Altitude and regional gradients in chronic kidney disease prevalence in Costa Rica: Data from the Costa Rican Longevity and Healthy Aging Study

Abstract

Summary Objectives Recent studies in Central America indicate that mortality attributable to chronic kidney disease (CKD) is rising rapidly. We sought to determine the prevalence and regional variation of CKD and the relationship of biologic and socioeconomic factors to CKD risk in the older-adult population of Costa Rica. Methods We used data from the Costa Rican Longevity and Health Aging Study (CRELES). The cohort was comprised of 2657 adults born before 1946 in Costa Rica, chosen through a sampling algorithm to represent the national population of Costa Ricans >60 years of age. Participants answered questionnaire data and completed laboratory testing. The primary outcome of this study was CKD, defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2. Results The estimated prevalence of CKD for older Costa Ricans was 20% (95% CI 18.5 – 21.9%). In multivariable logistic regression, older age (adjusted odds ratio [aOR] 1.08 per year, 95%CI 1.07–1.10, p<0.001) was independently associated with CKD. For every 200 meters above sea level of residence, subjects’ odds of CKD increased 26% (aOR 1.26 95% CI 1.15–1.38, p<0.001). There was large regional variation in adjusted CKD prevalence, highest in Limon (40%, 95% CI 30%–50%) and Guanacaste (36%, 95% CI 26–46%) provinces. Regional and altitude effects remained robust after adjustment for socioeconomic status. Conclusions We observed large regional and altitude-related variations in CKD prevalence in Costa Rica, not explained by the distribution of traditional CKD risk factors. More studies are needed to explore the potential association of geographic and environmental exposures with the risk of CKD.

Evaluation of biochemical profile of Chronic Kidney Disease of uncertain etiology in Sri Lanka

“…Interestingly only 11% of CKDu patients had high serum cholesterol and only 22.7% were on lipid lowering medications. Even though the prevalence of obesity was 20% and lower than CKD (31.6%) [25], it was higher than previously described in CKDu (0%) [7,17], and lower than Mesoamericam Nephropathy in Costa-Rica (26.4%) [26]. BMI is significantly positively correlated with the HbA1C and the serum cholesterol.…”

Mortalidad y egresos hospitalarios por enfermedad renal crónica de causas no tradicionales

“…5,15 Por otro lado, la tendencia en la provincia de Limón fue reportada en un estudio realizado en 2016. 16 El comportamiento de los casos por ERCnt en la provincia de Limón podría ser explicado por un mejor registro de la enfermedad y a la conciencia sobre la epidemia de ERCnt del personal de salud. 17 Cabe resaltar que en Guanacaste y Limón también atraen las proporciones más altas de inmigrantes de otros países centroamericanos, incluyendo Nicaragua, donde la epidemia de ERCnt ha sido ampliamente documentada, por lo que en parte podría explicar estos hallazgos.…”

“…17 Cabe resaltar que en Guanacaste y Limón también atraen las proporciones más altas de inmigrantes de otros países centroamericanos, incluyendo Nicaragua, donde la epidemia de ERCnt ha sido ampliamente documentada, por lo que en parte podría explicar estos hallazgos. 16,18,19 Un reciente metaanálisis encontró evidencia consistente del efecto adverso de los agroquímicos sobre el desarrollo de la enfermedad renal crónica en las personas y, en algunos casos, asociación con insuficiencia renal en etapa terminal. 1 El efecto adverso también se relacionó con la exposición acumulada y consumir agua de pozo, posible fuente de exposición a agroquímicos.…”

Inequalities in disability-free and disabling multimorbid life expectancy in Costa Rica, Mexico, and the United States

“…To the best of our knowledge, there has only been one study that has specifically investigated multimorbidity in Costa Rica (Assari & Lankarani, 2015), and another study that described the prevalence of multimorbidity in their sample, but it was not the focus of the paper (Madrigal-Leer et al, 2020). Other studies have mainly focused on one chronic disease (e.g., diabetes, chronic kidney disease, cardiovascular disease) (Evans-Meza et al, 2019;Harhay et al, 2016;Jiménez-Montero & Villegas-Barakat, 2021;Santamaría-Ulloa & Montero-López, 2020;Vega-Solano et al, 2021;Wesseling et al, 2015), psychiatric comorbidities (e.g., bipolar disorder, substance abuse, depression) (Escamilla et al, 2002;Obando et al, 2004), or frailty (Picado-Ovares et al, 2019). This is a significant gap in the literature because Costa Rica has a rapidly ageing population and unusually high life expectancy relative to its GDP compared with other countries in the region.…”