International efforts to address nephropathy epidemics in Central America and Mexico

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.