Online Program

International efforts to address nephropathy epidemics in Central America and Mexico

Tuesday, November 5, 2013 : 12:30 p.m. - 12:45 p.m.

Jennifer Crowe, MPH, PhD, Central American Institute for Studies on Toxic Substances (IRET) / Program for Health, Work and Environment (SALTRA), Universidad Nacional, Heredia, Costa Rica
Catharina Wesseling, MD, PhD, Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Christer Hogstedt, MD, PhD, Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Kristina Jakobsson, MD, PhD, Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
Rebekah Lucas, PhD, Centre for Global Health Research, Department of Epidemiology and Global Health, Umea University, Umea, Sweden
David Wegman, MD, MSc, Department of Work Environment, University of Massachusetts Lowell, Cambridge, MA
Background: Epidemics of chronic kidney disease of unknown etiology (CKDu) occur in multiple populations of Mesoamerica. CKDu appears disproportionally among young male sugarcane workers and has completely overwhelmed the healthcare systems in some areas. Similar phenomena have been reported in agricultural populations in Sri Lanka and India. Despite efforts of individual researchers and a call for action from the Central American Ministers of Health, the etiology continues to be unknown, thereby limiting interventions. Possible hypotheses include chronic heat stress and dehydration during work, environmental toxins, and genetic susceptibility, embedded in a complex structure of socioeconomic determinants. The intricate nature of the possible causal pathways requires transdisciplinary collaboration. Methods: In November 2012, SALTRA (Program for Work, Health and Environment in Central America) organized a workshop with 50 researchers from 15 countries with specialties in occupational health, environmental health, clinical and experimental nephrology, pathology, genetics, social sciences, law and epidemiology. Participants paid their own expenses. Experts submitted pre-workshop papers regarding different hypotheses, participated in working groups during the event, and edited reports after the event. Results: A detailed technical report and several articles in scientific journals are being prepared regarding the state of the art of the CKDu epidemic and research and policy priorities. The Consortium of the Epidemic of Nephropathy in Central America and Mexico (CENCAM) was established during the workshop, which continues this innovative international, transdisciplinary work facilitating collaborative research to determine the causes of CKDu as well as interventions based on current scientific evidence through links with policy makers.

Learning Areas:

Occupational health and safety
Public health or related research

Learning Objectives:
Describe the epidemic of chronic kidney disease happening in Central America and Mexico and the populations most affected. Identify the main objectives and outcomes of an international workshop to address the nephropathy epidemics in Central America and Mexico. Discuss efforts currently in place to maintain international and transdisciplinary collaboration to address the nephropathy epidemic in Central America and Mexico.

Keyword(s): Collaboration, Occupational Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the coordinator of the November 2012 International Workshop held in Costa Rica and am the coordinator of the temporary board for the CENCAM Consortium described in the abstract. I am the principal investigator in a four-year project on heat-related exposure in sugarcance workers in Costa Rica and have been active in collaborations to use the data from this research to contribute to the kidney disease epidemics in Central America and Mexico.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.