While there are differing hypotheses about the primary causes, many CKDu researchers agree that the disease is likely multifactorial. The extreme burden placed on affected families, communities, and healthcare systems has created an urgent public health problem. CKDu with similar characteristics is present among agricultural workers in other tropical regions including Sri Lanka and India. Studies have also documented a high prevalence of low kidney function, suggestive of CKD, in non-agricultural workers including miners and construction workers but few have confirmed CKD based on two eGFR values as per clinical guidelines. Several studies have identified the disease among sugarcane workers. Agricultural workers appear to be highly affected, suggesting the potential role of occupational exposures including agrichemicals and heat stress. and Europe typically affects older men and women with near equal frequency, in Central America one form of CKD disproportionately affects younger men ( 60 years, diabetes, hypertension, glomerulonephritis or obesity. Reported mortality rates from chronic kidney disease (CKD) in Central America have been increasing over the past three decades, with the highest rates (60–70 deaths / 100,000 population) among men in El Salvador and Nicaragua respectively. Conclusionĭespite efforts to enroll participants without CKD, our identification of prevalent CKD among agricultural and non-agricultural workers in the MANOS cohort indicates notable kidney disease in the region, particularly among sugarcane workers. Nicaraguan sugarcane had the lowest prevalence, likely due to kidney function screenings prior to employment. Age-standardized prevalence was highest in Salvadoran sugarcane (14.1%), followed by Salvadoran corn (11.6%), and Nicaraguan brickmaking (8.1%). Prevalence of CKD at baseline was 7.4% ( n = 42). Kidney function parameters were compared by CKD status. Age-standardized prevalence was calculated by industry, country, and demographic measures. CKD at baseline is defined as eGFR ≤ 60 ml/min/1.73m 2 at both timepoints. At six months, serum was collected again prior to the work shift. Serum specimens were analyzed for kidney function parameters, and used to calculate estimated glomerular filtration rate (eGFR). Investigators administered questionnaires, collected biological samples, and observed workers for three consecutive workdays at the worksite. Workers with no known diabetes, hypertension, or CKD were recruited from sugarcane, corn, plantain, brickmaking, and road construction industries ( n = 569). The objective of this manuscript is to describe the MANOS cohort recruitment, baseline data collection, and CKDu prevalence after two rounds. The Mesoamerican Nephropathy Occupational Study (MANOS) is a prospective cohort study of CKDu among agricultural and non-agricultural workers in El Salvador and Nicaragua. Mortality from chronic kidney disease of unknown etiology (CKDu) is extremely high along the Pacific coast of Central America, particularly among sugarcane workers.
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