Prevalence and Risk Factors for CKD in the General Population of Southwestern Nicaragua

Abstract

BackgroundStudies have described Mesoamerican nephropathy among agricultural workers of El Salvador and northwestern Nicaragua. Data on prevalence and risk factors for CKD beyond agricultural workers and in other regions in Nicaragua are sparse.MethodsWe recruited participants from 32 randomly selected communities in the Department of Rivas’s ten municipalities in two phases. In phase 1, we screened participants using a field-based capillary creatinine measuring system and collected self-reported information on lifestyle and occupational, exposure, and health histories. Two years later, in phase 2, we enrolled 222 new participants, performing serum creatinine testing in these participants and confirmatory serum creatinine testing in phase 1 participants.ResultsWe enrolled 1242 of 1397 adults (89%) living in 533 households (median age 41 years; 43% male). We confirmed CKD (eGFR<60 ml/min per 1.73 m2) in 53 of 1227 (4.3%) evaluable participants. In multivariable testing, risk factors for prevalent CKD included age (odds ratio [OR], 1.92; 95% confidence interval [95% CI], 1.89 to 1.96) and self-reported history of hypertension (OR, 1.95; 95% CI, 1.04 to 3.64), diabetes (OR, 2.88; 95% CI, 1.40 to 5.93), or current or past work in the sugarcane industry (OR 2.92; 95% CI, 1.36 to 6.27).ConclusionsAdjusted CKD prevalence was about 5% with repeat confirmatory testing in southwest Nicaragua, lower than in the northwest region. Risk factors included diabetes, hypertension, and current or prior work in the sugarcane industry but not in other forms of agricultural work. Formal CKD surveillance programs in Nicaragua are needed to assess the overall burden of CKD nationally, with a focus on agricultural workers.

Population Estimates of GFR and Risk Factors for CKD in Guatemala

“…Many prior studies on CKD and CKDu in Central America have relied on self-report of diabetes or hypertension. 15,44,46 Our findings suggest, that in the context of J o u r n a l P r e -p r o o f rural populations with limited access to healthcare and high prevalence of diabetes or hypertension, self-report is unlikely to yield the true prevalence of these conditions and may lead to classification errors, for example, between traditional CKD and CKDu cases. 47 The presence of CKD in some respondents without diabetes and hypertension, the very low prevalence of proteinuria in those with CKD ( Figure 2), and the association between CKD and sugar cane agriculture among participants with high poverty levels all are circumstantial evidence for the likely existence of at least some CKDu in our sample.…”

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

“…1 , Table 1 ). In our review, some national surveys assessed the prevalence of diabetes via population representative samples [ 33 , 36 , 38 , 40 , 42 – 44 , 47 , 49 , 55 , 60 , 61 , 65 , 66 , 68 , 72 , 85 – 87 , 89 , 91 , 96 , 98 , 105 , 107 ] and used similar population sampling methods (e.g., multi-stage, clustered, probabilistic sampling), whereas other studies focused on specific geographic regions or communities [ 34 , 35 , 37 , 45 , 46 , 48 – 54 , 56 – 58 , 63 , 67 , 73 – 75 , 77 , 82 – 84 , 92 – 95 , 102 , 110 – 112 ], recruited participants from clinical settings [ 51 , 59 , 62 , 69 , 95 ], or focused on specific age groups [ 37 , 42 , 56 – 58 , 75 , 109 , 112 ]. Also, the age range of the population surveyed—and consequently, age-adjustment estimates—varied among surveys.…”

“…Most of the participants lived in poverty. Ferguson, 2020 [ 54 ] 2012–2014 Nicaragua Study of CVRF in Southwestern Nicaragua Department of Rivas agricultural communities N = 1227 (533 households) (56.3% women) Age range 17.4–101.8 years Venous blood samples obtained, but unclear if blood glucose measurements used for assessment Overall prevalence, based on self-report = 7% McDonald Posso, 2013 [ 55 ] 2010–2011 Panama [Primera Encuesta de Factores de Riesgo de Enfermedad Cardiovascular (PREFREC)] Diabetes sub-analysis Single-stage, probabilistic and randomized sampling Provinces of Panama and Colon, 5 health regions and city of Panama N = 1074 men and 2516 women Age ≥ 18 years Self-report or FBG >126 mg/dL or HbA1c ≥ 6.5% (≥ 48 mmol/mol) 7.3% self-reported having diabetes and 2.2% were not aware of having diabetes; hence the estimated prevalence was 9.5%. The age-adjusted rate for the 2012 Panamanian population was 7.7%.…”

CKD and CKDu in Northern Peru: a cross-sectional analysis under the DEGREE protocol

“…Although, in the Brazilian northeast region the temperature could regularly rise over 38 °C (100°F), neither a higher prevalence of CKD, nor CKDu cases, have been reported among Brazilian agricultural workers [12]. Peru, a country closer to the equator, has reported a CKD prevalence of 13-21% [13,14], which is comparable to that in El Salvador and Nicaragua [15,16]. Approximately 50% of the end stage population of CKD in Peru does not receive dialysis or renal replacement therapy (RRT), since the health system does not have the necessary resources (technological and human) [17,18].…”