Kidney Disease in Nicaragua: Evaluating Prevalence and Risk Factors

描述（由申请人提供）：尼加拉瓜的公共卫生专业人员报告了对区域性肾病流行的担忧。尼加拉瓜卫生部（Ministerio De Salud Republica de Nicaragua - MINSA）的监测数据将肾功能不全（RI）列为该国太平洋沿岸城市的主要原因。初步研究表明，60 岁以下男性的患病率很高，并且 RI 与农业工作和不受管制的酒精消费之间存在关联。为了更好地描述情况，北卡罗来纳大学 (UNC) 肾脏中心、尼加拉瓜国立自治大学 Lesn (UNAN-Lesn) 及其 Centro de Investigacisn en Demografma y Salud (CIDS) 结成了联盟，并制定了为期三年、分两阶段的调查策略。在为期 3 年的资助的第一年，第一阶段将包括通过测量血清肌酐、尿白蛋白和肌酐，对从尼加拉瓜 Lesn 人口的代表性群体中随机选出的 1,500 名社区成员进行肾病横断面筛查。此阶段研究的目的是确定受影响地区的疾病流行情况。在资助的第二年和第三年，第二阶段将包括在第一阶段研究筛选的对象中进行嵌套病例对照研究。这将包括对肾脏疾病进行后续筛查，并对估计的 150 例肾脏疾病病例和 300 例对照进行详细的假定危险因素清单。这部分研究的具体目的是确定以下因素是否与肾脏疾病相关：1）农业类型和持续时间2）消费当地生产的甘蔗酒精； 3) 主要水源类型。工作合作已经建立，我们提出的两阶段研究计划是确定尼加拉瓜肾病是否确实存在高患病率的关键一步，并揭示可改变的风险因素，这将有助于中美洲最贫穷国家之一的预防工作。尼加拉瓜人获得医疗保健的机会有限，并且肾衰竭的维持治疗（透析和移植）并不常见。这笔赠款将为尼加拉瓜肾脏疾病的理解、预防和管理的未来研究奠定基础，这项工作将由 CIDS 发起和开展。公共健康相关性：这是北卡罗来纳大学教堂山分校和尼加拉瓜人口与健康研究中心的美国研究人员之间的一个合作研究项目，旨在研究尼加拉瓜的肾脏疾病。尼加拉瓜是美洲最贫穷的国家之一。有一些早期证据表明，尼加拉瓜的肾病发病率很高，该国几乎无法获得医疗保健治疗，包括几乎无法进行透析（当肾脏完全衰竭时，这种治疗对维持生命至关重要）。这项研究将首次对尼加拉瓜的肾脏疾病进行正确的估计，并将确定多种环境和职业暴露、自制酒精的使用以及水源类型是否与肾脏疾病有关。了解这些关联可以对该地区减少肾脏疾病产生重大影响，因为这些类型的暴露可以通过教育和政府监管来改变。

DESCRIPTION (provided by applicant): Public health professionals in Nicaragua report concerns for a regional epidemic of renal disease. Surveillance data from the Nicaraguan Ministry of Health (Ministerio De Salud Republica de Nicaragua - MINSA) lists renal insufficiency (RI) as the primary cause of death in municipalities on the pacific coast of the country. Preliminary research suggests a high prevalence amongst males less than 60 years of age, as well as an association between RI, and agricultural work and consumption of an unregulated form of alcohol. In order to better describe the situation the University of North Carolina (UNC) Kidney Center, La Universidad Nacional Autsnoma de Nicaragua, Lesn (UNAN- Lesn), and its Centro de Investigacisn en Demografma y Salud (CIDS) have formed an alliance and devised a three year, two phase investigation strategy. In year 1 of the 3-year grant, the first phase will include a cross sectional screening of 1,500 community members randomly selected from representative clusters within Lesn, Nicaragua's population for kidney disease through measurement of serum creatinine and urine albumin and creatinine. The aim of this phase of the study is to determine the prevalence of disease in the effected region. In years 2 and 3 of the grant, phase two will include a nested case-control study among those screened in the first phase of the study. This will include a follow-up screening for kidney disease and a detailed inventory of postulated risk factors in an estimated 150 kidney disease cases and 300 controls. The specific aims for this portion of the study are to determine if the following factors are associated with kidney disease: 1) type and duration of farming 2) consumption of locally made sugar cane-based alcohol; and 3) type of primary water sources. A working collaboration has been established and our proposed two-phase research plan is a critical step to identify if indeed there is a high prevalence of kidney disease in Nicaragua, and to reveal modifiable risk factors which would aid prevention efforts in one of the poorest countries in Central America. Nicaraguans have limited access to healthcare and maintenance therapy for kidney failure (dialysis and transplantation) is not commonly available. This grant will provide the foundation for future research into the understanding, prevention and management of kidney disease in Nicaragua, an endeavor that will be initiated and conducted by CIDS. PUBLIC HEALTH RELEVANCE: This is a collaborative research project between U.S. investigators at the University of North Carolina at Chapel Hill, North Carolina and the Center for Demographic and Health Research in Nicaragua to study kidney disease in Nicaragua. Nicaragua is one of the poorest countries in the Americas. There is some early evidence that there is a high rate of kidney disease in Nicaragua, a country with little access to health care for treatment, including almost no availability of dialysis (a treatment critical to sustain life when the kidneys completely fail). This research will provide the first proper estimates of kidney disease in Nicaragua and will also determine if several environmental and occupational exposures, use of homemade alcohol, and types of water sources are associated with kidney disease. Understanding these associations can have a large impact in reducing kidney disease in the area since these types of exposures can be modified through education and government regulation.