Environmental and Occupational Risk Factors Associated with Chronic Kidney Disease of Unknown Etiology in West Javanese Rice Farmers, Indonesia

Abstract

Chronic kidney disease of unknown etiology (CKDu) in agricultural population is an increasing issue. This study aims to obtain a prevalence estimate of CKDu in male rice farmers in West Java, Indonesia; and analyze the relationship between CKDu and environmental and occupational factors. The study design was cross-sectional. This study included 354 healthy male farmers in two rice agriculture areas in West Java with different altitudes (low altitude and high-altitude location). This research included blood and urine sampling from the farmers for serum creatinine (SCr) level and proteinuria; questionnaire on demographic information, occupational factors and other risk factors for CKDu. We measured ambient temperature and humidity in both study locations for environmental factors. From SCr level and proteinuria, we categorized the farmers into five stages of CKD; then we distinguished CKDu from CKD if the farmers had stage 1–4 of CKD but without diabetes, hypertension and other traditional causes. Data were analyzed with multivariate logistic regression to get prevalence odd ratios of CKDu and its relationship with environmental and occupational factors, adjusted with other risk factors of CKDu. The overall prevalence of CKD was 24.9% and CKDu was 18.6%. For the environmental factors, farm location (high altitude versus low altitude location) was associated with CKDu (Prevalence Odds Ratio (POR): 2.0; 95% CI: 1.2–3.5). For the occupational factors, although not significant, the risk of CKDu increased with the longer use of insecticide and with the more frequent of insecticide use. We suggested that there was a need to conduct future research to investigate more on the association of those environmental and occupational factors with CKDu.

The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review

“…In one such study conducted in the disease endemic North Central Province in Sri Lanka, CKDu prevalence among adults was reported as 6.0% [ 17 ], while it was estimated as 13.3% among adults in the Uddanam region in India [ 26 ]. Similar cross-sectional studies of CKDu in other farming communities such as among the west Javanese rice farmers in Indonesia (18.6%) [ 11 ], residents of León in Nicaragua (7.4–8.4%) [ 27 ], suggest a high prevalence of this disease, although these statistics vary depending on the study. Another key limitation is the lack of a standardized disease diagnosis approach as well as the lack of intensive data collection from population surveys.…”

“…CKDu incidences first emerged in several Mesoamerican countries, including El Salvador, Nicaragua, Guatemala, Mexico, Panama, and Costa Rica [ 8 ], Andhra Pradesh in India, the El-Minia Governorate in Egypt, and several provinces of Sri Lanka [ 9 ]. Current evidence presented in various studies suggests incidences in several other South East Asian countries, including Thailand [ 10 ], Indonesia [ 11 ], the Philippines, and Taiwan; in Tanzania, South Africa, Cameroon, Brazil, Peru, Ecuador, and Dominican Republic [ 12 ]; in parts of the United States of America [ 11 ] and Belfast in the United Kingdom [ 13 ]. Clinical, histological, biochemical, environmental, and socio-economic factors associated with CKDu are comparable across its geographical distribution and are considered a rapidly growing public health concern worldwide [ 14 , 15 ].…”

“…A recent cross-sectional study with male rice farmers in Karawang and Bogor Regency, in West Java Province in Indonesia, evidenced the presence of CKDu. Out of the 354 healthy male farmers, the total CKD prevalence was 24.9%, and CKDu prevalence was 18.6% [ 11 ]. The determination was based on conventional markers, and no novel biomarker-based studies were reported from Indonesia.…”

Prevalence Studies on CKDu Need Stringent Reporting on Outcomes to Enhance Comparability

“…The authors wish to acknowledge the important work of Fitria et al: Environmental and Occupational Risk Factors Associated with Chronic Kidney Disease of Unknown Etiology in West Javanese Rice Farmers, Indonesia [ 1 ] and all those working to understand CKDu.…”

Reply to “Comment on Fitria et al. ‘Environmental and Occupational Risk Factors Associated with Chronic Kidney Disease of Unknown Etiology in West Javanese Rice Farmers, Indonesia’ Int. J. Environ. Res. Public Health, 2020, 17, 4521”

“…Thank you for the opportunity to provide a response to the comment submitted by Jakobsson et al [ 1 ] on our paper “Environmental and Occupational Risk Factors Associated with Chronic Kidney Disease of Unknown Etiology in West Javanese Rice Farmers, Indonesia” [ 2 ].…”