Prevalence and Risk Factors for CKD Among Brickmaking Workers in La Paz Centro, Nicaragua
Prevalence and Risk Factors for CKD Among Brickmaking Workers in La Paz Centro, Nicaragua
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DOI：
10.1053/j.ajkd.2019.01.017
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发表时间：
2019-08-01
影响因子：
13.2
通讯作者：
Scammell, Madeleine K.
中科院分区：
文献类型：
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作者：
Gallo-Ruiz, Lyanne;Sennett, Caryn M.;Scammell, Madeleine K.
理由与目的：在中美洲，非传统病因的慢性肾脏疾病（CKD）在农业工人中有很高的患病率。很少有研究评估非农业职业工人的CKD患病率，这是本调查的目的。研究设计：前瞻性队列研究。背景和参与者：在尼加拉瓜La Paz Centro的手工制砖厂工作的男女工人（n = 224）。预测因素：年龄、性别、教育程度、吸烟状况、体重指数、饮酒、饮水、CKD一级亲属、工作年限、每周工作时间、工作类别、研究访问（基线和随访）、自我报告的高血压和糖尿病。结果：CKD定义为在间隔4个月和CKD分期的2个时间点估计肾小球滤过率(eGFR) < 60 mL/min/1.73 m(2)。分析方法：采用非结构化协方差矩阵的线性混合效应模型来评估人口统计学、职业风险因素和eGFR基线之间的关系。还评估了危险因素和时间与eGFR变化之间的相互作用。采用多变量logistic回归模型评价CKD的预测因素。结果：CKD患病率为12.1% (n = 27)， 100%为男性，30%为5期CKD (eGFR < 15 mL/min/1.73 m(2))， 22%年龄小于35岁。基线和随访时egfr < 60 mL/min/1.73 m(2)的参与者比例分别为13.8%和15.2%。线性回归分析显示，基线时肾功能较低的显著预测因素包括：烤箱工作、年龄较大、缺乏教育和有直系亲属患有CKD。使用逻辑回归分析确定CKD的预测因素包括工作和缺乏教育。局限性：粗略的工作分类测量，随访损失，自我报告暴露。结论：在这一砖瓦工人人群中，CKD的患病率很高，这表明影响中美洲的CKD流行病并不局限于农业工人。这些结果与职业热暴露是该地区肾脏疾病危险因素的假设一致。
Rationale & Objective: In Central America, there is a high prevalence of chronic kidney disease (CKD) of nontraditional etiology often observed among agricultural workers. Few studies have assessed CKD prevalence among workers in nonagricultural occupations, which was the objective of this investigation.Study Design: Prospective cohort study.Setting & Participants: Male and female workers (n = 224) employed by artisanal brickmaking facilities in La Paz Centro, Nicaragua.Predictors: Age, sex, education, smoking status, body mass index, alcohol consumption, water consumption, first-degree relative(s) with CKD, years worked, hours worked per week, job category, study visit (baseline and follow-up), and self-reported hypertension and diabetes.Outcomes: CKD defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) at 2 time points 4 months apart and CKD stage.Analytical Approach: A linear mixed-effects model with an unstructured covariance matrix was used to evaluate the association between demographics, occupational risk factors, and eGFR at baseline. The interaction between risk factors and time with change in eGFR was also evaluated. Multivariable logistic regression models were used to evaluate predictors of CKD.Results: The CKD prevalence was 12.1% (n = 27), 100% of cases were male, 30% had stage 5 CKD (eGFR < 15 mL/min/1.73 m(2)), and 22% were younger than 35 years. Proportions of participants with eGFRs < 60 mL/min/1.73 m(2) at baseline and follow-up were 13.8% and 15.2%, respectively. Linear regression analysis demonstrated significant predictors of lower kidney function at baseline including oven work, older age, lack of education, and having an immediate family member with CKD. Predictors of CKD identified using logistic regression analysis included oven work and lack of education.Limitations: Crude job classification measures, loss to follow-up, self-reported exposures.Conclusions: The prevalence of CKD is high in this population of brick workers, suggesting that the epidemic of CKD affecting Mesoamerica is not limited to agricultural workers. These results are consistent with the hypothesis that occupational heat exposure is a risk factor for kidney disease in this region.