Acute Kidney Injury in Sugarcane Workers at Risk for Mesoamerican Nephropathy.

RATIONALE & OBJECTIVE: Mesoamerican nephropathy (MeN), a form of chronic kidney disease (CKD) of unknown cause in Central America, affects young individuals working in physically strenuous occupations. Repeated episodes of work-related kidney injury may lead to CKD in this setting. We aimed to better understand the burden and natural history of acute kidney injury (AKI) in workers at risk for MeN. STUDY DESIGN: Cross-sectional study of active sugarcane workers, followed by prospective follow-up of individuals with AKI. SETTING & PARTICIPANTS: 326 sugarcane workers with normal preharvest serum creatinine (Scr) values and no history of CKD in an MeN hotspot in Nicaragua near the end of the harvest, and prospective follow-up of workers with AKI. PREDICTOR: AKI during the harvest, as defined by Scr level increase ≥ 0.3mg/dL over baseline to a level ≥ 1.3mg/dL. OUTCOMES: Kidney function trajectory and development of CKD over 12 months. ANALYTICAL APPROACH: Linear regression models were used to analyze the association between job category and kidney function. For workers with AKI, the effect of time on Scr level was evaluated using linear mixed effects. RESULTS: 34 of 326 participants were found to have AKI, with a median late-harvest Scr level of 1.64mg/dL in the AKI group. Workers without AKI had a median Scr level of 0.88mg/dL. AKI was more common among cane cutters compared with other field workers. Participants with AKI had variable degrees of kidney function recovery, with median 6- and 12-month Scr values of 1.25 and 1.27mg/dL, respectively (P < 0.001 for each follow-up value compared to late-harvest Scr). When we compared workers' kidney function before the AKI episode to their kidney function at last follow-up, 10 participants with AKI developed de novo estimated glomerular filtration rate < 60mL/min/1.73m2 and 11 had a >30% decrease in estimated glomerular filtration rate. LIMITATIONS: Follow-up limited to 1 year and some loss to follow-up in the prospective component of the study. Broad definition of AKI that includes both acute and subacute kidney injury. CONCLUSIONS: In a group of sugarcane workers with normal preharvest kidney function, newly decreased kidney function developing during the harvest season was common. Of those with kidney injury, nearly half had established CKD 12 months later.

FACTORES RELACIONADOS AL CUMPLIMIENTO Y ABANDONO DEL TRATAMIENTO ANTITUBERCULOSO EN PACIENTES EN LEÓN, NICARAGUA / FACTORS RELATED TO COMPLIANCE AND ABANDONMENT OF ANTITUBERCULOSIS TREATMENT IN PATIENTS IN LEÓN, NICARAGUA / FATORES ASSOCIADOS À ADESÃO E NÃO ADESÃO AO TRATAMENTO DA TUBERCULOSE EM PACIENTES EM LEON, NICARÁGUA

Objetivo: identificar los factores relacionados al cumplimiento y abandono del tratamiento antituberculoso en pacientes del Hospital Rosario Lacayo de la ciudad de León, Nicaragua. Método: estudio de casos y controles no pareados en pacientes con tuberculosis durante octubre 2015- agosto 2016. Se definieron como casos los pacientes que abandonaron el tratamiento por 30 días consecutivos o más; como controles los que completaron el tratamiento y fueron dados de alta por curación. Los factores se identificaron mediante el cálculo de odds ratios y los intervalos de confianza al 95%. Resultados: se estudiaron 28 casos y 98 controles. El abandono del tratamiento se asoció al sexo masculino, a no recibir explicación acerca de la enfermedad, a que no se brindaran consejos sobre estilo de vida, a no conocer el esquema de tratamiento empleado y a la mala relación con el personal de salud. Conclusión: el abandono del tratamiento antituberculoso se relacionó a factores no modificables (sexo masculino) y a otros cuyo control optimizaría el cumplimiento (no recibir explicación sobre la enfermedad y mala relación con el personal de salud). Además, es prioritario brindar atención de forma integral a los pacientes y mejorar la información recibida sobre tuberculosis.

Objective: to identify factors related to compliance and abandonment of antituberculosis treatment in patients of the Rosario Lacayo Hospital in the city of León, Nicaragua. Method: study of unpaired cases and controls in patients with tuberculosis during October 2015 to August 2016. Patients who abandoned treatment for 30 consecutive days or longer were defined as cases; As controls those who completed the treatment and were discharged by cure. Factors were identified by calculating odds ratios and 95% confidence intervals. Results: we studied 28 cases and 98 controls. The abandonment of the treatment was associated with the male sex, not receiving an explanation about the disease, no advice on lifestyle, not knowing the treatment scheme used and poor relationship with health personnel. Conclusion: the abandonment of tuberculosis treatment was related to non-modifiable factors (male sex) and to others whose control would optimize compliance (not receiving explanation about the disease and poor relation with health personnel). In addition, it is a priority to provide comprehensive care to patients and to improve the information received about tuberculosis.

Objetivo: identificar os fatores relacionados ao atendimento e ao abandono do tratamento da tuberculose em pacientes do Hospital Rosario Lacayo da cidade de Leon, na Nicarágua. Métodos: estudo de caso-controle não pareado em pacientes com tuberculose durante outubro de 2015 e agosto de 2016. Os pacientes que interromperam o tratamento por 30 dias consecutivos ou mais foram definidos como casos; como controles aqueles que completaram o tratamento e receberam alta por cura. Os fatores foram identificados calculando odds ratio e intervalos de confiança de 95%. Resultados: a idade média dos participantes foi de 19,1 anos, o sexo feminino predominou com 82,0%. 25,4% mencionado estudo e trabalho. 65,3% do total da amostra relataram níveis de estresse moderado a elevado. A prevalência do consumo de álcool no último ano e no último mês foi de 59,0 e 32,2%, respectivamente. 27,5% do total da amostra relataram consumo dependente, seguido por 16,6% do consumo prejudicial. Conclusão: o abandono do tratamento da tuberculose foi relacionada a fatores não modificáveis (masculinos) e a outros cujo o controle otimizaria o cumprimento (não receber uma explicação sobre a doença e má relação com o pessoal de saúde). Além disso, é prioridade ofertar atenção integral aos pacientes e melhorar as informações recebidas sobre a tuberculose.