Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy
Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy
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早期肾功能丧失的人群水平检测：对具有中美洲肾病风险的年轻成人队列进行 7 年随访
DOI：
10.1093/ije/dyad151
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发表时间：
2023
影响因子：
7.7
通讯作者：
Gonzalez-Quiroz M
中科院分区：
文献类型：
--
作者：
Gonzalez-Quiroz M
研究背景中美洲肾病是中美洲地区过早死亡的主要原因。由于难以区分潜在引发因素与常见暴露之间的联系，确定病因的努力受到阻碍，这些暴露被认为会加剧所有形式的已确立的慢性肾病(CKD)的进展。我们探索了高危人群中疾病发病或偏离健康估计肾小球滤过率分布[偏离∼EGFR(健康)]的证据。方法对来自尼加拉瓜西北部11个农村社区的两个社区队列(18-30岁的成年人，n= 351和420)分别进行了7年和3年的随访。我们使用隐马尔可夫模型检验了(I)发生慢性肾脏病和(Ii)离开∼EGFR(健康)的时间点两者之间的关系。男性和女性分别发生了53次(在1,878次访问中，2.7%)和8次(在1,067次访问中，0.8%)可能偏离∼EGFR(健康)的事件。甘蔗工作的累积时间和过度职业性日晒的症状与CKD事件相关。在时间更新的分析中，同样的暴露与偏离∼EGFR(健康)的可能性以及测量和自我报告的体重减轻、恶心、呕吐和痉挛，以及非类固醇抗炎药物的使用有关。此外，提示另一种暴露的综合征与疾病发病的证据相关联，支持可能的单独的未知启动因素，需要进一步的研究。同时，应采取干预措施，减少职业风险的影响。
BackgroundMesoamerican nephropathy is a leading contributor to premature mortality in Central America. Efforts to identify the cause are hampered by difficulties in distinguishing associations with potential initiating factors from common exposures thought to exacerbate the progression of all forms of established chronic kidney disease (CKD). We explored evidence of disease onset or departure from the healthy estimated glomerular filtration rate distribution [departure from ∼eGFR(healthy)] in an at-risk population.MethodsTwo community-based cohorts (adults aged 18–30 years,n= 351 and 420) from 11 rural communities in Northwest Nicaragua were followed up over 7 and 3 years respectively. We examined associations with both (i) incident CKD and (ii) the time point of departure from ∼eGFR(healthy), using a hidden Markov model.ResultsCKD occurred in men only (male incidence rate: 0.7%/year). Fifty-three (out of 1878 visits, 2.7%) and 8 (out of 1067 visits, 0.8%) episodes of probable departure from ∼eGFR(healthy)occurred in men and women, respectively. Cumulative time in sugarcane work and symptoms of excess occupational sun exposure were associated with incident CKD. The same exposures were associated with probability of departure from ∼eGFR(healthy)in time-updated analyses along with measured and self-reported weight loss, nausea, vomiting and cramps, as well as non-steroidal anti-inflammatory drug use.ConclusionsCKD burden in this population is high and risk factors for established disease are occupational. Additionally, a syndrome suggesting an alternative exposure is associated with evidence of disease onset supporting a possible separate unknown initiating factor for which further investigation is needed. Interventions to reduce the impact of occupational risks should be pursued meanwhile.
DOI：
10.2215/cjn.13841215
发表时间：
2016-08-01
影响因子：
9.8
作者：
Glaser, Jason;Lemery, Jay;Johnson, Richard J.
通讯作者：
Johnson, Richard J.
影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
影响因子：
8.3
作者：
Garcia-Trabanino, Ramon;Jarquin, Emmanuel;Barregard, Lars
通讯作者：
Barregard, Lars