The Chronic Kidney Disease Epidemic in El Salvador: A Cross-Sectional Study

Abstract

INTRODUCTION Chronic kidney disease has reached epidemic levels in several Central American countries since the early years of this century. In El Salvador, it is the second cause of death in men, the fi fth in persons over 18 years old and the third cause of hospital deaths in the adult population. Its features, especially those of a subtype unassociated with traditional risk factors such as diabetes and high blood pressure, are only partially understood.OBJECTIVE Estimate the magnitude of chronic kidney disease in the adult population of El Salvador, considering both prevalence of the disease in its diverse forms as well as presence of potential risk factors nationally and in major subpopulations.METHODS A descriptive, cross-sectional analysis was conducted on data obtained from the Survey of Chronic Non-communicable Diseases in Adults in El Salvador, completed in 2015. The original data (interviews and measurements) were collected between October 2014 and March 2015 from 4817 adults employing a two-stage probabilistic cluster sample, with stratifi cation of primary sampling units. Our analysis, using 20 of the 118 primary variables included in the original survey, focused on point estimation of prevalence rates and means, related to both traditional biological risk factors and nontraditional ones, such as insuffi cient hydration, strenuous working conditions and exposure to toxic agents. A separate analysis was performed to estimate prevalence of chronic kidney disease from nontraditional causes. Corresponding confi dence intervals were calculated with proper weighting. RESULTSThe general prevalence of chronic kidney disease in El Salvador was 12.8% (men 18.0%; women 8.7%). Of the chronically ill kidney patients, 13.1% were between 20 and 40 years of age. Among biological risk factors, the most frequent was high blood pressure (37.0%). Among nontraditional risk factors, high levels of sugary drink consumption (81.0%), insuffi cient hydration (65.9%) and high levels of exposure to agrochemicals in the work environment (12.6%) were also observed. Prevalence of chronic kidney disease from nontraditional causes was 3.9% (men 6.1%; women 2.2%).CONCLUSIONS Chronic kidney disease has reached epidemic proportions in El Salvador. The data confi rm a health tragedy that, although especially striking older men, also takes a severe toll on young men and women. The results confi rm fi ndings of previous research in several Salvadoran agricultural communities. The relatively high level of population exposure to agrochemicals is important and alarming, especially in rural areas, meriting health-impact studies that include and go beyond possible impact on chronic kidney disease.

Kidney disease hotspots and water balance in a warming world

“…In El Salvador, CKD is the second cause of death in men and the fifth in persons more than 18 years old. Death ascribed to kidney disease increased by 153% between 1997 and 2012 [10 ▪ ,11,12]. A kidney health research team found an 18% prevalence of CKD in Bajo Lempa, Usulután in 2009 [13].…”

El impacto sobre la salud colectiva de las conductas censurables en la investigación sanitaria

“…Desde finales del siglo XX, se viene constatando la trágica irrupción de una dolencia que ha alcanzado proporciones epidémicas y que se ensaña en hombres jóvenes de comunidades agrícolas de Nicaragua y El Salvador, la ERC [13]. Para por lo menos un tercio de las decenas de miles de afectados por ERC, puede descartarse que las causas sean las que típicamente determinan el daño renal crónico: hipertensión y diabetes [14]. Esta modalidad epidémica ha sido bautizada de varios modos, especialmente como Enfermedad Renal Crónica de Causas no Tradicionales (ERCnT) [15].…”

Chronic Interstitial Nephritis in Agricultural Communities

“…5,6 In Nicaragua, kidney disease–related mortality as high as 70/100,000 population has been reported, and the overall mortality is 12-fold higher than in the United States and Cuba, 7,8 whereas in El Salvador, CKD is the second leading cause of death in men, and overall kidney disease–related mortality is nine-fold higher than in the United States and Cuba. 7,9 CINAC prevalence in some regions of Sri Lanka is 6%–14.4% in men and 3.7%–17% in women, with higher prevalence of severe CKD in men. 10,11 The lack of kidney failure care in endemic areas has resulted in marked morbidity and mortality.…”