Spatial Distribution of Unspecified Chronic Kidney Disease in El Salvador by Crop Area Cultivated and Ambient Temperature

Vandervort, Darcy R.; López, Dina L.; Orantes, Carlos M.; Rodríguez, David Sarias

doi:10.37757/mr2014.v16.n2.6

Cited by 39 publications

(17 citation statements)

References 32 publications

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“…An association between paraquat/pesticides and CKDu has been suggested (31). Lebov et al (32,33) found significant associations of select pesticides, including paraquat, with kidney failure in pesticide applicators and their wives.…”

Section: Discussionmentioning

confidence: 99%

Potential Mechanisms Involved in Chronic Kidney Disease of Unclear Etiology

Holliday

Bustamante

et al. 2022

CJASN

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Background and objectivesThe etiology of chronic kidney disease of unclear etiology, also known as Mesoamerican nephropathy, remains unclear. We investigated potential etiologies for Mesoamerican nephropathy in an immigrant dialysis population.Design, setting, participants, & measurementsMigrants with Mesoamerican nephropathy kidney failure (n=52) were identified by exclusion of known causes of kidney disease and compared using a cross-sectional survey with demographically similar patients with kidney failure from other causes (n=63) and age/sex/place of origin–matched healthy participants (n=16). Survey results were extended to the bench; C57BL/6 mice (n=73) received 10–15 weekly intraperitoneal injections of paraquat (a reactive oxygen species–generating herbicide) or vehicle. Kidney function, histology, and expression of organic cation transporter-2 (proximal tubule entry for paraquat) and multidrug and toxin extrusion 1 (extrusion pathway) were examined. Kidney biopsies from Nicaraguan patients with acute Mesoamerican nephropathy were stained for the above transporters and compared with patients with tubulointerstitial nephritis and without Mesoamerican nephropathy.ResultsPatients with Mesoamerican nephropathy and kidney failure were young agricultural workers, almost exclusively men; the majority were from Mexico and El Salvador; and they had prior exposures to agrochemicals, including paraquat (27%). After adjustment for age/sex, exposure to any agrochemical or paraquat was associated with Mesoamerican nephropathy kidney failure (odds ratio, 4.86; 95% confidence interval, 1.82 to 12.96; P=0.002 and odds ratio, 12.25; 95% confidence interval, 1.51 to 99.36; P=0.02, respectively). Adjusted for age/sex and other covariates, 1 year of agrochemical exposure was associated with Mesoamerican nephropathy kidney failure (odds ratio, 1.23; 95% confidence interval, 1.04 to 1.44; P=0.02). Compared with 16 matched healthy controls, Mesoamerican nephropathy kidney failure was significantly associated with exposure to paraquat and agrochemicals. Paraquat-treated male mice developed kidney failure and tubulointerstitial nephritis consistent with Mesoamerican nephropathy. Organic cation transporter-2 expression was higher in male kidneys versus female kidneys. Paraquat treatment increased organic cation transporter-2 expression and decreased multidrug and toxin extrusion 1 expression in male kidneys; similar results were observed in the kidneys of Nicaraguan patients with Mesoamerican nephropathy.ConclusionsExposure to agrochemicals is associated with Mesoamerican nephropathy, and chronic exposure of mice to paraquat, a prototypical oxidant, induced kidney failure similar to Mesoamerican nephropathy.

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Section: Discussionmentioning

confidence: 99%

Potential Mechanisms Involved in Chronic Kidney Disease of Unclear Etiology

Holliday

Bustamante

et al. 2022

CJASN

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“…The environmental conditions observed across this population (higher temperatures, lower altitude, and much of the population living in and around agricultural land) concur with the environmental characteristics associated with CKDu across the literature. 13,37,57,58 The highest prevalence of CKDu was observed in Andhra Pradesh. This observation also corroborates with findings from other Indian studies 6,59 which found that the Exchange rate (RS to USD) 0.001 at time of questionnaire; Hypertension = systolic bp ≥140 mm Hg, or diastolic bp ≥90 mm Hg; Diabetes = fasting glucose ≥7 mg/l; Proteinuria = ACR [Albumin Creatinine Ratio] ≥30 mg/mmol.…”

Section: Discussionmentioning

confidence: 99%

“…This finding corroborates with a previous study in El Salvador whereby proximity to specific crop types was significantly associated with suspected CKDu mortality and hospital admissions rates. 37 There are few studies that investigated the spatial distribution of CKDu in relation to proximity to land cover; however, there are some studies and reviews in India which investigated the association between CKDu and agricultural occupation, which suggest that those cultivating rice and cashew crops, as well as those using pesticides are the most affected subgroup of agricultural laborers. 16,59,60 Although the current dataset does not contain detailed employment information or high-resolution crop detail, collecting this data will be key in future studies across India to geographically highlight specific subcommunities which may be at a higher risk and help direct future observational and treatment plans in affected regions.…”

Section: Discussionmentioning

confidence: 99%

“…We investigated the associations of the following environmental risk factors: (1) ambient temperature, 23,35 (2) altitude, 10,36 and (3) residential proximity to agricultural land 37 with eGFR as a continuous variable and risk of eGFR <60 as a categorical marker of CKD stage 3 or worse. 1,38 Proximity to agricultural land is increasingly being studied as a proxy to agrochemical exposure due to resource and financial constraints of effectively measuring pesticides in laboratories.…”

Section: Methodsmentioning

confidence: 99%

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Environmental risk factors for reduced kidney function due to undetermined cause in India

Hamilton

Jarhyan

Fecht

et al. 2021

Environmental Epidemiology

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“…However, Ordunez et al suggested, in an analysis of time‐trends and the mortality pattern in Central America from 1997 to 2013, that the heat stress hypothesis could not fully explain the MeN epidemic [46]. Similarly, van Dervort et al reported a lack of association between high ambient temperature and occurrence of CKDu in El Salvador [47]. The lack of high prevalence of CKDu among farming communities in other areas with similar climate also does not support this hypothesis [48].…”

Section: Methodsmentioning

confidence: 99%

Chronic kidney disease of unknown aetiology: A comprehensive review of a global public health problem

Rao,

Bangera,

Nagaraju

et al. 2023

Tropical Med Int Health

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The term chronic kidney disease of unknown aetiology (CKDu) refers to chronic kidney disease (CKD) in the absence of diabetes, long-standing hypertension, glomerulonephritis, obstructive uropathy or other apparent causes. An increasing number of CKDu cases have been reported from Latin America, Sri Lanka, India and others over the last two decades. These regional nephropathies share the following common attributes: (a) they affect low-to-middle income countries with tropical climates, (b) involve predominantly rural agricultural communities, (c) male predilection, (d) absence of significant proteinuria and hypertension, and (e) chronic tubulointerstitial nephritis on kidney biopsy. The current body of literature suggests that CKDu may be caused by heat stress, agrochemicals, contaminated drinking water or heavy metals; however, considerable regional disparities in CKDu research make it difficult to establish a common causal link. In the absence of a definite aetiology, specific preventive and therapeutic interventions are lacking. Improvement of working conditions of farmers and labourers, provision of safe drinking water and changes in agricultural practices are some of the measures that have been implemented; however, there is lack of data to assess their impact on the incidence and progression of CKDu. There is a need for a concerted global effort to address the current knowledge gaps, and to develop effective and sustainable strategies to tackle this devastating disease.K E Y W O R D S agrochemicals, chronic kidney disease of uncertain aetiology, chronic renal insufficiency, endemic nephropathy, epidemiology, groundwater, interstitial nephritis, public health measures, risk factors Indu Ramachandra Rao and Ashika Bangera contributed equally to this work.

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Spatial Distribution of Unspecified Chronic Kidney Disease in El Salvador by Crop Area Cultivated and Ambient Temperature

Cited by 39 publications

References 32 publications

Potential Mechanisms Involved in Chronic Kidney Disease of Unclear Etiology

Potential Mechanisms Involved in Chronic Kidney Disease of Unclear Etiology

Environmental risk factors for reduced kidney function due to undetermined cause in India

Chronic kidney disease of unknown aetiology: A comprehensive review of a global public health problem

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