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肾脏疾病区域流行病的担忧。尼加拉瓜卫生部的监测数据将肾功能不全列为该国太平洋沿岸城市的主要死亡原因。初步研究表明，在60岁以下的男性中发病率很高，RI与农业工作和非管制形式的酒精消费之间存在关联。为了更好地描述这种情况，北卡罗来纳州大学肾脏中心、尼加拉瓜国立自治大学（UNAN-Lesn）及其人口与健康研究中心（CIDS）组成了一个联盟，并制定了一项为期三年、分两个阶段的研究战略。在为期3年的赠款的第一年，第一阶段将包括通过测量血清肌酐和尿白蛋白和肌酐，对从尼加拉瓜Lesn人口中有代表性的群体中随机选择的1,500名社区成员进行肾脏疾病的横断面筛查。这一阶段研究的目的是确定受影响地区的疾病流行率。在赠款的第二年和第三年，第二阶段将包括在研究第一阶段筛选的人群中进行嵌套病例对照研究。这将包括对估计150例肾脏疾病病例和300例对照患者进行肾脏疾病的随访筛查和假定风险因素的详细清单。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）农业的类型和持续时间2）当地生产的甘蔗酒精的消费;和3）主要水源的类型。我们已经建立了一个工作合作，我们提出的两阶段研究计划是确定尼加拉瓜是否确实存在肾病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，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，预防和管理提供未来研究的基础，这将由CIDS发起和进行。公共卫生相关性：这是北卡罗来纳州查佩尔山北卡罗来纳州大学的美国调查人员与尼加拉瓜人口与健康研究中心合作开展的一项研究项目，目的是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，这个国家几乎没有医疗保健，包括几乎没有透析（当肾脏完全衰竭时，透析是维持生命的关键治疗）。这项研究将提供尼加拉瓜肾脏疾病的第一个适当的估计，并将确定是否有几个环境和职业暴露，使用自制酒精和水源类型与肾脏疾病有关。了解这些关联可以对减少该地区的肾脏疾病产生很大影响，因为这些类型的暴露可以通过教育和政府监管进行修改。

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.