Evidence for CKDnt being primarily an occupation driven disease in Mesoamerica

ABSTRACT

An epidemic of fatal chronic kidney disease unrelated to diabetes, hypertension and other known causes of CKD, is ongoing in Mesoamerica since several decades. This epidemic of non- traditional origin (CKDnt) has caused the premature deaths of tens of thousands of young people, mostly male agricultural workers. A number of etiologies have been proposed, including recurrent heat stress and dehydration, pesticides, metals, infectious diseases, nephrotoxic medications, alcohol, tobacco, and genetic factors. An important question to answer is whether the disease is primarily driven by occupational or by non-occupational environmental, behavioral or genetic factors. To answer this question an extensive review was undertaken of peer reviewed studies, i.e. articles published in the scientific literature and academic theses on the subject. As the basis for examining the potential occupational nature of CKDnt, data were extracted from 25 investigations with epidemiologic results, regarding the setting, design and objectives, population and time of follow-up, exposures and outcomes, covariates and statistical analyses, main results, limitations and conclusions. The validity of the authors’ conclusions was scrutinized and evidence pro and against an occupational nature of each study was formulated. Numerous other articles without epidemiologic study results were also reviewed, which provided valuable background and complementary information, even if they were not directly considered for the evaluation of a potential occupational origin...