The epidemic of chronic kidney disease of unconventional origin in Central America
– a call for transdisciplinary research and action
During the last 20 years Central America have seen a dramatic increase of chronic kidney disease, unexplained by conventional risk factors (CKDu), which primarily affects male labourers in the agricultural sector. Similar increases are also reported from Sri Lanka and India. Alleged risk factors include environmental toxins. However, recent observations indicate that repeated dehydration due to strenuous work may be a tentative risk factor. If true, climate change will dramatically increase the population under risk.
Collaborative efforts from the scientific community are needed to identify etiology and preventive measures for CKDu. With this objective, the university-based program Salud de Trabajo (SALTRA) invited research groups to a transdisciplinary workshop in Costa Rica, November 2012.
More than 50 researchers from 15 countries participated, with expertise in epidemiology, occupational health, clinical and experimental nephrology, and environmental and social sciences. The goal was to present state of knowledge and gaps, and to elaborate strategies for future research. Findings from the first biopsy study from the region were reported, unexpectedly demonstrating a mixed pattern of glomerular and tubular sclerosis. A mechanistically plausible link between dehydration and high NSAID consumption, both driven by extreme ergonomic work load and musculoskeletal strain, and kidney damage was also proposed.
A Research Consortium, CENCAM, was initiated, open for scientists. Stakeholders are invited as observers.
In a Statement the existence of a high prevalence of CKDu in Central America is acknowledged. Poverty and deplorable work conditions are pointed out as driving forces behind the occurrence, and the lack of treatment. Urgent actions are demanded, ranging from access to water at all worksites to etiologic research, and strengthened resources and knowledge transfer to the healthcare sector.
Papers summarizing the current state of knowledge, and working group reports was published as a Technical Report from SALTRA in the beginning of 2013. Summary presentations for publication in international journals and at international scientific meetings have been prepared.
For more information: Please contact jennifer.croweATuna.cr