The Chorotega CKDu Epidemiology Field Study

Chorotega CKDu 流行病学实地研究

• 批准号: 10908055
• 负责人: Mariela Arias-Hidalgo
• 金额: $ 30.03万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-25 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10908055
• 关键词: Acute Renal Failure with Renal Papillary Necrosis; Address; Affect; Age Distribution; Agricultural Workers; Agriculture; Biological; Biological Markers; Case/Control Studies; Cessation of life; Chemical Exposure; Chemicals; Child; Chronic Kidney Failure; Clinical; Clinical assessments; Collaborations; Communities; Community Health; Costa Rica; County; Data; Data Coordinating Center; Dietary Factors; Disease; Enrollment; Environmental Exposure; Environmental Health; Environmental and Occupational Exposure; Epidemic; Epidemiology; Ethical Issues; Etiology; Exposure to; Family; Family Study; Foundations; Frequencies; Funding; Future; Genetic Predisposition to Disease; Glomerular Filtration Rate; Goals; Government Officials; Health; Health Personnel; Healthcare; Heat Stress Disorders; Human; Individual; Injury to Kidney; Intervention; Kidney; Knowledge; Language; Liberia; Life Style; Measurement; Measures; Metals; Methods; Natural History; Non-Steroidal Anti-Inflammatory Agents; North Carolina; Occupational; Occupational Exposure; Occupational Health; Participant; Patient Self-Report; Pesticides; Pharmaceutical Preparations; Phenotype; Physicians; Policies; Prevalence; Prevention; Prospective Studies; Province; Public Health; Research; Research Design; Research Personnel; Resources; Risk Assessment; Risk Factors; Sampling; Science; Seasons; Serum; Sex Distribution; Silicones; Site; Solid; Universities; Urine; Vulnerable Populations; Woman; Work; Workplace; agricultural community; combustion product; community based participatory research; dietary; drinking water; epidemiology study; field study; kidney biopsy; male; predictive marker; premature; prospective; recruit; response; safety and feasibility; social; urinary

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.

抽象的 病因不明的慢性肾病（CKDu）在哥斯达黎加已达到流行病的程度 瓜纳卡斯特省（乔罗特加地区）已成为过早死亡的主要原因。 CKDu有 年轻男性农业工人的负担很重，但妇女和儿童也受到影响，其 其原因仍然很大程度上未知。响应 RFA 慢性肾脏病现场流行病学网站 农业社区病因不明的疾病研究联盟（CURE 联盟），我们 建议招募、登记和跟踪 400 名有 CKDu 证据的参与者和 400 名对照参与者 对 CKDu 的个体风险因素和背景暴露进行综合评估。我们提出一个 作为利比里亚大学合作的一部分，位于利比里亚乔罗特加地区的流行病学现场中心 北卡罗来纳州教堂山分校、哥斯达黎加大学和乔罗特加地区的当地肾脏病学家。我们的 研究设计包括一项大型病例对照研究，其中包含嵌套子研究和最先进的研究 识别 CKDu 风险因素和原因的评估方法。我们将进行临床评估并 收集广泛的生物和环境/职业样本和数据。除了广泛的分析 自我报告的生活方式/人口、环境和职业因素以及环境因素的范围 在病例对照研究中，我们将进行 1) 一项巢式家庭研究来评估家庭 聚集/遗传易感性； 2）连续靶向和非靶向对照的前瞻性研究 通过尿液和饮水测量当代环境/职业化学暴露（暴露组学） 水与急性肾损伤 (AKI) 和新发 CKDu 指标的关系； 3）一个有前景的领域 对农业和建筑业采用的代表性控制样本进行研究以进行调查 通过重复测量目标和非目标化学品暴露来控制季节性工作场所暴露 （暴露组学，包括但不限于农药、金属和燃烧产物），通过尿液和 通过硅胶腕带采样器，测量与热应激相关的 AKI。我们建议组建一个 具有足够广度、深度和规模的资源，可以对各种风险因素进行信息评估， 包括环境/职业暴露和健康背景，有足够的权力来识别一种或多种 更多 CKDu 病因可作为预防、干预或政策的目标。