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Randomized Controlled Trial
. 2011 Sep;26(9):2798-805.
doi: 10.1093/ndt/gfq385. Epub 2010 Jul 8.

Prevalence of and risk factors for chronic kidney disease in rural Nicaragua

Julie K O'Donnell  1 , Matthew Tobey, Daniel E Weiner, Lesley A Stevens, Sarah Johnson, Peter Stringham, Bruce Cohen, Daniel R Brooks
Affiliations
Randomized Controlled Trial

Prevalence of and risk factors for chronic kidney disease in rural Nicaragua

Julie K O'Donnell et al. Nephrol Dial Transplant. 2011 Sep.

Abstract

Background: Mostly anecdotal reports describe a high prevalence of chronic kidney disease in northwestern Nicaragua, predominantly among younger men, resulting in substantial morbidity and mortality. The true prevalence, nature and aetiology of kidney disease in this region remain unknown.

Methods: We performed a population-based prevalence study in Quezalguaque, Nicaragua to assess the frequency of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2), and compared the prevalence of reduced eGFR in Quezalguaque with the USA using the NHANES 1999-2006 data. We also conducted an embedded case-control study in a subset of participants to assess kidney disease risk factors.

Results: From 1882 eligible households, 771 individuals from 300 households participated in the prevalence study, 98 (13%) of whom had reduced eGFR. Reduced eGFR was more common among older participants, men and participants living at lower altitudes. Among 18-29-year-old participants, 2.6% had reduced eGFR, and among 30-41-year-old participants, 7.4% had reduced eGFR; this compares with 0.2% and 0.8%, respectively, in NHANES. No individuals in these age groups were diabetic. Among cases, only 27% had dipstick proteinuria of 1+ or greater, compared with 7% of controls. Haematuria did not significantly differ between cases and controls (24% versus 18%). In age- and sex-adjusted models, hypertension and residence at lower altitude were independently associated with reduced eGFR, while occupational history was not associated with reduced eGFR.

Conclusions: Kidney disease appears common in residents of Quezalguaque, Nicaragua, particularly in younger men, with features most consistent with tubulointerstitial disease. Further research is needed to elucidate the causes of kidney disease in this region.

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Figures

Fig. 1.
Fig. 1.
Derivation of the participant populations for the cohort and case–control studies. Thirteen households (dagger) were unavailable on two attempts, and 15 declined evaluation. Twenty-five (double dagger) declined further evaluation. In 54 of 272 households (asterisk), the randomly selected control was a case, and no further occupant was selected as a control.
Fig. 2.
Fig. 2.
Prevalence of kidney disease in Quezalguaque compared with the USA using the NHANES 1999–2006 data: men (a) and women (b).
See this image and copyright information in PMC

References

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