Exploring risk factors and predictors of endemic CKDu in agricultural regions of four Central America countries

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PROJECT SUMMARY Chronic kidney disease of unknown origin (CKDu) is highly prevalent in several tropical regions, including Central America where it is most common among young adult males working in sugarcane and other agricultural activities. It has taken a terrible toll on families living in vulnerable conditions in rural areas. Despite efforts to study CKDu over the last two decades, its causes are not fully understood and the disease continues to claim lives and overwhelm healthcare systems. This project aims to identify risk factors and predictors for estimated glomerular filtration rate (eGFR) decline among young individuals with and without CKDu in rural endemic areas in four Central American countries: Costa Rica, Panama, Nicaragua and Guatemala. We will comprehensively assess multiple risk factors related to 1) strenuous manual labor under heat stress with inadequate rest; 2) social determinants (e.g., poverty, malnutrition, low birth weight); 3) vector-borne or zoonotic diseases; and 4) exposure to known or novel toxins (e.g., heavy metals, agrochemicals, silica). We will also collect bio-banked specimens to assess genetic risk factors and novel biomarkers of acute kidney injury (AKI), as determined by the NIH Chronic Kidney Diseases of Uncertain Etiology (CURE) consortium. As a Field Epidemiology Site, our primary study aims are: (a) identification of cases and controls in endemic agricultural communities; (b) longitudinal follow-up of both cases and controls; and (c) biopsies in a subset of individuals. Our proposal takes advantage of the SALTRA network (Central American Program for Health, Work and Environment). SALTRA has nearly 20 years of experience conducting research in the region and has longstanding relationships with local communities, organizations and governmental organizations, public health authorities and local nephrologists on the front lines of fighting this disease.