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. 2025 Jun 25:983:179642.
doi: 10.1016/j.scitotenv.2025.179642. Epub 2025 May 22.

Environmental exposure assessment in the international prospective study of Chronic Kidney Disease of UnceRtain Etiology (CKDu) in Agricultural Communities (CURE) research consortium: Design and protocol development

Marvin González-Quiroz  1 , Anna Aceituno  2 , Shuchi Anand  3 , Alexander van Geen  4 , Lawrence S Engel  5 , Emmanuel Jarquin  6 , Clemens Ruepert  7 , Nicole Villegas-González  8 , Mariela Arias-Hidalgo  9 , Nora Franceschini  10 , Daylin Anchía-Pastrán  11 , Karla Solano-Diaz  12 , Andrea Corrales-Vargas  13 , Jennifer Crowe  14 , Idalina Cubilla-Batista  15 , Hildaura Acosta  16 , Adriana Mike  17 , Carolina Guzmán-Quilo  18 , Aurora Aragón  19 , Indiana López-Bonilla  20 , Peter Rohloff  21 , Madeleine K Scammell  22 , Ramón Garcia-Trabanino  23 , Juan Amador Velázquez  24 , Daniel R Brooks  25 , Sumit Mohan  26 , Jai Radhakrishnan  27 , Balaji Gummidi  28 , Vivekanand Jha  29 , Whitney Collado  30 , Vivek Bhalla  31 , David J Friedman  32 , Sushrut S Waikar  33 , Karen Kesler  34 , Lillian Trochinski  35 , P Lee Ferguson  36 , Patrick J Parsons  37 , Heileen Hsu-Kim  38 , Carin Huset  39 , Susan Summer Jenkins  40 , Susan R Mendley  41 , Jill F Lebov  42 , Bonnie R Joubert  43 , Ana Navas-Acien  44
Affiliations

Environmental exposure assessment in the international prospective study of Chronic Kidney Disease of UnceRtain Etiology (CKDu) in Agricultural Communities (CURE) research consortium: Design and protocol development

Marvin González-Quiroz et al. Sci Total Environ. .

Abstract

Background: Chronic kidney disease of unknown etiology (CKDu) is a major health concern among outdoor manual workers in rural Central America and South Asia. The CURE study is a prospective longitudinal cohort designed to investigate CKDu's environmental risk factors through standardized exposure assessments, questionnaires, and biological and environmental sample collection.

Methods: This manuscript details the development of a standardized exposure assessment protocol within the CKDu CURE Consortium. The study recruits adults (18-45 years) from CKDu hotspots across five countries, ensuring proportional representation across three eGFR categories (20-59, 60-89, ≥90 mL/min/1.73m2) and excluding participants with diabetes or other known CKD causes. The CURE study is committed to promptly returning clinically and environmentally relevant test results to participants after analysis.

Results: Exposure assessment includes demographics, healthcare access, nephrotoxic medications, infectious pathogens, and agricultural work conditions (e.g., heat stress, hydration, diet, agrochemicals, toxicants). Biological and environmental samples (water, dust, soil, wristbands) are collected considering seasonal variations. Omics analyses, including metabolomics, will investigate environmental and biological interactions. Statistical analyses will assess relationships between exposures and CKDu onset or progression, incorporating environmental mixture analyses.

Conclusion: CURE will provide critical insights into CKDu risk factors, supporting future research and prevention strategies. A comprehensive exposure assessment will enhance understanding of environmental contributors, guiding interventions at individual, workplace, and community levels to mitigate CKDu's impact.

Keywords: CKDu; Chronic kidney disease; Environmental exposures; Metals; Pesticides; Polycyclic aromatic hydrocarbons; Research consortium; Trace elements.

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Conflict of interest statement

Declaration of competing interest VJ reports consulting fee/honoraria from Bayer, Astra Zeneca, Boehringer Ingelheim, Biocryst, Vera, Visterra, Otsuka, Novartis, Astra Zeneca, Chinook, Biocryst and Alpine under the policy of all payments going to the organization. SM report consulting fees from Sanofi and DEKA Research. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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