Gonzalez-Quiroz, M; Smpokou, E-T; Silverwood, R; Camacho, A; Faber, D; La Rose Garcia, B; Oomatia, A; ... Caplin, B; + view all Gonzalez-Quiroz, M; Smpokou, E-T; Silverwood, R; Camacho, A; Faber, D; La Rose Garcia, B; Oomatia, A; Hill, M; Glaser, J; Le Blond, J; Wesseling, C; Aragoon, A; Smeeth, L; Pearce, N; Nitsch, D; Caplin, B; - view fewer (2018) Decline in Kidney Function among Apparently Healthy Young Adults at Risk of Mesoamerican Nephropathy. Journal of the American Society of Nephrology , 29 (8) pp. 2200-2212. 10.1681/ASN.2018020151.

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Abstract

Background: There are epidemic levels of chronic kidney disease (CKD) of undetermined cause clustering in agricultural communities in low-and-middle income countries, most prominently in Central America. We aimed to investigate the natural history of, and factors associated with, loss of kidney function in a high-risk population. Methods: A 2-year prospective community-based longitudinal study with 6-monthly follow-up was conducted in nine rural communities in North-western Nicaragua, including all men (n=263) and a random sample of women (n=87), aged 18-30, without self-reported CKD, diabetes or hypertension. Growth mixture modelling was used to identify subgroups of estimated glomerular filtration rate (eGFR) trajectory and weighted multinomial logistic regression to examine associations with proposed risk factors. Results: Three sub-populations of eGFR trajectory among men were identified: 81% remained stable (mean baseline eGFR: 116mL/min/1.73m2 ; mean change in eGFR over follow-up: - 0.6mL/min/1.73m2 /year); 9.5% experienced rapid decline despite normal baseline kidney function (112mL/min/1.73m2 ; -18.2mL/min/1.73m2 /year); whilst 9.5% had baseline renal dysfunction (58mL/min/1.73m2 ; -3.8mL/min/1.73m2 /year). Two sub-populations were identified in women: 96.6% remained stable (121mL/min/1.73m2 ; -0.6mL/min/1.73m2 /year); and 3.4% experienced rapid decline (132mL/min/1.73m2 ; -14.2mL/min/1.73m2 /year, n=3 cases). Among men, at baseline, outdoor and agricultural work along with lack of available shade during work-breaks were associated with rapid decline status. Conclusion: There is an aggressive kidney disease in Nicaragua that is without clear cause. While associated with agricultural work the range of study participants that sustained loss of eGFR suggests that other factors also play a role.

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