Decline in Kidney Function among Apparently Healthy Young Adults at Risk of Mesoamerican Nephropathy
Decline in Kidney Function among Apparently Healthy Young Adults at Risk of Mesoamerican Nephropathy
复制标题
DOI：
10.1681/asn.2018020151
复制
发表时间：
2018-08-01
影响因子：
13.6
通讯作者：
Caplin, Ben
中科院分区：
文献类型：
--
作者：
Gonzalez-Quiroz, Marvin;Smpokou, Evangelia-Theano;Caplin, Ben
背景：病因不明的慢性肾脏病（CKD）在中美洲被称为中美洲肾病（Mesoamerican nephropathy），在中低收入国家已被发现。我们调查的自然历史，和相关因素，肾功能丧失的高风险人群中，这种disease.Methods我们进行了一项为期2年的前瞻性，纵向研究，随访每6个月在9个农村社区在尼加拉瓜西北部，包括所有男性（n=263）和随机抽样的妇女（n=87）年龄18-30岁，没有自我报告的慢性肾脏病，糖尿病或高血压。我们使用生长混合模型来确定eGFR轨迹的亚群，并使用加权多项logistic回归来检查与拟议风险因素的关联。（平均基线eGFR;随访期间平均eGFR变化）：81%保持稳定（116 ml/min/1.73 m（2）; -0.6 ml/min/1.73 m（2）/年），9.5%的患者尽管基线功能正常，但仍经历了快速下降（112 ml/min/1.73 m（2）; -18.2 ml/min/1.73 m（2）/年），9.5%基线功能障碍（58 ml/min/1.73 m（2）; -3.8 ml/min/1.73 m（2）/年）。在妇女中：96.6%保持稳定（121 ml/min/1.73 m（2）; -0.6 ml/min/1.73 m（2）/年），3.4%经历快速下降（132 ml/min/1.73 m（2）; -14.6 ml/min/1.73 m（2）/年; n=3名女性）。在男性中，户外和农业工作，缺乏阴凉处的可用性，在工作休息期间，在基线报告，与快速下降。结论虽然中美洲肾病与农业工作，其他因素也可能有助于这种疾病。
Background Epidemic levels of CKD of undetermined cause, termed Mesoamerican nephropathy in Central America, have been found in low- and middle-income countries. We investigated the natural history of, and factors associated with, loss of kidney function in a population at high risk for this disease.Methods We conducted a 2-year prospective, longitudinal study with follow-up every 6 months in nine rural communities in northwestern Nicaragua and included all men (n=263) and a random sample of women (n=87) ages 18-30 years old without self-reported CKD, diabetes, or hypertension. We used growth mixture modeling to identify subgroups of eGFR trajectory and weighted multinomial logistic regression to examine associations with proposed risk factors.Results Among men, we identified three subpopulations of eGFR trajectory (mean baseline eGFR; mean eGFR change over follow-up): 81% remained stable (116 ml/min per 1.73 m(2); -0.6 ml/min per 1.73 m(2) per year), 9.5% experienced rapid decline despite normal baseline function (112 ml/min per 1.73 m(2); -18.2 ml/min per 1.73 m(2) per year), and 9.5% had baseline dysfunction (58 ml/min per 1.73 m(2); -3.8 ml/min per 1.73 m(2) per year). Among women: 96.6% remained stable (121 ml/min per 1.73 m(2); -0.6 ml/min per 1.73 m(2) per year), and 3.4% experienced rapid decline (132 ml/min per 1.73 m(2); -14.6 ml/min per 1.73 m(2) per year; n=3 women). Among men, outdoor and agricultural work and lack of shade availability during work breaks, reported at baseline, were associated with rapid decline.Conclusions Although Mesoamerican nephropathy is associated with agricultural work, other factors may also contribute to this disease.