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126 The epidemic of chronic kidney disease of unconventional origin in Central America - a call for transdisciplinary research and action
  1. C I Wesseling1,
  2. Crowe2,
  3. Hogstedt3,
  4. Lucas4,
  5. Jakobsson5,
  6. Wegman6
  1. 1IRET-Salud, Universidad Nacional (on leave), Heredia, Costa Rica
  2. 2IRET, Universidad Nacional, Heredia, Costa Rica
  3. 3Karolinska Institute, Stockholm, Sweden
  4. 4Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  5. 5Lund university, Lund, Sweden
  6. 6University of Massachusetts at Lowell, Lowell, United States of America

Abstract

Background Central Americahas seen a dramatic increase of chronic kidney disease, unexplained by conventional risk factors (CKDu), primarily affecting adult male agricultural labourers. Increases of CKDu are also reported from Sri Lanka and India. Alleged risk factors include environmental toxins. However, observations from Nicaragua and El Salvadorindicate that repeated dehydration due to strenuous work in tropical climate may be a major risk factor that urgently needs to be explored using epidemiologic, experimental and interventional approaches. If heat stress and dehydration prove to be risk factors in themselves, or in combination with others, climate change will dramatically increase the population under risk in the near future. CKD increase in developing countries, regardless of conventional or unconventional origin, is overwhelming the healthcare systems.

Objectives Collaborative efforts are needed to identify the aetiology of CKDu, and its prevention. To identify current knowledge and gaps, and to propose future research, the university-based program Salud, Trabajo y Ambiente en América Central (SALTRA) sponsored a workshop in Costa Rica, November 2012.

Method Over 50 researchers from 15 countries participated, with expertise in epidemiology, occupational health, clinical and experimental nephrology and nephropathology, environmental and social sciences. Recent findings were reported, including the first biopsy study in CKDu cases from the region, demonstrating an unexpected mixed pattern of glomerular and tubular sclerosis. A mechanistically plausible link between concomitant dehydration and high NSAID consumption, driven by extreme ergonomic work load and musculoskeletal strain, leading to kidney damage was also proposed.

Results Papers summarising current knowledge, and working group reports and recommendations are made openly available on a website. Summary presentations will be published in international peer-review journals. A Research Consortium (SALTRA coordinating) was initiated.

A Statement was issued noting the high prevalence of CKDu in Central America, poverty and deplorable work conditions as driving forces, and the lack of treatment. Urgent actions are demanded.

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