The Chorotega CKDu Epidemiology Field Study

摘要 病因不明的慢性肾脏病（CKDu）在哥斯达黎加的 瓜纳卡斯特省（Chorotega地区），在那里它已成为过早死亡的主要原因。CKDu拥有 这是年轻男性农业工人的沉重负担，但妇女和儿童也受到影响， 其原因在很大程度上仍然不明。针对慢性肾脏病现场流行病学研究中心的RFA 农业社区研究联盟（CURE联盟）中病因不明的疾病，我们 建议招募、入组和随访400名有CKDu证据的参与者和400名对照参与者， 全面评估CKDu的个体风险因素和背景暴露。我们提出了一个 流行病学现场中心在利比里亚，Chorotega地区，作为大学之间的合作的一部分， 北卡罗来纳州查佩尔山、哥斯达黎加大学和Chorotega地区的当地肾病学家。我们 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技术水平暴露 评估方法，以确定CKDu的风险因素和原因。我们将进行临床评估， 收集广泛的生物和环境/职业样本和数据。除了分析广泛的 一系列自我报告的生活方式/人口统计学、环境和职业因素以及环境 在病例对照研究中，我们将进行1）巢式家族研究，以评估家族性 聚集/遗传易感性; 2）在系列靶向和非靶向的对照中进行的前瞻性研究 当代环境/职业化学品暴露（尿液和饮水中测量） 水与急性肾损伤（阿基）和新发CKDu指标的关系; 3）前瞻性领域 在农业和建筑业中采用的具有代表性的控制样本中进行研究， 通过重复测量有针对性和非有针对性的化学品接触， （生物组学，包括但不限于农药、金属和燃烧产物），在尿液中进行评估， 通过硅胶腕带采样器，与热应激相关阿基的测量相关。我们建议， 有足够的广度、深度和规模的资源，以便能够对广泛的风险因素进行信息评估， 包括环境/职业接触和健康情况，有足够的权力确定一个或 可作为预防、干预或政策目标的更多CKDu原因。

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.