CKDu in Salvadoran and Nicaraguan Agricultural Communities

项目摘要 在中美洲存在慢性肾病（CKD）的流行，并且患病率已经降低。 在过去的20年里不断增加。萨尔瓦多萨尔瓦多和尼加拉瓜的肾脏疾病总死亡率最高 CKD是世界上最严重的疾病，是工作年龄男性死亡的第二大原因。在美国 在欧洲，CKD在老年人群（年龄> 60岁）中很常见，对男性和女性的影响相同，主要是 因为糖尿病和高血压相比之下，在中美洲的某些地区， 影响年轻男性，似乎与糖尿病或高血压无关。农业工人是最 受影响，但具体原因仍然未知。未知的慢性肾脏疾病的类似流行 病因学（CKDu）存在于斯里兰卡和印度。美国国立卫生研究院正在建立一项研究， 该联盟将汇集广泛的专业知识，使发现科学能够了解 CKDu和疾病进展的原因。该联盟还将努力确定潜在的治疗方法， 目标和公共卫生干预措施，并将包括一个科学数据协调中心，外地 流行病学网站和肾脏科学核心。该联盟将共同努力， 流行病学研究设计，执行生物采样和环境 评估，对收集的样本和数据应用分析战略，并传播结果。这是一项建议 为萨尔瓦多和尼加拉瓜的一个现场流行病学研究中心。 我们的目标是：（1）与CURE联盟指导委员会和SDCC制定研究方案， 对CKDu的原因和进展进行纵向研究;（2）让多达880名萨尔瓦多人参与并表示同意 和居住在有充分记录的高风险CKDu社区的巴布亚新几内亚参与者加入CURE （3）进行临床评估，收集生物和环境样本，并管理 确定疾病状况和风险因素的问卷调查，以检验多个假设 纵向三年;（4）研究者之间进行多方位、持续的沟通 以及当地和国际利益相关者，包括向CURE传达个体肾功能结果 参与者，并将整体研究结果提供给队列参与者，当地合作伙伴，科学界，公共卫生 官员和公众。我们的研究团队目前在这个问题上有很强的历史。 相关性 据估计，慢性肾脏疾病是全球第12大死亡原因，肾脏疾病是"热点"。 不明原因的疾病。我们对中环慢性肾病高危人群的研究 美国（肾脏疾病"热点"）将有助于科学地了解环境因素， 疾病的易感性和严重性，特别注重预防和治疗的机会。

PROJECT SUMMARY There is an epidemic of chronic kidney disease (CKD) in Central America, and the prevalence has been increasing over the past 20 years. El Salvador and Nicaragua have the highest overall mortality rates from kidney disease in the world, and CKD is the second leading cause of mortality among men of working age. In the US and Europe, CKD is common in older populations (age>60), affects men and women equally, and is primarily due to diabetes and hypertension. In contrast, CKD in certain regions of Central America disproportionately affects younger men and appears to be unrelated to diabetes or hypertension. Agricultural workers are the most affected, but the specific cause(s) remains unknown. Similar epidemics of chronic kidney disease of unknown etiology (CKDu) exist in Sri Lanka and India. The US National Institutes of Health is establishing a research consortium that will bring together a broad range of expertise and enable discovery science to understand the cause or causes of CKDu and disease progression. The Consortium will also work to identify potential therapeutic targets and public health intervention and will consist of a Scientific Data Coordinating Center, Field Epidemiology Sites, and a Renal Science Core. The Consortium will work together to finalize ethical epidemiology research designs, execute common strategies for biological sampling and environmental assessment, apply analytic strategies for collected samples and data, and disseminate results. This is a proposal for a Field Epidemiology Site in El Salvador and Nicaragua. Our aims are: (1) Develop study protocol with the CURE Consortium Steering Committee and SDCC to conduct longitudinal research on the causes and progression of CKDu; (2) Engage and consent up to 880 Salvadoran and Nicaraguan participants residing in well-documented high-risk CKDu communities into the CURE Consortium; (3) Conduct clinical assessments, collect biological and environmental samples, and administer questionnaires to determine disease status and risk factors for the examination of multiple hypotheses longitudinally for three years; (4) Engage in multi-directional and sustained communication among investigators and stakeholders locally and internationally, including communicating individual kidney function results to CURE participants, and overall study results to cohort participants, local partners, the scientific community, public health officials, and the general public. Our study team currently has a strong history together on this topic. Relevance Chronic kidney disease is estimated to be the 12th leading cause of death globally, with “hot spots” of kidney disease with no known causes. Our study of a high-risk population affected by chronic kidney disease in Central America (kidney disease “hot spots”) will contribute to scientific understanding of environmental contributors of disease susceptibility and severity with a particular focus on opportunities for prevention and treatment.