Online Program

Chronic kidney disease and differential health outcomes among men and women in northwest Nicaragua

Monday, November 4, 2013

Tiziana Lemma, PhD, Graduate School at Mount Sinai, Ichan School of Medicine at Mount Sinai, New York, NY
Nathan Raines, Ichan School of Medicine at Mount Sinai, New York, NY
Christopher Pool, Mount Sinai School of Medicine, New York, NY
Mark Kurzrok, Icahn School of Medicine at Mount Sinai, New York, NY
Perry E. Sheffield, MD, Dept of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
Christina Wyatt, MD, Icahn School of Medicine at Mount Sinai, New York, NY
The region of Guanacastal Sur in Northwest Nicaragua has been plagued by an epidemic of chronic kidney disease (CKD). The etiology of the disease is unknown, but recent research studies have pointed to occupational exposure to agricultural chemicals and chronic dehydration as possible causes. In order to identify risk factors for the epidemic, we conducted an investigation among five communities in the Chichigalpa municipality, where the majority of the population is employed in the surrounding sugar cane fields. We surveyed participants on their occupational history, exposures and practices, and matched the results with blood tests for serum creatinine and hemoglobin A1c (HbA1c) and physical measurements. Our results show that 38% of the screened male population had kidney damage (defined as eGFR<60 mL/min/1.73m2), whereas only 8% of screened women had reduced renal function. Furthermore, the average age of women with kidney disease was 50, while men with GFR<60 mL/min/1.73 m2 were significantly younger, with an average age of 37 (p<0.005). Only a small percentage of participants diagnosed with CKD had comorbidities typically associated with the disease: 2% had signs of diabetes, 11% showed signs of hypertension, and 15% were obese. These results strongly suggest that occupational and environmental factors might have a role in the development of CKD. Potential factors that might explain the observed gender discrepancy in CKD prevalence can be ascribed to differences in the division of labor and exposure to nephrotoxic substances. Further analysis of our data will help to identify risk factors and preventive measures.

Learning Areas:

Occupational health and safety
Public health or related research

Learning Objectives:
Describe the epidemic of chronic kidney disease of unknown etiology (CKDu) in Northwest Nicaragua Compare the prevalence of chronic kidney disease among men and women working in sugar cane fields in the Northwest area of Nicaragua Identify potential risk factors for the epidemic associated with occupational and environmental exposure of sugar cane workers Formulate concrete hypotheses that might elucidate the high prevalence of chronic kidney disease in the region of Guanacastal Sur in Nicaragua

Keyword(s): Occupational Exposure, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: With a Ph.D. in Molecular Biology, I transitioned to public health to better understand and explain the social determinants of health. During my MPH studies, I was selected for the Mount Sinai Global Health Summer Program Fellowship, with placement in Nicaragua. In this role, I investigated the epidemic of chronic kidney disease in Northwest Nicaragua. I assisted in designing the research study, developing the survey instruments, and I interviewed farm workers and analyzed data.
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.

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