Exploring risk factors and predictors of endemic CKDu in agricultural regions of four Central America countries

探索四个中美洲国家农业区地方性 CKDu 的风险因素和预测因素

• 批准号: 10300422
• 负责人: Jennifer Crowe
• 金额: $ 41.6万
• 依托单位: UNIVERSIDAD NACIONAL, COSTA RICA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10300422
• 关键词: Acute Renal Failure with Renal Papillary Necrosis; Agrochemicals; Area; Biological Markers; Biological Specimen Banks; Biopsy; Blood; Case-Control Studies; Central America; Central American; Chronic Kidney Failure; Collaborations; Collection; Costa Rica; Country; Coupled; DNA; DNA sequencing; Data; Deposition; Detection; Disease; Disease Progression; Electron Microscopy; Enrollment; Environmental Exposure; Environmental and Occupational Exposure; Epidemiology; Etiology; Exposure to; Factor Analysis; Family; Fever; Genetic; Glomerular Filtration Rate; Government; Guatemala; Health; Health Personnel; Healthcare Systems; Heat Stress Disorders; Heavy Metals; Histopathology; Immunoglobulin G; Immunoglobulin M; Incidence; Individual; Infectious Agent; Injury to Kidney; Kidney; Kidney Diseases; Longitudinal cohort; Low Birth Weight Infant; Malnutrition; Manuals; Mass Spectrum Analysis; Measurement; Measures; Metals; Morphology; Natural History; Nicaragua; Panama; Patients; Poverty; Proteinuria; Public Health; RNA; Renal Tissue; Renal function; Research; Rest; Risk; Risk Factors; Role; Rural; Saccharum; Silicon Dioxide; Site; Specimen; Spottings; Tissues; Toxic Environmental Substances; Toxin; Tubular formation; United States National Institutes of Health; Universities; Visit; Work; Zoonoses; acronyms; agricultural activity; agricultural community; agricultural region; authority; base; biobank; case control; community organizations; design; experience; fighting; follow-up; genetic risk factor; kidney biopsy; member; novel; novel marker; pathogen; population based; professional atmosphere; programs; prospective; rural area; social determinants; transcriptome sequencing; vector-borne; working men; young adult

PROJECT SUMMARY Chronic kidney disease of unknown origin (CKDu) is highly prevalent in several tropical regions, including Central America where it is most common among young adult males working in sugarcane and other agricultural activities. It has taken a terrible toll on families living in vulnerable conditions in rural areas. Despite efforts to study CKDu over the last two decades, its causes are not fully understood and the disease continues to claim lives and overwhelm healthcare systems. This project aims to identify risk factors and predictors for estimated glomerular filtration rate (eGFR) decline among young individuals with and without CKDu in rural endemic areas in four Central American countries: Costa Rica, Panama, Nicaragua and Guatemala. We will comprehensively assess multiple risk factors related to 1) strenuous manual labor under heat stress with inadequate rest; 2) social determinants (e.g., poverty, malnutrition, low birth weight); 3) vector-borne or zoonotic diseases; and 4) exposure to known or novel toxins (e.g., heavy metals, agrochemicals, silica). We will also collect bio-banked specimens to assess genetic risk factors and novel biomarkers of acute kidney injury (AKI), as determined by the NIH Chronic Kidney Diseases of Uncertain Etiology (CURE) consortium. As a Field Epidemiology Site, our primary study aims are: (a) identification of cases and controls in endemic agricultural communities; (b) longitudinal follow-up of both cases and controls; and (c) biopsies in a subset of individuals. Our proposal takes advantage of the SALTRA network (Central American Program for Health, Work and Environment). SALTRA has nearly 20 years of experience conducting research in the region and has longstanding relationships with local communities, organizations and governmental organizations, public health authorities and local nephrologists on the front lines of fighting this disease.

项目摘要 在几种热带 地区，包括中美洲的年轻男性最常见的地区 在甘蔗和其他农业活动中工作。这给家庭带来了巨大的损失 生活在农村地区的脆弱条件下。尽管努力在最后两个研究CKDU 几十年来，其原因尚未完全理解，该疾病继续夺取生命和 压倒性的医疗保健系统。该项目旨在确定风险因素和预测因素 估计有和没有的年轻人的肾小球滤过率（EGFR）下降 CKDU在四个中美洲国家的农村流行地区：哥斯达黎加，巴拿马， 尼加拉瓜和危地马拉。我们将全面评估与 1）在热应力下剧烈的手动劳动，休息不足； 2）社会决定因素 （例如，贫困，营养不良，低出生体重）； 3）媒介传播或人畜共患病；和4） 暴露于已知或新颖的毒素（例如重金属，农产品，二氧化硅）。我们也会 收集生物银行标本，以评估遗传危险因素和急性的新生物标志物 由NIH慢性肾脏疾病确定的肾脏损伤（AKI） （治愈）财团。作为现场流行病学网站，我们的主要研究目的是：（a） 识别流行农业社区中的案件和控制； （b）纵向 案例和对照的随访； （c）一个个体中的活检。我们的 提案利用Saltra网络（中美洲健康计划， 工作和环境）。萨尔特拉（Saltra）有近20年的研究经验 该地区并与当地社区，组织和 正面的政府组织，公共卫生当局和地方肾病学家 与这种疾病作斗争的路线。