Original Investigation
Pathogenesis and Treatment of Kidney Disease
Decreased Kidney Function of Unknown Cause in Nicaragua: A Community-Based Survey

https://doi.org/10.1053/j.ajkd.2009.12.012Get rights and content

Background

End-stage kidney disease overwhelms health services in Central America. We determined prevalences of decreased kidney function in distinct populations in the most affected region of Nicaragua.

Study Design

Cross-sectional survey.

Setting & Participants

Total populations aged 20-60 years of 5 villages in Northwest Nicaragua: mining/subsistence farming (elevation, 100-300 m above sea level), banana/sugarcane (100-300 m), fishing (0-100 m), services (0-100 m), and coffee (200-675 m); 479 men and 617 women (83% response).

Predictor or Factor

Village; participant sex, age, and occupation; conventional chronic kidney disease risk factors.

Outcomes

Serum creatinine (SCr) values greater than laboratory reference range for sex, estimated glomerular filtration rate <60 mL/min/1.73 m2, proteinuria stratified in the low (dipstick protein excretion, 30-300 mg/dL) and high (>300 mg/dL) range.

Results

Prevalences of abnormal SCr levels: 18% (of all men) and 5% (of all women); in the mining/subsistence farming village, 26% and 7%; banana/sugarcane, 22% and 6%; fishing, 13% and 4%; services, 0% and 1%; and coffee, 7% and 0%. Prevalences of estimated glomerular filtration rate <60 mL/min/1.73 m2: 14% (of all men) and 3% (of all women); in the listed villages, 19% and 5%, 17% and 4%, 10% and 2%, 0% and 0%, and 7% and 0%, respectively. Proteinuria, predominantly in the low range, affected 14% and 11% of all men and women without marked differences between villages. By occupation, abnormal SCr levels occurred in 31% and 24% of male and female agricultural workers at 100-300 m above sea level, but not at higher altitudes, and also was high in male artisans (43%), construction workers (15%), and miners (14%). In logistic regression models, for the banana/sugarcane and mining/subsistence farming villages, high blood pressure and age were significant predictors of abnormal SCr levels in men, and for mining/subsistence farming, age in women.

Limitations

Causality is not addressed.

Conclusions

In some Nicaraguan villages and population segments, men in particular show a high prevalence of decreased kidney function of unknown origin, possibly environmental or occupational.

Section snippets

Setting and Study Population

This cross-sectional survey established the prevalence of decreased kidney function in populations aged 20-60 years of 5 villages in Northwest Nicaragua. The villages were selected by convenience, with a maximum of 800 inhabitants to be manageable, and represent distinct economic profiles and locations at different altitudes: gold mining and subsistence farming (200-300 m above sea level), large-scale banana and sugarcane production (100-200 m above sea level), small-scale fishery near the

Results

Of 1,314 inhabitants aged 20-60 years, 1,096 were included in the analyses, with an overall response rate of 83% (75% of men, 88% of women), ranging from 67% of men in the services village to 94% of women in the banana/sugarcane village. Six women from 3 villages were excluded for not providing blood and urine samples. Refusals were <10% for each village. Nonparticipation was caused mostly by migration for work according to information provided by family members (Fig 1). Most nonresponders were

Discussion

A single determination of SCr and a dipstick for proteinuria in a single spot sample is not sufficient for the diagnosis of CKD on an individual basis. However, the finding of high prevalences of abnormal SCr levels in specific segments of the population in a population-based study with extensive coverage is highly worrying. In the banana/sugarcane and mining/subsistence farming villages, about a quarter of the men had abnormal SCr values indicative of decreased kidney function, and ∼18% had an

Acknowledgements

We thank all students and technicians at UNAN-León and UNAN-Managua (Milton Vallejos, Ergin Rodríguez, Efrén Altamirano, Eduardo Centeno, Sara Cárdenas, Yanitcia Blandón, Bayardo Castillo, Indira Valladarez, José Ramón Parajón, Yorling Maryorga, Armando Bravo, and Ervin Baca) who assisted in the difficult field work and Ministry of Health Laboratory (Alcides González, Consuelo Vega, Harold García, and Margarita Brenes) and Marcos Vanegas and the administrative team of the Research Centre on

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    Originally published online as doi:10.1053/j.ajkd.2009.12.012 on February 1, 2010.

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    Copyright © 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.