Environmental risk factors for reduced kidney function due to undetermined cause in India: an environmental epidemiologic analysis.
Environmental risk factors for reduced kidney function due to undetermined cause in India: an environmental epidemiologic analysis.
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DOI：
10.1097/ee9.0000000000000170
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发表时间：
2021-10
期刊：
影响因子：
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通讯作者：
Mohan S
中科院分区：
文献类型：
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作者：
Hamilton SA;Jarhyan P;Fecht D;Venkateshmurthy NS;Pearce N;Narayan KMV;Ali MK;Mohan V;Tandon N;Prabhakaran D;Mohan S
补充数字内容可在文本中找到。慢性肾脏疾病的流行正在低收入和中等收入国家的农村社区发生，这些国家没有糖尿病和高血压等常见肾脏疾病风险因素。这种病因不明的慢性肾病主要发生在中美洲和南亚的农业社区。因此，环境风险因素，包括热应激，重金属暴露，低海拔已被假设为风险因素。我们进行了一项环境流行病学分析，调查报告该疾病的印度的这些暴露情况。我们在2010年、2011年和2014年在印度北方和南方的农村和城市地区使用了随机样本人群（n = 11，119）。我们调查了热指数，海拔高度，和附近的农田估计肾小球滤过率（eGFR）使用卫星衍生的数据分配到住宅坐标的关联。我们使用logistic回归对这些暴露与eGFR进行建模，以估计低eGFR的风险，并使用线性混合模型（LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-LIGHT-L 55岁以上、男性和居住在农田附近与低eGFR风险增加相关[比值比（OR）（95%置信区间（CI）分别为2.24（1.43，3.56）、2.32（1.39，3.88）和1.47（1.16，2.36）]。在吕宋，靠近农田与低eGFR相关[-0.80（-0.44，-0.14）]。没有观察到与温度或海拔的关联。年龄较大、男性、居住在农田附近与eGFR呈负相关。这些分析对于确定高风险亚群落非常重要，并有助于指导未来的环境调查。
Supplemental Digital Content is available in the text. An epidemic of chronic kidney disease is occurring in rural communities in low-income and middle-income countries that do not share common kidney disease risk factors such as diabetes and hypertension. This chronic kidney disease of unknown etiology occurs primarily in agricultural communities in Central America and South Asia. Consequently, environmental risk factors including heat stress, heavy metals exposure, and low altitude have been hypothesized as risk factors. We conducted an environmental epidemiological analysis investigating these exposures in India which reports the disease. We used a random sample population in rural and urban sites in Northern and Southern India in 2010, 2011, and 2014 (n = 11,119). We investigated associations of the heat index, altitude, and vicinity to cropland with estimated glomerular filtration rate (eGFR) using satellite-derived data assigned to residential coordinates. We modeled these exposures with eGFR using logistic regression to estimate the risk of low eGFR, and linear mixed models (LMMs) to analyze site-specific eGFR-environment associations. Being over 55 years of age, male, and living in proximity to cropland was associated with increased risk of low eGFR [odds ratio (OR) (95% confidence interval (CI) = 2.24 (1.43, 3.56), 2.32 (1.39, 3.88), and 1.47 (1.16, 2.36)], respectively. In LMMs, vicinity to cropland was associated with low eGFR [−0.80 (−0.44, −0.14)]. No associations were observed with temperature or altitude. Older age, being male, and living in proximity to cropland were negatively associated with eGFR. These analyses are important in identifying subcommunities at higher risk and can help direct future environmental investigations.