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

项目摘要 不明原因的慢性肾脏病（CKDu）在几个热带国家中非常流行。 包括中美洲在内的地区，在那里它在年轻的成年男性中最常见 从事甘蔗和其他农业活动。它给家庭带来了可怕的损失， 生活在农村地区的弱势群体。尽管在过去两年中努力研究CKDu 几十年来，其原因尚未完全了解，这种疾病继续夺去生命， 压倒医疗系统。该项目旨在确定风险因素和预测因素， 估计肾小球滤过率（eGFR）下降的年轻人与没有 四个中美洲国家农村流行地区的CKDu：哥斯达黎加、巴拿马、 尼加拉瓜和危地马拉。我们将全面评估与以下方面相关的多种风险因素： 1)热应激下的繁重体力劳动，休息不足; 2）社会因素 (e.g.,贫困、营养不良、出生体重低）; 3）病媒传染或人畜共患疾病;以及4） 暴露于已知或新的毒素（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。 肾损伤（阿基），由NIH慢性肾脏疾病不确定病因确定 （CURE）财团。作为现场流行病学研究中心，我们的主要研究目标是：（a） 在地方性流行病农业社区确定病例和控制;（B）纵向 病例和对照组的随访;以及（c）个体亚组的活组织检查。我们 该提案利用了SALTRA网络（中美洲卫生方案， 工作与环境）。SALTRA拥有近20年的研究经验， 该地区并与当地社区、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.