Identifying Contributing Factors to the Progression of Chronic Kidney Disease of Unknown Etiology in Sri Lanka

确定斯里兰卡病因不明的慢性肾病进展的影响因素

• 批准号: 9231203
• 负责人: STEPHEN L SCHENSUL
• 金额: $ 18.51万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-20 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9231203
• 关键词: Address; Adult; Affect; Age; Age-Years; Agricultural Workers; Agriculture; Agrochemicals; Air; Alcohol consumption; Alcohols; Area; Atrophic; Ayurvedic Medicine; Balkans; Behavior; Behavioral Genetics; Caring; Central America; Cessation of life; Chronic Kidney Failure; Collaborations; Communities; Community Health; Comorbidity; Connecticut; Contracts; Country; Creatinine; Dehydration; Dependence; Diabetes Mellitus; Dialysis procedure; Disease; Disease Progression; Economics; Egypt; Elements; End stage renal failure; Environment; Epidemic; Etiology; Exposure to; Faculty; Family; Farming environment; Female; Fibrosis; Food; Government; Guidelines; Health; Health Personnel; Healthcare; High Prevalence; Hot Spot; Household; Hydration status; Hypertension; India; Individual; Injury; Institution; Interdisciplinary Study; Interview; Investigation; Joints; Kidney Failure; Kidney Transplantation; Land Holding; Left; Link; Longevity; Maternal and Child Health; Measures; Medical; Modeling; Monitor; Nature; Pattern; Pesticides; Policies; Prevalence; Prevention; Prevention approach; Productivity; Province; Public Health; Quality of life; Recruitment Activity; Renal function; Reporting; Research; Risk; Rural; Sampling; Sampling Studies; Scientist; Seeds; Serum; Soil; Sri Lanka; Staging; Students; Surveys; Testing; Time; Tobacco; Tobacco use; Tubular formation; Universities; Water; Woman; Work; abstracting; behavioral health; benefit sharing; exposure route; farmer; health care service utilization; improved; low and middle-income countries; male; medication compliance; men; prevent; psychologic; screening; social; social stigma; sociologist

Abstract Over the last two decades there has been a rapid increase in chronic kidney disease of unknown etiology (CKDu) that has emerged in rural, arid, agricultural lowland regions in multiple countries. These regions report 15 to 20% prevalence among men and women between the ages of 30 to 60. CKDu is a progressive and irreversible disease resulting in renal failure and death unless dialysis or a kidney transplant is available. The primary effort to date has focused on identification of the etiological factors that cause CKDu, but the result of intensive investigation have been frustratingly inconclusive leaving public health officials and agricultural workers with little guidance for preventing the disease. In the absence of an approach to prevention, this proposed research will focus on identifying factors associated with delaying progression of the disease in Sri Lanka, one of the countries hardest hit by the CKDu epidemic. The project will be conducted in a rural endemic area of Sri Lanka and calls for an interdisciplinary study focused on identifying the environmental, behavioral and health care factors that are associated with the rate of progression of CKDu from moderate to more advanced CKDu. The project is a collaboration between the University of Connecticut in the US and the University of Peradeniya in Sri Lanka and involves environmental, social and medical scientists from both institutions. A sample of 300 male and female farmers with moderate CKDu as measured by their serum creatinine level will be generated from a Ministry of Health screening in the study area conducted prior to the initiation of the project and followed by quarterly serum creatinine testing by the project to determine trajectory of progression for the individuals in the study sample. The project objective is to identify the factors in the domains of the environment, behavior and health care that are associated with more rapid or slower CKD progression. The specific aims of this proposed project are to: (1) Assess and monitor agrochemicals in water and soil of the microenvironments of individuals with CKDu; (2) Identify behaviors related to farming including hydration, pesticide and agrochemical use during farming, and non-farming behavior including psychological states, stigma, alcohol and tobacco use; (3) Examine the use of health care by individuals with CKDu including use of allopathic v. non-allopathic (e.g. ayurvedic, healer, spiritualist) care, medication adherence, and co-morbidities; and (4). Increase the capacity of faculty and students from both institutions to conduct interdisciplinary research with regard to CKDu in Sri Lanka and other endemic countries. The proposed study would be the first in Sri Lanka to focus on disease progression and potentially transformative for these affected communities. The project also provides the opportunity for cross-disciplinary, cross-national exchange that can be generate a model for addressing NCDs in Sri Lanka and other countries.

抽象的 在过去的二十年里，病因不明的慢性肾病迅速增加 （CKDu）已出现在多个国家的农村、干旱、农业低地地区。这些地区 据报道，30 岁至 60 岁的男性和女性中，患病率为 15% 至 20%。CKDu 是一种 进行性和不可逆转的疾病，导致肾功能衰竭和死亡，除非进行透析或肾脏修复 可以进行移植。迄今为止的主要工作集中于确定病因 导致 CKDu 的原因，但深入调查的结果却令人沮丧地没有结论 公共卫生官员和农业工人缺乏预防这种疾病的指导。在 由于缺乏预防方法，这项拟议的研究将侧重于确定因素 与延缓斯里兰卡疾病的进展有关，斯里兰卡是受疫情影响最严重的国家之一 CKDu流行病。该项目将在斯里兰卡的农村流行地区进行，并呼吁 跨学科研究的重点是确定环境、行为和医疗保健因素 与 CKDu 从中度到更晚期 CKDu 的进展速度相关。项目 是美国康涅狄格大学和斯里兰卡佩拉德尼亚大学合作的项目 兰卡，涉及两个机构的环境、社会和医学科学家。样本300个 根据血清肌酐水平测量，患有中度 CKDu 的男性和女性农民将 卫生部在研究开始前对研究区域进行的筛查得出的结果 项目，然后由该项目进行季度血清肌酐测试，以确定轨迹 研究样本中个体的进展。该项目的目标是确定影响因素 与更快或更慢相关的环境、行为和医疗保健领域 CKD 进展。本项目的具体目标是： (1) 评估和监测农用化学品 CKDu 患者微环境的水和土壤中； (2) 识别相关行为 农业，包括农业期间的水合作用、农药和农用化学品的使用以及非农业行为 包括心理状态、耻辱、酗酒和吸烟； (3)检查医疗保健的使用情况 患有 CKDu 的个体，包括使用对抗疗法与非对抗疗法（例如阿育吠陀、治疗师、招魂术） 护理、药物依从性和合并症；和（4）。提高教师和学生的能力 两个机构就斯里兰卡和其他国家的 CKDu 进行跨学科研究 流行国家。拟议的研究将是斯里兰卡第一个关注疾病进展的研究 并可能为这些受影响的社区带来变革。该项目还提供了 跨学科、跨国交流的机会，可以产生解决问题的模型 斯里兰卡和其他国家的非传染性疾病。