CKDu in Salvadoran and Nicaraguan Agricultural Communities

项目总结 中美洲有一种慢性肾脏疾病(CKD)的流行，其流行率一直是 在过去的20年里不断增加。萨尔瓦多和尼加拉瓜的肾脏总死亡率最高。 慢性肾脏病是世界上最严重的疾病，慢性肾脏病是劳动年龄男性死亡的第二大原因。在美国 在欧洲，慢性肾脏病在老年人群(60岁)中很常见，对男性和女性的影响均等，主要是 由于糖尿病和高血压。相比之下，中美洲某些地区的CKD不成比例 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(S)尚不清楚。类似疫情的慢性肾脏疾病的不明原因 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开展一项研究 该联盟将汇集广泛的专业知识，使发现科学能够了解 CKDU和疾病进展的原因或原因。该联盟还将致力于确定潜在的治疗方法 目标和公共卫生干预，并将包括一个科学数据协调中心，实地 流行病学网站和肾脏科学核心。该联盟将共同努力，最终敲定道德规范 流行病学研究设计、执行生物采样和环境方面的通用策略 评估，对收集的样本和数据应用分析策略，并传播结果。这是一项建议 在萨尔瓦多和尼加拉瓜的一个现场流行病学网站。 我们的目标是：(1)与CURE联盟指导委员会和SDCC共同制定研究方案，以进行 CKDU病因和进展的纵向研究；(2)880名萨尔瓦多人的订婚和同意 以及居住在有良好记录的高风险CKDu社区的尼加拉瓜参与者进入治愈 (3)进行临床评估，收集生物和环境样本，并管理 用于检验多重假设的确定疾病状况和危险因素的问卷调查 纵向三年；(四)调查人员多方位、持续沟通 以及本地和国际利益相关者，包括传达个人肾功能结果以治愈 参与者，并将总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 官员和普通民众。我们的研究团队目前在这个问题上有很深的渊源。 相关性 慢性肾脏疾病被认为是全球第12大致死原因，其中肾脏是“热点”。 病因不明的疾病。中部地区慢性肾脏疾病高危人群的研究 美国(肾脏疾病“热点”)将有助于科学理解 疾病易感性和严重性，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.