The Chorotega CKDu Epidemiology Field Study

摘要 原因不明的慢性肾脏病在哥斯达黎加已达到流行程度 瓜纳卡斯特省(乔罗特加地区)，在那里它已成为过早死亡的主要原因。CKDu有 年轻的男性农业工人负担很重，但妇女和儿童也受到影响，其 原因在很大程度上仍不清楚。慢性肾脏疾病现场流行病学现场RFA应对措施 农业社区中的不明病因疾病研究联盟(治愈联盟) 建议招募、登记和跟踪400名参与者，并提供CKDu证明和400名对照参与者 对CKDU的个体风险因素和背景暴露的综合评估。我们提出了一个 科罗特加地区利比里亚流行病学现场中心，作为科罗特加大学 北卡罗来纳州教堂山大学、哥斯达黎加大学和乔罗特加地区的当地肾病学家。我们的 研究设计包括一项大型病例对照研究，包括嵌套子研究和最新研究 慢性肾功能不全危险因素及病因评估方法(S)。我们将进行临床评估和 收集广泛的生物和环境/职业样本和数据。除了分析广泛的 自我报告的生活方式/人口、环境、职业因素和环境的范围 测量在病例对照研究中，我们将进行1)嵌套式家庭研究，以评估家族性 聚集/遗传易感性；2)在系列靶向和非靶向对照中的前瞻性研究 当代环境/职业化学暴露(暴露组学)在尿液和饮酒中的测量 水与急性肾损伤(AKI)和新发CKDU的测量有关；以及3)一个有前景的领域 在农业和建筑业中使用的具有代表性的控制措施样本中的研究 通过重复测量定向和非定向化学品暴露的季节性工作场所暴露 (暴露组学，包括但不限于杀虫剂、金属和燃烧产物)，在尿液和 通过硅胶腕带取样器，与热应激相关的AKI测量相关。我们建议组建一家 具有足够广度、深度和规模的资源，以便能够对广泛的风险因素进行信息性评估； 包括环境/职业暴露和健康情况，具有足够的能力确定一个或多个 CKDU的病因更多，可以作为预防、干预或政策的目标。

ABSTRACT Chronic kidney disease of uncertain etiology (CKDu) has reached epidemic proportions in Costa Rica’s Guanacaste province (Chorotega region), where it has become a leading cause of premature death. CKDu has a high burden among young, male agricultural workers, but women and children are also affected, and its causes remain largely unknown. In response to the RFA for Field Epidemiology Sites for the Chronic Kidney Diseases of UnceRtain Etiology in Agricultural Communities Research Consortium (CURE Consortium), we propose to recruit, enroll and follow 400 participants with evidence of CKDu and 400 control participants for comprehensive assessments of individual risk factors and contextual exposures for CKDu. We propose an Epidemiology Field Center in Liberia, Chorotega region, as part of a collaboration among the University of North Carolina at Chapel Hill, the University of Costa Rica and local nephrologists in the Chorotega region. Our study design includes a large case-control study with nested substudies and state-of-the art exposure assessment methods to identify risk factors and cause(s) of CKDu. We will conduct clinical assessments and collect extensive biological and environmental/occupational samples and data. In addition to analysis of a wide range of self-reported lifestyle/demographic, environmental, and occupational factors and environmental measurements in the case-control study, we will conduct 1) a nested family study to assess familial aggregation/genetic susceptibility; 2) a prospective study among controls of serial targeted and non-targeted contemporary environmental/occupational chemical exposures (exposomics) measured in urine and drinking water in relation to measures of acute kidney injury (AKI) and new-onset CKDu; and 3) a prospective field study among a representative sample of controls employed in agriculture and construction to investigate seasonal workplace exposures through repeat measures of targeted and non-targeted chemical exposures (exposomics, including but not limited to pesticide, metals, and combustion products), assessed in urine and via silicone wristband samplers, in relation to measures of heat stress-related AKI. We propose to assemble a resource of sufficient breadth, depth and size to permit informative assessments of a wide range of risk factors, including environmental/occupational exposures and health contexts, with sufficient power to identify one or more causes of CKDu that could be targeted for prevention, intervention or policy.