Epidemiological characteristics of chronic kidney disease of non-traditional causes in women of agricultural communities of El Salvador.

INTRODUCTION: In El Salvador end-stage renal disease (ESRD) was the first cause of hospital mortality overall, the first cause of hospital deaths in men, and the fifth cause of hospital mortality in women in 2013. In agricultural communities, chronic kidney disease (CKD) occurs predominantly in male agricultural workers, but it also affects women to a lesser degree, even those who are not involved in agricultural work. Internationally, most epidemiological CKD studies emphasize men and no epidemiological studies focused exclusively on women. OBJECTIVE: To describe the epidemiological characteristics of CKD in females in agricultural communities of El Salvador. METHODS: A cross-sectional epidemiological study was carried out in 2009 - 2011 based on active screening for CKD and risk factors in women aged ≥ 18 years in 3 disadvantaged populations of El Salvador: Bajo Lempa (Usulután Department), Guayapa Abajo (Ahuachapán Department), and Las Brisas (San Miguel Department). Epidemiological and clinical data were gathered through personal history, as well as urinalysis for renal damage markers, determinations of serum creatinine and glucose, and estimation of glomerular filtration rates. CKD cases were confirmed at 3 months. RESULTS: Prevalence of CKD was 13.9% in 1,412 women from 1,306 families studied. Chronic kidney disease of nontraditional causes (CKDu), not attributed to diabetes mellitus, hypertension, or proteinuric primary glomerulopathy (proteinuria > 1 g/L) was 6.6%. Prevalence of chronic renal failure was 6.8%. Prevalence of renal damage markers was 9.8% (microalbuminuria (30 - 300 mg/L) 5.7%; macroalbuminuria (> 300 mg/L) 2%; and hematuria, 2.1%. Prevalence of chronic kidney disease risk factors was: diabetes mellitus, 9.3%; hypertension, 23%; family history of CKD, 16%; family history of diabetes mellitus (DM), 18.7%; family history of hypertension (HT), 31.9%; obesity, 21%; central obesity, 30.7%; NSAID use, 84.3%; agricultural occupation, 15.2%; and contact with agrochemicals, 33.1%. CONCLUSIONS: CKD in women of Salvadoran agricultural communities is associated with disadvantaged populations, traditional (DM, HT, obesity) and non-traditional causes (environmental and occupational exposure to toxic agents and inadequate working conditions). Our results reinforce the hypotheses emerging from other studies, suggesting a multifactorial etiopathology including environmental and occupational nephrotoxic exposure.

Epidemiology of chronic kidney disease in adults of Salvadoran agricultural communities.

INTRODUCTION: In El Salvador, chronic kidney disease is a serious and growing public health problem. Chronic renal failure was the first cause of hospital deaths in men and the fifth in women in 2011. OBJECTIVE: Determine prevalence of CKD, CKD risk factors (traditional and nontraditional) and renal damage markers in the adult population of specific rural areas in El Salvador; measure population distribution of renal function; and identify associated risk factors in CKD patients detected. METHODS: A cross-sectional analytical epidemiological study was conducted based on active screening for chronic kidney disease and risk factors in persons aged ≥18 years during 2009-2011. Epidemiological and clinical data were gathered through personal history, as well as urinalysis for renal and vascular damage markers, determinations of serum creatinine and glucose, and estimation of glomerular filtration rates. Chronic kidney disease cases were confirmed at three months. Multiple logistical regression was used for statistical analysis. RESULTS: Prevalence of chronic kidney disease was 18% (23.9% for men and 13.9% for women) in 2388 persons: 976 men and 1412 women from 1306 families studied. Chronic kidney disease with neither diabetes nor hypertension nor proteinuria ≥1 g/L (51.9%) predominated. Prevalence of chronic renal failure was 11% (17.1% in men and 6.8% in women). Prevalence of renal damage markers was 12.5% (higher in men): microalbuminuria, 6.9%; proteinuria (0.3 g/L), 1.7%; proteinuria (1g/L), 0.6%; proteinuria (2 g/L), 0.4 %; and hematuria, 1.5%. Prevalence of chronic kidney disease risk factors was: diabetes mellitus, 9%; hypertension, 20.9%; family history of chronic kidney disease, 16.5%; family history of diabetes mellitus, 18.5%; family history of hypertension, 30.6%; obesity, 21%; central obesity, 24.9%; NSAID use, 84.2%; smoking, 9.9%; alcohol use, 15%; agricultural occupation, 31.2%; and contact with agrochemicals, 46.7%. Chronic kidney disease was significantly associated with male sex, older age, hypertension, agricultural occupation, family history of chronic kidney disease and contact with the agrochemical methyl parathion. CONCLUSIONS: The results of this study support suggestions from other research that we are facing a new form of kidney disease that could be called agricultural nephropathy.

Chronic kidney disease and associated risk factors in the Bajo Lempa region of El Salvador: Nefrolempa study, 2009.

INTRODUCTION: In El Salvador, end-stage renal disease is the leading cause of hospital deaths in adults, the second cause of death in men and the fifth leading cause of death in adults of both sexes in the general population. OBJECTIVE: Identify risk factors for chronic kidney disease and urinary markers of renal and vascular damage, measure kidney function and characterize prevalence of chronic kidney disease in persons aged ≥18 years in the Bajo Lempa region of El Salvador. METHODS: A cross-sectional analytical epidemiological study was carried out using active screening for chronic kidney disease and associated risk factors in individuals aged ≥18 years in the Bajo Lempa Region, a rural, coastal area in El Salvador. Door-to-door visits and clinical examinations were conducted. Epidemiological and clinical data were collected including: family and personal clinical history of disease; biological, behavioral, social and environmental risk factors; physical measurements; urinalysis for markers of renal and vascular damage; and blood tests (serum creatinine, serum glucose, lipid profile). Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease formula. Chronic kidney disease case confirmation was done three months later. Multiple logistic regression was used for data analysis. RESULTS: A total of 375 families and 775 individuals (343 men, 432 women) were studied-88.3% of the total resident population in the region. Elevated prevalence of risk factors was observed: diabetes mellitus, 10.3%; hypertension,16.9%; family history of chronic kidney disease, 21.6%; dyslipidemias, 63.1%; overweight, 34%; obesity, 22.4%; metabolic syndrome, 28.8%; use of non-steroidal anti-inflammatory drugs, 74.8%; infectious diseases, 86.9%; agricultural occupation, 40.6% (80.6% in men); and contact with agrochemicals, 50.3% (82.5% in men). Prevalence renal damage markers was 15.8% (greater in men): microalbuminuria 6.3%; proteinuria 5.7%; hematuria 3.5%; proteinuria-hematuria 0.3%. Proteinuria of <1 g/L predominated. Prevalence of chronic kidney disease was 17.9% (25.7% in men; 11.8% in women). Distribution by stages: stage 1, 4.6%; stage 2, 3.5%; stage 3, 6.2%; stage 4, 3.0%; stage 5, 0.6%. In patients with chronic kidney disease, most common was non-diabetic chronic kidney disease (86.3%), followed by chronic kidney disease associated with neither diabetes nor hypertension (54.7%). Prevalence of chronic renal failure was 9.8% (17% in men; 4.1% in women). Multiple logistic regression showed significant association with increasing age, male sex, hypertension and family history of chronic kidney disease. CONCLUSIONS: Elevated prevalence of chronic kidney disease, chronic renal failure and risk factors was found, compared to international reports. Most common was chronic kidney disease of unknown cause, associated with neither diabetes nor hypertension. Associations were found with age, male sex, hypertension and family history of chronic kidney disease, with decline in kidney function beginning at early ages. Male farmers have a dual burden of non traditional (occupational, toxic environmental) and traditional (vascular) risk factors that could act in synergy, contributing to kidney damage.

INTRODUCCIÓN En El Salvador, la enfermedad renal crónica terminal es la causa principal de muerte hospitalaria en adultos, la segunda causa de muerte en los hombres y la quinta causa principal de muerte entre adultos de ambos sexos en la población general. OBJETIVO Identificar los factores de riesgo de la enfermedad renal crónica y los marcadores de daño renovascular en orina, medir la función renal y caracterizar la prevalencia de enfermedad renal crónica en personas X18 años de edad en la región del Bajo Lempa en El Salvador. METODOS Se realizó un estudio epidemiológico transversal y analítico de la enfermedad renal crónica y los factores de riesgo asociados en individuos con edades X18 años por medio de pesquisa activa en la Región del Bajo Lempa, una zona costera rural en El Salvador. Se efectuaron visitas casa por casa y consultas médicas. Se recolectaron datos epidemiológicos y clínicos que incluían: historia clínica personal y familiar para la enfermedad; factores de riesgo biológicos, de conducta, sociales y ambientales; mediciones físicas; análisis de orina buscando marcadores de daño renovascular y exámenes de sangre (creatinina y glucosa en suero, lipidograma). La tasa de filtración glomerular se calculó usando la fórmula de MDRD (sigla en inglés de Modificación de la Dieta en la Enfermedad Renal). La confirmación de casos de enfermedad renal crónica se realizó en un período de tres meses. Se utilizó la regresión logística múltiple para analizar los datos. RESULTADOS Se estudiaron un total de 375 familias y 775 individuos (343 hombres, 432 mujeres), el 88,3% del total de la población residente en la región. Se observó una elevada prevalencia de factores de riesgo: diabetes mellitus en 10,3%; hipertensión en 16,9%; antecedentes familiares de enfermedad renal crónica en 21,6%; dislipidemias en 63,1%; sobrepeso en 34%; obesidad en 22,4%; síndrome metabólico en 28,8%; uso de medicamentos anti-inZ amatorios no esteroideos en 74,8%, enfermedades infecciosas en 86,9%, 40,6 % eran agricultores (80,6% de los hombres) y 50,3% tenían contacto con agroquímicos (82,5% de los hombres). La prevalencia de marcadores de daño renal fue de 15,8% (mayor en los hombres): microalbuminuria de 6,3%; proteinuria de 5,7%; hematuria de 3,5%; proteinuria-hematuria de 0,3%. Predominó la proteinuria <1 g/L. La prevalencia de enfermedad renal crónica fue de 17,9% (25,7 en los hombres; 11,8% en las mujeres). La distribución por estadios fue la siguiente: estadio 1, un 4,6%; estadio 2, un 3,5%' estadio 3, un 6,2%; estadio 4, un 3,0% y en estadio 5, un 0,6%. En pacientes con enfermedad renal crónica, la más común fue la enfermedad renal crónica no diabética (86,3%), seguida de la enfermedad renal crónica no asociada a diabetes ni a hipertensión (54,7%). La prevalencia de la insuficiencia renal crónica fue de 9,8% (17% en los hombres y 4,1% en mujeres). La regresión logística múltiple mostro una asociación significativa con el aumento de la edad, sexo masculino, hipertensión y antecedentes familiares de enfermedad renal crónica. CONCLUSIONES Se halló una elevada prevalencia de enfermedad renal crónica, insuficiencia renal crónica y factores de riesgo en comparación con lo reportado internacionalmente. La más frecuente fue la enfermedad renal crónica de causa desconocida, no asociada con diabetes ni hipertensión. Se encontraron asociaciones con la edad, sexo masculino, hipertensión e historia familiar de enfermedad renal crónica, con una disminución de la función renal que comienza a edades tempranas. Los agricultores hombres tienen la doble carga de riesgos no tradicionales (ocupacionales, toxico-ambientales) y tradicionales (vasculares) que podrían actuar de manera sinérgica, contribuyendo al daño renal. PALABRAS CLAVE Enfermedad renal crónica/epidemiologia, factores de riesgo, prevalencia, salud ocupacional, salud ambiental, plaguicidas, agroquímicos, El Salvador