The epidemiology of renal replacement therapy in two different parts of the worldThe Latin American Dialysis and Transplant Registry versus the European Renal Association-European Dialysis and Transplant Association Registry

Publisher Copyright: © 2018 Pan American Health Organization. All rights reserved.Objective: To compare the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in Latin America and Europe, as well as to study differences in macro-economic indicators, demographic and clinical patient characteristics, mortality rates, and causes of death between these two populations. Methods: We used data from 20 Latin American and 49 European national and subnational renal registries that had provided data to the Latin American Dialysis and Renal Transplant Registry (RLADTR) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, respectively. The incidence and prevalence of RRT in 2013 were calculated per million population (pmp), overall and by subcategories of age, sex, primary renal disease, and treatment modality. The correlation between gross domestic product and the prevalence of RRT was analyzed using linear regression. Trends in the prevalence of RRT between 2004 and 2013 were assessed using Joinpoint regression analysis. Results: In 2013, the overall incidence at day 91 after the onset of RRT was 181 pmp for Latin American countries and 130 pmp for European countries. The overall prevalence was 660 pmp for Latin America and 782 pmp for Europe. In the Latin American countries, the annual increase in the prevalence averaged 4.0% (95% confdence interval (CI): 2.5%-5.6%) from 2004 to 2013, while the European countries showed an average annual increase of 2.2% (95% CI: 2.0%-2.4%) for the same time period. The crude mortality rate was higher in Latin America than in Europe (112 versus 100 deaths per 1 000 patient-years), and cardiovascular disease was the main cause of death in both of those regions. Conclusions. There are considerable differences between Latin America and Europe in the epidemiology of RRT for ESRD. Further research is needed to explore the reasons for these differences.Peer reviewe

Incidence, mortality, and prevalence of end-stage chronic renal disease in the Bajo Lempa region of El Salvador: A ten-year community registry

The Bajo Lempa is an impoverished rural coastal region of El Salvador affected by the chronic kidney disease (CKD) epidemic known as Mesoamerican nephropathy. The local community organisation Fondo Social de Emergencia para la Salud (FSES) (Emergency social fund for health) is helping to fight the epidemic in 42 communities of the region (19,223 inhabitants; average age 26.7 years; 48.5% male; 40.2% <18 years). Objectives: To report annual rates of end-stage renal disease (ESRD) incidence and patient mortality in these communities during a 10-year period (2004–2013), and the prevalence of patients receiving renal replacement therapy (RRT) as of 31 December 2013. Methods: The FSES recorded new ESRD cases, basic patient history, form of RRT if received and patient deaths. Results: We registered 271 new ESRD cases (annual average 27.1; 89% male; average age 55.6 years, four <18 years). Average annual ESRD incidence rate: 1409.8 per million population (pmp). Two-thirds did not report diabetes or hypertension. 94 patients (34.7%) received RRT: 58 in the Ministry of health, 26 in private services, 9 in social security and 1 in the military health system. 246 patients died (annual average 24.6 deaths; 89.4% male; average age 56.1 years; 92.3% at home). Average annual mortality rate: 128/100,000 population. Prevalence of patients receiving RRT in 2013: 1300.5 pmp (N = 25; 84% male; average age 51 years). Conclusions: This region has a high incidence of ESRD. Few receive RRT. Patient mortality is high even with RRT. Most patients are male (9:1). Social determinants influence the high mortality

Nefropatía terminal en pacientes de un hospital de referencia en El Salvador

Objetivos. El Salvador es un país con alta mortalidad por nefropatía terminal (NT). El objetivo de este estudio consistió en conocer las características epidemiológicas de una serie de nuevos casos de NT atendidos en un hospital de referencia de este país. Métodos. Se realizó un estudio transversal de todos los nuevos casos que iniciaron diálisis crónica entre noviembre de 1999 y marzo de 2000. Mediante una entrevista personal se obtuvieron datos sobre aspectos clínicos, demográficos, laborales y ambientales. Resultados. Durante los 5 meses que duró el estudio se observaron 205 nuevos casos de NT. Entre los 202 entrevistados, se diferenciaron claramente dos grupos: uno de 67 pacientes (33%) con factores de riesgo conocidos de NT, similares a los de países desarrollados (fundamentalmente, diabetes mellitus, hipertensión arterial y consumo crónico de antiinflamatorios no esteroideos), y otro de 135 pacientes (67%) con características peculiares, en los que no se pudo detectar ningún factor asociado. La mayoría de estos últimos pacientes eran hombres, agricultores, habitantes de zonas costeras o adyacentes a ríos, que años atrás habían estado expuestos, sin protección, a insecticidas o plaguicidas agrícolas por razones laborales. Conclusiones. Se ha identificado un importante grupo de pacientes con NT que aparentemente carecen de una causa para su enfermedad y que presentan características peculiares que permiten sospechar una relación con la exposición laboral a insecticidas o plaguicidas. Son necesarios nuevos estudios para confirmar esta hipótesis

Prevalence of patients receiving renal replacement therapy in El Salvador in 2014

El Salvador has the highest renal failure mortality rate in the Americas. Five healthcare providers offer renal replacement therapy (RRT) in the country. The national RRT prevalence has never been reported. Aims: To determine the RRT prevalence in El Salvador and some basic characteristics. Methods: The association of nephrology coordinated a nationwide cross-sectional survey during the third quarter of 2014. 31 renal centres participated in the survey, covering 99.5% of patients. Results: National RRT prevalence: 595 per million population (pmp), N = 3807, average age 50.4 years old, 67.5% male. By modality: peritoneal dialysis (PD) 289 pmp, haemodialysis (HD) 233 pmp, with functioning kidney transplantation 74 pmp (living donor only). Social security covers 25% of the population but treats 49.7% of RRT patients. Generally, higher prevalence was observed in municipalities with renal centres or located on the coast or lowlands. Ninety-five per cent of HD patients receive fewer than 3 weekly sessions. Of PD patients, 59% do not belong to a continuous outpatient or automated programme, and 25% still use rigid catheter. Aetiology of chronic kidney disease: unavailable/undetermined 50%, hypertension 21.1%, diabetes 18.9%, glomerulonephritis 6.7%, obstructive causes 1.2%, tubulointerstitial 0.9%, polycystic 0.4% and other 0.7%. Discussion: Despite the increase in RRT services, the prevalence is lower than the Latin American average (660 pmp). Three quarters of HD and PD patients are under-dialysed. Obsolete RRT techniques are still used. The presence of Mesoamerican nephropathy influences the demographic characteristics (many young patients, two-thirds male, high prevalence in lowlands and coastlands)

Decreased Kidney Function Among Agricultural Workers In El Salvador

Background: An epidemic of chronic kidney disease of unknown cause has emerged along the Pacific coast of Central America, particularly in relatively young male sugarcane workers. In El Salvador, we examined residence and occupations at different altitudes as surrogate risk factors for heat stress. Study Design: Cross-sectional population-based survey. Setting & Participants: Populations aged 20-60 years of 5 communities in El Salvador, 256 men and 408 women (participation, 73%): 2 coastal communities with current sugarcane and past cotton production and 3 communities above 500 m with sugarcane, coffee, and service-oriented economies. Predictor: Participant sex, age, residence, occupation, agricultural history by crop and altitude, and traditional risk factors for CKD. Outcomes: Serum creatinine (SCr) level greater than the normal laboratory range for sex, estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2, and proteinuria categorized as low (protein excretion <30-<300 mg/dL) and high grade (<300 mg/dL). Results: Of the men in the coastal communities, 30% had elevated SCr levels and 18% had eGFR <60 mL/min/1.73 m 2 compared with 4% and 1%, respectively, in the communities above 500 m. For agricultural workers, prevalences of elevated SCr levels and eGFR <60 mL/min/1.73 m 2 were highest for coastal sugarcane and cotton plantation workers, but were not increased in sugarcane workers at 500 m or subsistence farmers. Women followed a weaker but similar pattern. Proteinuria was infrequent, of low grade, and not different among communities, occupations, or sexes. The adjusted ORs of decreased kidney function for 10-year increments of coastal sugarcane or cotton plantation work were 3.1 (95% CI, 2.0-5.0) in men and 2.3 (95% CI, 1.4-3.7) in women. Limitations: The cross-sectional nature of the study limits etiologic interpretations. Conclusion: Agricultural work on lowland sugarcane and cotton plantations was associated with decreased kidney function in men and women, possibly related to strenuous work in hot environments with repeated volume depletion.Antecedentes: Ha surgido una epidemia de enfermedad renal crónica de causa desconocida a lo largo de la costa del Pacífico de América Central, particularmente en trabajadores varones relativamente jóvenes de la caña de azúcar. En El Salvador, examinamos la residencia y las ocupaciones a diferentes altitudes como factores de riesgo sustitutos del estrés por calor. Diseño del estudio: Encuesta poblacional transversal. Entorno y participantes: Poblaciones de 20 a 60 años de 5 comunidades en El Salvador, 256 hombres y 408 mujeres (participación, 73%): 2 comunidades costeras con producción actual de caña de azúcar y algodón pasado y 3 comunidades por encima de 500 m con caña de azúcar, café, y economías orientadas a los servicios. Predictor: sexo del participante, edad, residencia, ocupación, historial agrícola por cultivo y altitud, y factores de riesgo tradicionales de ERC. Resultados: nivel de creatinina sérica (SCr) mayor que el rango normal de laboratorio para el sexo, tasa de filtración glomerular estimada (eGFR) <60 ml / min / 1,73 m 2 y proteinuria categorizada como baja (excreción de proteínas <30- <300 mg / dL ) y alto grado (<300 mg / dL). Resultados: De los hombres de las comunidades costeras, el 30% tenía niveles elevados de SCr y el 18% tenía eGFR <60 mL / min / 1,73 m 2 en comparación con 4% y 1%, respectivamente, en las comunidades por encima de 500 m. Para los trabajadores agrícolas, las prevalencias de niveles elevados de SCr y eGFR <60 ml / min / 1,73 m 2 fueron más altas para los trabajadores de las plantaciones costeras de caña de azúcar y algodón, pero no aumentaron en los trabajadores de la caña de azúcar a 500 mo los agricultores de subsistencia. Las mujeres siguieron un patrón más débil pero similar. La proteinuria fue poco frecuente, de bajo grado y no difirió entre comunidades, ocupaciones o sexos. Las OR ajustadas de la función renal disminuida para incrementos de 10 años de trabajo en plantaciones costeras de caña de azúcar o algodón fueron 3,1 (IC del 95%, 2,0-5,0) en los hombres y 2,3 (IC del 95%, 1,4-3,7) en las mujeres. Limitaciones: La naturaleza transversal del estudio limita las interpretaciones etiológicas. Conclusión: El trabajo agrícola en las plantaciones de caña de azúcar y algodón de las tierras bajas se asoció con una disminución de la función renal en hombres y mujeres, posiblemente relacionada con el trabajo extenuante en ambientes cálidos con agotamiento repetido del volumen.Antecedentes: Uma epidemia de doença renal crônica de causa desconhecida surgiu ao longo da costa do Pacífico da América Central, particularmente em trabalhadores relativamente jovens da cana-de-açúcar. Em El Salvador, examinamos residência e ocupações em diferentes altitudes como fatores de risco substitutos para estresse por calor. Desenho do Estudo: Pesquisa transversal de base populacional. Cenário e participantes: Populações de 20-60 anos de 5 comunidades em El Salvador, 256 homens e 408 mulheres (participação, 73%): 2 comunidades costeiras com cana-de-açúcar atual e produção passada de algodão e 3 comunidades acima de 500 m com cana-de-açúcar, café, e economias orientadas a serviços. Preditor: Sexo do participante, idade, residência, ocupação, histórico agrícola por cultura e altitude e fatores de risco tradicionais para DRC. Resultados: nível de creatinina sérica (SCr) maior que a faixa normal de laboratório para sexo, taxa de filtração glomerular estimada (eTFG) <60 mL / min / 1,73 m 2 e proteinúria categorizada como baixa (excreção de proteína <30- <300 mg / dL ) e alto grau (<300 mg / dL). Resultados: Dos homens nas comunidades costeiras, 30% tinham níveis elevados de SCr e 18% tinham eTFG <60 mL / min / 1,73 m 2 em comparação com 4% e 1%, respectivamente, nas comunidades acima de 500 m. Para trabalhadores agrícolas, as prevalências de níveis elevados de SCr e eTFG <60 mL / min / 1,73 m 2 foram maiores para trabalhadores da cana-de-açúcar e plantadores de algodão costeiros, mas não aumentaram para trabalhadores da cana a 500 m ou agricultores de subsistência. As mulheres seguiram um padrão mais fraco, mas semelhante. A proteinúria era infrequente, de baixo grau e não diferente entre comunidades, ocupações ou sexos. Os ORs ajustados de função renal diminuída para incrementos de 10 anos de cana-de-açúcar costeira ou trabalho de plantação de algodão foram 3,1 (IC de 95%, 2,0-5,0) em homens e 2,3 (IC de 95%, 1,4-3,7) em mulheres. Limitações: A natureza transversal do estudo limita as interpretações etiológicas. Conclusão: O trabalho agrícola em plantações de cana-de-açúcar e algodão foi associado à diminuição da função renal em homens e mulheres, possivelmente relacionado ao trabalho extenuante em ambientes quentes com depleção de volume repetida.Universidad de El SalvadorUniversidad Nacional, Costa RicaUniversidad Nacional Autónoma de Nicaragua, León, NicaraguaMinisterio de Salud, El SalvadorCentro de Hemodiálisis, El SalvadorLund University, SwedenKarolinska Institutet, SwedenInstituto Regional de Estudios en Sustancias Tóxica

Nefropatía mesoamericana: revisión breve basada en el segundo taller del Consorcio para el estudio de la Epidemia de Nefropatía en Centroamérica y México (CENCAM)

Mesoamerican nephropathy (MeN) is a form of endemic chronic kidney disease (CKD) unrelated to diabetes or hypertension and its causes are still undetermined. Clinically, patients with MeN have no or only mild proteinuria and mild or absent systemic hypertension. MeN is highly prevalent and with elevated mortality in the Pacific coast of Central America. The Consortium for the Study of the Epidemic of Nephropathy in Central America and Mexico (CENCAM) held a workshop in San José, Costa Rica to review all available scientific evidence, identify knowledge gaps, and propose recommendations. The purpose of this review is to present a brief summary of the update on the current evidence evaluated during the workshop, which is available in the full Scientific Report. Although the aetiology is still not clear, there is consensus among most researchers that MeN has an important occupational and environmental component, and that physical exertion under heat stress is probably related to the disease. Continuous repetitive episodes of dehydration and heat stress may play an important role in the pathophysiology of the disease. It is likely that the cause of MeN is multifactorial, and other risk factors have been proposed that deserve to be studied in greater depth, including: exposure to some agrochemicals, some infectious agents (Leptospira and others), frequent use of analgesics, genetic susceptibility, and social determinants of health. MeN poses a historic challenge for Latin American nephrology, and its approach must be multi-sectoral.La nefropatía mesoamericana (NME) es una forma de enfermedad renal crónica (ERC) endémica que no está relacionada con la diabetes ni con la hipertensión y cuyas causas son aún indeterminadas. Clínicamente, los pacientes con MeN no tienen o sólo tienen una proteinuria leve y una hipertensión sistémica leve o ausente. La MeN es altamente prevalente y con elevada mortalidad en la costa del Pacífico de América Central. El Consorcio para el Estudio de la Epidemia de Nefropatía en Centroamérica y México (CENCAM) celebró un taller en San José, Costa Rica, para revisar toda la evidencia científica disponible identificar los vacíos de conocimiento y proponer recomendaciones. El propósito de esta revisión es presentar un breve resumen de la actualización de la evidencia actual evidencia actual evaluada durante el taller, que está disponible en el Informe Científico completo. Aunque la etiología aún no está clara, hay consenso entre la mayoría de los investigadores que la MeN tiene un importante componente laboral y ambiental, y que el esfuerzo físico esfuerzo físico bajo estrés térmico está probablemente relacionado con la enfermedad. Los episodios repetitivos y continuos de deshidratación y estrés térmico pueden desempeñar un papel importante en la fisiopatología de la de la enfermedad. Es probable que la causa de la NME sea multifactorial, y se han propuesto otros factores de riesgo que merecen ser estudiados en mayor profundidad. Se han propuesto otros factores de riesgo que merecen ser estudiados en mayor profundidad, entre ellos: la exposición a algunos productos agroquímicos, algunos agentes infecciosos (Leptospira y otros), el uso frecuente de analgésicos, la susceptibilidad genética susceptibilidad genética y los determinantes sociales de la salud. La MeN plantea un desafío histórico para la nefrología latinoamericana, y su abordaje debe ser multisectorial.Universidad Nacional, Costa Rica.Instituto Regional de Estudios en Sustancias Tóxica

Incidencia, mortalidad y prevalencia de enfermedad renal crónica terminal en la región del Bajo Lempa, El Salvador: 10 años de registro comunitario.

The Bajo Lempa is an impoverished rural coastal region of El Salvador affected by the chronic kidney disease (CKD) epidemic known as Mesoamerican nephropathy. The local community organisation Fondo Social de Emergencia para la Salud (FSES) (Emergency social fund for health) is helping to fight the epidemic in 42 communities of the region (19,223 inhabitants; average age 26.7 years; 48.5% male; 40.2% To report annual rates of end-stage renal disease (ESRD) incidence and patient mortality in these communities during a 10-year period (2004-2013), and the prevalence of patients receiving renal replacement therapy (RRT) as of 31 December 2013. The FSES recorded new ESRD cases, basic patient history, form of RRT if received and patient deaths. We registered 271 new ESRD cases (annual average 27.1; 89% male; average age 55.6 years, four This region has a high incidence of ESRD. Few receive RRT. Patient mortality is high even with RRT. Most patients are male (9:1). Social determinants influence the high mortality

Intervention to diminish dehydration and kidney damage among sugarcane workers

Objective The aim of this study was to assess the potential to reduce kidney function damage during the implementation of a water, rest, shade (WRS) and efficiency intervention program among sugarcane workers. Methods A WRS intervention program adapted from the US Occupational Safety and Health Administration (OSHA) coupled with an efficiency program began two months into the 5-month harvest. One of the two groups of workers studied was provided with portable water reservoirs, mobile shaded tents, and scheduled rest periods. Health data (anthropometric and questionnaires), blood, and urine were collected at baseline and at three subsequent times over the course of the harvest. Daily wet bulb globe temperatures (WBGT) were recorded. Results Across a working day there were changes in biomarkers indicating dehydration (urine osmolality) and serum albumin and reduced estimated glomerular filtration rate (eGFR). Cross-shift eGFR decrease was present in both groups; -10.5 mL/min/1.73m2 [95% confidence interval (95% CI) -11.8– -9.1], but smaller for the intervention group after receiving the program. Decreased eGFR over the 5-month harvest was seen in both groups: in the one receiving the intervention -3.4 mL/min/1.73m2 (95% CI -5.5– -1.3) and in the other -5.3 (95% CI -7.9– -2.7). The decrease appeared to halt after the introduction of the intervention in the group receiving the program. Conclusion A WRS and efficiency intervention program was successfully introduced for workers in sugarcane fields and appears to reduce the impact of heat stress on acute and over-harvest biomarkers of kidney function. Further research is needed to determine whether biomarker changes predict reduced risk of chronic kidney disease in this type of work

Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy.

Mesoamerican nephropathy (MeN), an epidemic in Central America, is a chronic kidney disease of unknown cause. In this article, we argue that MeN may be a uric acid disorder. Individuals at risk for developing the disease are primarily male workers exposed to heat stress and physical exertion that predisposes to recurrent water and volume depletion, often accompanied by urinary concentration and acidification. Uric acid is generated during heat stress, in part consequent to nucleotide release from muscles. We hypothesize that working in the sugarcane fields may result in cyclic uricosuria in which uric acid concentrations exceed solubility, leading to the formation of dihydrate urate crystals and local injury. Consistent with this hypothesis, we present pilot data documenting the common presence of urate crystals in the urine of sugarcane workers from El Salvador. High end-of-workday urinary uric acid concentrations were common in a pilot study, particularly if urine pH was corrected to 7. Hyperuricemia may induce glomerular hypertension, whereas the increased urinary uric acid may directly injure renal tubules. Thus, MeN may result from exercise and heat stress associated with dehydration-induced hyperuricemia and uricosuria. Increased hydration with water and salt, urinary alkalinization, reduction in sugary beverage intake, and inhibitors of uric acid synthesis should be tested for disease prevention