore unlikely that the kidney disease mentioned is related to the volcanic activity. There is a high prevalence of Chronic Kidney Disease (CKD) in Nicaragua, specifically at lower elevations where the main occupations are related to agriculture and mining (Ramirez-Rubio et al 2013;Weiner et al 2013).…”

Section: Perceived Personal Impactsmentioning

confidence: 99%

Perception of a chronic volcanic hazard: persistent degassing at Masaya volcano, Nicaragua

Manen

2014

J Appl. Volcanol.

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This study takes a combined qualitative and quantitative approach to examining the chronic hazard posed by persistent degassing at Masaya volcano, Nicaragua. The gas is a highly salient threat in communities surrounding Masaya volcano, with the elevated salience level of his invisible hazard deriving from the highly perceptible impacts of the degassing; these include individual and material impacts such as increased prevalence of self-reported respiratory disease and decreased crop diversification and productivity. Qualitative results concur with findings from a quantitative assessment of ambient SO 2 exposure using diffusion tubes: the current level of SO 2 degassing far exceeds international guideline values, making it a likely cause of adverse health effects for the general population. Conversely contaminant levels of heavy and toxic metals in foodstuffs were found to be below international standards. A community-based integrated hazard mitigation approach identified by this research is the cultivation of crops, particularly pineapple (Ananas comosus) and pitaya (Hylocereus sp.), that are better able to withstand the local environmental conditions (e.g. increased atmospheric SO 2 and acid gas deposition). Despite this, little is known regarding disaster response and risk reduction at the community level and the gas hazard is largely overlooked. This shows large scope for increasing resilience in collaboration with the community, through for example the development of community-level risk management committees, improvement and implementation of (gas) mitigation strategies and disaster preparedness approaches. By reducing the impacts of the chronic hazard posed by persistent volcanic degassing, resilience to acute hazards is also likely to improve.

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The Central American Epidemic of CKD

Cited by 97 publications

References 27 publications

Hydration and Chronic Kidney Disease Progression: A Critical Review of the Evidence

Hydration and Chronic Kidney Disease Progression: A Critical Review of the Evidence

Changes in kidney function among Nicaraguan sugarcane workers

Perception of a chronic volcanic hazard: persistent degassing at Masaya volcano, Nicaragua

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