Exploring risk factors and predictors of endemic CKDu in agricultural regions of four Central America countries

项目总结 不明原因慢性肾脏病(CKDu)在几个热带地区高度流行 地区，包括在年轻成年男性中最常见的中美洲 从事甘蔗和其他农业活动。它给家庭造成了可怕的损失 生活在农村地区的脆弱条件下。尽管过去两年来一直在努力研究CKDu 几十年来，其原因尚不完全清楚，这种疾病继续夺走生命和 压倒医疗保健系统。该项目旨在确定风险因素和预测因素 有无肾小球滤过率(EGFR)的年轻人的估计肾小球滤过率(EGFR)下降 CKDu在四个中美洲国家的农村流行地区：哥斯达黎加、巴拿马、 尼加拉瓜和危地马拉。我们将综合评估与以下各项相关的多重风险因素 1)热应激下繁重的体力劳动，休息不足；2)社会决定因素 (例如，贫穷、营养不良、低出生体重)；3)媒介传播或人畜共患疾病；以及4) 接触已知或新的毒素(例如，重金属、农用化学品、二氧化硅)。我们还将 收集生物库标本以评估急性胰腺炎的遗传风险因素和新的生物标志物 NIH病因不明的慢性肾脏疾病所确定的肾脏损伤(AKI) (治愈)财团。作为现场流行病学网站，我们的主要研究目标是：(A) 确定流行农业社区的病例和控制措施；(B)纵向 对病例和对照进行随访；(C)对部分个体进行活组织检查。我们的 该提案利用了SALTRA网络(中美洲健康方案， 工作和环境)。SALTRA拥有近20年的研究经验 并与当地社区、组织和 政府组织、公共卫生当局和当地肾病学家在前线 与这种疾病作斗争的路线。

PROJECT SUMMARY Chronic kidney disease of unknown origin (CKDu) is highly prevalent in several tropical regions, including Central America where it is most common among young adult males working in sugarcane and other agricultural activities. It has taken a terrible toll on families living in vulnerable conditions in rural areas. Despite efforts to study CKDu over the last two decades, its causes are not fully understood and the disease continues to claim lives and overwhelm healthcare systems. This project aims to identify risk factors and predictors for estimated glomerular filtration rate (eGFR) decline among young individuals with and without CKDu in rural endemic areas in four Central American countries: Costa Rica, Panama, Nicaragua and Guatemala. We will comprehensively assess multiple risk factors related to 1) strenuous manual labor under heat stress with inadequate rest; 2) social determinants (e.g., poverty, malnutrition, low birth weight); 3) vector-borne or zoonotic diseases; and 4) exposure to known or novel toxins (e.g., heavy metals, agrochemicals, silica). We will also collect bio-banked specimens to assess genetic risk factors and novel biomarkers of acute kidney injury (AKI), as determined by the NIH Chronic Kidney Diseases of Uncertain Etiology (CURE) consortium. As a Field Epidemiology Site, our primary study aims are: (a) identification of cases and controls in endemic agricultural communities; (b) longitudinal follow-up of both cases and controls; and (c) biopsies in a subset of individuals. Our proposal takes advantage of the SALTRA network (Central American Program for Health, Work and Environment). SALTRA has nearly 20 years of experience conducting research in the region and has longstanding relationships with local communities, organizations and governmental organizations, public health authorities and local nephrologists on the front lines of fighting this disease.