Genes and environment in chronic kidney disease hotspots

Friedman, David J.

doi:10.1097/mnh.0000000000000470

Cited by 18 publications

(9 citation statements)

References 67 publications

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“…The global health community acknowledges the pressing risks posed by uncontrolled diabetes and hypertension, significantly accelerating the progression to ESRD [ 4 ]. In our cohort, a concerning 10.1% of ESRD cases had unknown causes, echoing findings from other studies and suggesting potential genetic, viral, or environmental factors warranting further exploration [ 20 - 23 ].…”

Section: Discussionsupporting

confidence: 88%

Leading Causes of Chronic Kidney Disease Among Dialysis Patients in Al-Baha Region, Saudi Arabia

Alhazmi,

Alghamdi,

Alzahrani

et al. 2023

Cureus

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Introduction Chronic kidney disease (CKD) and its progression to end-stage renal disease (ESRD) represent a growing health concern globally, with hypertension and diabetes commonly identified as primary etiological factors. This study evaluates the demographic and health profiles of individuals undergoing dialysis treatment in the Al-Baha region of Saudi Arabia, aiming to identify the predominant causes of ESRD and the associated socioeconomic and healthcare-related factors. Methodology This cross-sectional study analyzed data from patients receiving dialysis in Al-Baha. We assessed variables including etiology of ESRD, demographic data, presence of comorbid conditions, initial symptoms, and pre-dialysis health care engagement. Statistical analysis focused on the prevalence and correlations between the different variables and ESRD. The study also examined patients’ educational background and employment status to ascertain ESRD’s socioeconomic impact. Results The study found hypertension and diabetes as the leading causes of ESRD. Unknown etiologies accounted for 10.1% of cases, highlighting an area for further research. Notably, coronavirus disease 2019 (COVID-19) and cardiogenic shock emerged as potential new contributors, each representing 1.7% of cases. Most patients resided in urban areas, with the largest age group being 46 to 55 years. Men had a higher prevalence of ESRD than women. Low educational attainment was significant among patients, and unemployment due to ESRD was prevalent, pointing towards the need for vocational support. Clinical findings revealed late referrals to nephrologists, with a substantial proportion of diagnoses occurring in emergency settings. Family history suggested a higher-than-expected genetic component of CKD in the region. Conclusion The study confirms hypertension and diabetes as principal contributors to ESRD in Al-Baha while also pointing to the emergence of COVID-19 as a potential risk factor. Socioeconomic factors, including educational and employment status, are critical to patient management and outcomes. The high percentage of unknown etiologies and familial CKD prevalence warrants additional research. Improving early detection, enhancing patient education, and fostering timely nephrology consultations could mitigate the progression to ESRD and enhance patient quality of life.

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Section: Discussionsupporting

confidence: 88%

Leading Causes of Chronic Kidney Disease Among Dialysis Patients in Al-Baha Region, Saudi Arabia

Alhazmi,

Alghamdi,

Alzahrani

et al. 2023

Cureus

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“…We observed that work-related CKD was associated with sociodemographic variables, mainly sex, age, and ethnicity. This is consistent with the target population: middleaged men between 30 and 50 years old [8,10,29,34]. Although the mestizo ethnicity was also associated with work-related CKD, previous studies have yet to find CKD-risk to be ethnicity-specific to the mestizo population [35,36].…”

Section: Discussionsupporting

confidence: 85%

Prevalence and Geographic Distribution of Self-Reported Chronic Kidney Disease and Potential Risk Factors in Central America

Figueroa-Solis

Gimeno

Rojas-Garbanzo

et al. 2023

IJERPH

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Background: Cases for chronic kidney disease of unknown etiology (CKDu) are increasing in specific disease hotspots located in rural agricultural communities over Central America. The goal of the study was to estimate the prevalence and geographic distribution of self-reported work-related CKD and associated risk factors for CKDu by industry sector in Central America. Methods: We calculated the prevalence and distribution of self-reported CKD, work-related CKD, and suspected CKDu risk factors among the 9032 workers in the Second Central American Survey of Working Conditions and Health (II ECCTS, 2018). We mapped the distribution of suspected CKDu risk factors to work-related CKDu and weather conditions using average annual temperatures. Results: The primary and secondary industry sectors showed the highest proportion of males, suspected CKDu risk factors, and work-related CKD. Age (30–49 years: OR = 2.38, 95% CI 1.03–5.51), ethnicity (mestizo: OR, 7.44, 95% CI: 2.14–25.82), and exposure to high physical work demands (OR = 2.45, 95% CI: 1.18–5.09) were associated with work-related CKD. The majority of work-related CKD were reported in the western parts of Honduras and Nicaragua, in hot temperature regions, and overlapped with those areas with a high density of CKDu risk factors. Finally, some areas clustered CKDu risk factors without any work-related CKD points, mainly in the western part of Guatemala. Conclusion: Our findings supplement prior CKDu findings regarding a high prevalence of work-related CKD among 30- to 49-year-old mestizo males in the primary and secondary sectors, in hot temperature areas, in the central and western region, and overlapping with persons reporting two or more CKDu risk factors. Moreover, several geographic areas with CKDu risk factor clusters had no reported work-related CKD. These areas represent new industries and sectors to be monitored for possible future increases of CKDu cases.

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“…Genetic susceptibility may also be an important trigger for clusters of CKDnt (73). One study in a hotspot in Nicaragua hypothesized that the much higher levels of uric acid in CKDnt patients as compared to family members without CKDnt suggests an extreme phenotype on the disease spectrum (71).…”

Section: Non-occupational Risk Factorsmentioning

confidence: 99%

Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

Wesseling

Glaser²,

Rodríguez-Guzmán

et al. 2020

Revista Panamericana De Salud Pública

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The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.

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Genes and environment in chronic kidney disease hotspots

Cited by 18 publications

References 67 publications

Leading Causes of Chronic Kidney Disease Among Dialysis Patients in Al-Baha Region, Saudi Arabia

Leading Causes of Chronic Kidney Disease Among Dialysis Patients in Al-Baha Region, Saudi Arabia

Prevalence and Geographic Distribution of Self-Reported Chronic Kidney Disease and Potential Risk Factors in Central America

Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

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