Longitudinal Study of Risk Factors for Mesoamerican Nephropathy among Agricultural Workers in El Salvador, Central America

项目摘要 中美洲有一种慢性肾脏疾病(CKD)的流行，其流行率一直是 在过去的20年里不断增加。萨尔瓦多是世界上肾脏疾病死亡率最高的国家。 慢性肾脏病是导致劳动年龄男子死亡的第二大原因。由于它的独特之处 这种疾病被称为中美肾病(男性)。在美国和欧洲，CKD是 常见于老年人群(60岁)，对男性和女性的影响均等，主要是由于糖尿病和 高血压。相比之下，中美洲某些地区的慢性肾脏病对年轻男性和 似乎与糖尿病或高血压无关。农业工人受到的影响最大，但具体的 原因(S)仍不得而知。这项拟议的研究的目标是调查暴露的潜在作用 除草剂草甘膦、重金属和高温胁迫对甘蔗和玉米工人男性风险的影响 在萨尔瓦多。这项拟议的研究旨在确定草甘膦、热应激和/或肾毒性 金属单独或组合在一起，都会导致肾脏损伤。我们还将调查肾脏损伤的生物标志物 随着时间的推移，会导致肾功能下降。 这项研究的结果可能有助于与这三项相关的职业和环境健康干预 暴露，以及有助于了解肾脏损伤的生物标志物，这可能被用于早期 检测和治疗以减轻肾脏损伤和CKD风险。这一结果也可能为其他CKD流行病提供信息 具有包括印度和斯里兰卡在内的我们国家所描述的类似特征。我们的目标 是：(1)在萨尔瓦多招募和建立300名甘蔗和玉米工人；(2)测量热量， 对工人进行身体检查，并收集尿液和血液样本，以确定暴露于 基线水平的金属和草甘膦，肾脏损伤的生物标记物，以及暴露于热应激和肌肉损伤， 连续三个工作日前、后工作；(3)调查行业、工作任务、任职年限、 金属、草甘膦和热应激，作为30个月期间肾功能(EGFR)的预测因子；(4)Bank 生物样本，用于将来分析出现的其他假说；以及(5)交流个人 肾功能结果给队列参与者，总体研究结果给队列参与者，科学 社区、公共卫生官员和普通公众。研究团队一直在计划这一纵向计划 近一年的队列研究，与糖厂、糖生产者协会、社区中心协调 (和领导人)在该国受影响最严重的沿海地区，玉米合作社高度集中， 2002年首次发表关于这种流行病的萨尔瓦多著名肾病学家，一位备受尊敬的 一名职业健康医生，他培训和支持萨尔瓦多的农业工人领导野外团队， 萨尔瓦多大学关于工作、健康和环境的项目。

Project Summary There is an epidemic of chronic kidney disease (CKD) in Central America, and the prevalence has been increasing over the past 20 years. El Salvador has the highest overall mortality rate from kidney disease in the world, and CKD is the second leading cause of mortality among men of working age. Due to its unique characteristics, the disease is referred to as Mesoamerican Nephropathy (MeN). In the US and Europe, CKD is common in older populations (age>60), affects men and women equally, and is primarily due to diabetes and hypertension. In contrast, CKD in certain regions of Central America disproportionately affects younger men and appears to be unrelated to diabetes or hypertension. Agricultural workers are the most affected, but the specific cause(s) remains unknown. The goal of the proposed research is to investigate the potential roles of exposure to the herbicide glyphosate, heavy metals and heat stress on the risk of MeN among sugarcane and corn workers in El Salvador. The proposed study aims to determine whether glyphosate, heat stress and/or nephrotoxic metals, alone or in combination, cause kidney injury. We will also investigate whether biomarkers of kidney injury lead to decreased kidney function over time. Results of the study may contribute to occupational and environmental heath interventions related to these three exposures, as well as contribute to the understanding of kidney injury biomarkers, which may be used for early detection and treatment to mitigate kidney injury and CKD risk. Results may also inform other CKD epidemics with similar characteristics that have been described in our countries including India and Sri Lanka. Our aims are: (1) Recruit and establish a cohort of 300 sugarcane and corn workers in El Salvador; (2) Measure heat, conduct physical examinations of workers, and collect urine and blood samples to characterize exposure to metals and glyphosate at baseline, biomarkers of kidney injury, and exposure to heat stress and muscle damage, pre- and post-shift over three consecutive workdays; (3) Investigate industry, job task, duration of employment, metals, glyphosate and heat stress, as predictors of kidney function (eGFR) over a 30-month period; (4) Bank biological samples for future analysis of additional hypotheses as they emerge; and (5) Communicate individual kidney function results to cohort participants, and overall study results to cohort participants, the scientific community, public health officials and the general public. The research team has been planning this longitudinal cohort study for nearly a year, coordinating with sugar mills, the sugar producers association, a community center (and leader) in the most affected coastal region of the country where corn cooperatives are highly concentrated, the leading El Salvadoran nephrologist who first published on this epidemic in 2002, a well-respected occupational health physician who trains and supports agricultural workers in El Salvador to lead the field team, and the University of El Salvador program on work, health and the environment.