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Chronic kidney disease epidemic in Central America: urgent public health action is needed amid causal uncertainty.

Ordunez P, Martinez R, Reveiz L, Chapman E, Saenz C, Soares da Silva A, Becerra F - PLoS Negl Trop Dis (2014)

View Article: PubMed Central - PubMed

Affiliation: Pan American Health Organization, Washington, D.C., United States of America.

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The 52nd Directing Council of the Pan American Health Organization (PAHO), in response to a call for action of the Minister of Health of El Salvador, recognized chronic kidney disease from nontraditional causes (CKDnT) affecting agricultural communities in Central America as a serious public health problem that requires urgent, effective, and concerted multisectoral action... A proxy for CKDnT mortality, the age standardized mortality rate due to chronic kidney disease—coded as N18 (CKD-N18) by the 2010 International Classification of Diseases—is notably higher for men and women in Nicaragua and El Salvador compared to other countries in the region and has been since at least 2000 (http://www.paho.org/hq/index.php?option=com_content&view=article&id=9402)... CKDnT has been largely reported in some clustered farming communities traditionally burdened by socioeconomic disadvantages from northern Nicaragua, the Pacific coast of El Salvador, and other countries such as Costa Rica, Guatemala, Honduras, and the south of Mexico... Along with exposure to pesticides, these seem to play an important role in the occurrence of the disease, particularly among sugarcane cutters... The weakness of regulatory systems, along with the agriculture dependency of local economies and cultural agricultural practices, contribute to poor compliance with international safety and health standards for the use of agrochemicals and for occupational hygiene... Other hypothesized causal agents merit further investigation... Nonsteroidal anti-inflammatory drugs, alcohol, and sugary beverage consumption have been associated with the disease, but their role remains controversial in current scientific evidence... However, these hypothesis have not been supported by evidence... Indeed, the human transmission of the West Nile virus, which has been associated with CKD, has not been documented in Central America until now... A CKDnT regional research agenda is imperative not only to drive efforts to determine the epidemic's causative agents but also to bridge the gap between research and public health interventions... The resolution on CKDnT in Central America approved by PAHO's Directing Council commits to coordinated and evidence-informed action to implement public policies, programs, and regulatory mechanisms to improve the social, environmental, occupational, and economic conditions of the affected communities and to strengthen surveillance and CKD-relevant health services... The resolution of PAHO also highlighted the relevance of multisectorial actions outside of the health sector—for instance, agriculture, trade, environment, occupational safety, affected communities, academia, and civil society, among others—to coordinate efforts, mobilize resources, prioritize the sustainability of actions to promote evidence-based public policies, and to reach the high level of commitment to reduce environmental risk factors to mitigate, on an urgent basis, the health, social, and economic consequences of this disease... An effective and urgent response to address and ultimately stop the epidemic is a moral duty not only for Central America but for the whole Pan American community.

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Related in: MedlinePlus

Chronic kidney disease (N18, ICD-10) age-specific mortality rate, selected countries, around 2008.(A) Mortality due to CKD (N18, ICD-10) in El Salvador and Nicaragua exhibited a pattern of excess mortality in young adults, starting at ages 25–29 years old. (B) Removing El Salvador and Nicaragua, panel B shows other countries of Central America also have an excess of premature mortality. Source: Regional Mortality Database. PAHO, WHO; 2014.
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pntd-0003019-g002: Chronic kidney disease (N18, ICD-10) age-specific mortality rate, selected countries, around 2008.(A) Mortality due to CKD (N18, ICD-10) in El Salvador and Nicaragua exhibited a pattern of excess mortality in young adults, starting at ages 25–29 years old. (B) Removing El Salvador and Nicaragua, panel B shows other countries of Central America also have an excess of premature mortality. Source: Regional Mortality Database. PAHO, WHO; 2014.

Mentions: Most Central American countries do not have surveillance systems capable of detecting chronic kidney disease (CKD). However, many reports [2]–[4] and data from PAHO show the epidemiological magnitude of the disease. A proxy for CKDnT mortality, the age standardized mortality rate due to chronic kidney disease—coded as N18 (CKD-N18) by the 2010 International Classification of Diseases—is notably higher for men and women in Nicaragua and El Salvador compared to other countries in the region and has been since at least 2000 (http://www.paho.org/hq/index.php?option=com_content&view=article&id=9402). CKD-N18 data also show disproportionate mortality from the disease in males compared to females (Figure 1). Mortality due to CKD in El Salvador and Nicaragua exhibited a pattern of excess mortality in young adults (Figure 2), which is consistent with many other clinical and epidemiological reports [2]–[4].


Chronic kidney disease epidemic in Central America: urgent public health action is needed amid causal uncertainty.

Ordunez P, Martinez R, Reveiz L, Chapman E, Saenz C, Soares da Silva A, Becerra F - PLoS Negl Trop Dis (2014)

Chronic kidney disease (N18, ICD-10) age-specific mortality rate, selected countries, around 2008.(A) Mortality due to CKD (N18, ICD-10) in El Salvador and Nicaragua exhibited a pattern of excess mortality in young adults, starting at ages 25–29 years old. (B) Removing El Salvador and Nicaragua, panel B shows other countries of Central America also have an excess of premature mortality. Source: Regional Mortality Database. PAHO, WHO; 2014.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4125233&req=5

pntd-0003019-g002: Chronic kidney disease (N18, ICD-10) age-specific mortality rate, selected countries, around 2008.(A) Mortality due to CKD (N18, ICD-10) in El Salvador and Nicaragua exhibited a pattern of excess mortality in young adults, starting at ages 25–29 years old. (B) Removing El Salvador and Nicaragua, panel B shows other countries of Central America also have an excess of premature mortality. Source: Regional Mortality Database. PAHO, WHO; 2014.
Mentions: Most Central American countries do not have surveillance systems capable of detecting chronic kidney disease (CKD). However, many reports [2]–[4] and data from PAHO show the epidemiological magnitude of the disease. A proxy for CKDnT mortality, the age standardized mortality rate due to chronic kidney disease—coded as N18 (CKD-N18) by the 2010 International Classification of Diseases—is notably higher for men and women in Nicaragua and El Salvador compared to other countries in the region and has been since at least 2000 (http://www.paho.org/hq/index.php?option=com_content&view=article&id=9402). CKD-N18 data also show disproportionate mortality from the disease in males compared to females (Figure 1). Mortality due to CKD in El Salvador and Nicaragua exhibited a pattern of excess mortality in young adults (Figure 2), which is consistent with many other clinical and epidemiological reports [2]–[4].

View Article: PubMed Central - PubMed

Affiliation: Pan American Health Organization, Washington, D.C., United States of America.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The 52nd Directing Council of the Pan American Health Organization (PAHO), in response to a call for action of the Minister of Health of El Salvador, recognized chronic kidney disease from nontraditional causes (CKDnT) affecting agricultural communities in Central America as a serious public health problem that requires urgent, effective, and concerted multisectoral action... A proxy for CKDnT mortality, the age standardized mortality rate due to chronic kidney disease—coded as N18 (CKD-N18) by the 2010 International Classification of Diseases—is notably higher for men and women in Nicaragua and El Salvador compared to other countries in the region and has been since at least 2000 (http://www.paho.org/hq/index.php?option=com_content&view=article&id=9402)... CKDnT has been largely reported in some clustered farming communities traditionally burdened by socioeconomic disadvantages from northern Nicaragua, the Pacific coast of El Salvador, and other countries such as Costa Rica, Guatemala, Honduras, and the south of Mexico... Along with exposure to pesticides, these seem to play an important role in the occurrence of the disease, particularly among sugarcane cutters... The weakness of regulatory systems, along with the agriculture dependency of local economies and cultural agricultural practices, contribute to poor compliance with international safety and health standards for the use of agrochemicals and for occupational hygiene... Other hypothesized causal agents merit further investigation... Nonsteroidal anti-inflammatory drugs, alcohol, and sugary beverage consumption have been associated with the disease, but their role remains controversial in current scientific evidence... However, these hypothesis have not been supported by evidence... Indeed, the human transmission of the West Nile virus, which has been associated with CKD, has not been documented in Central America until now... A CKDnT regional research agenda is imperative not only to drive efforts to determine the epidemic's causative agents but also to bridge the gap between research and public health interventions... The resolution on CKDnT in Central America approved by PAHO's Directing Council commits to coordinated and evidence-informed action to implement public policies, programs, and regulatory mechanisms to improve the social, environmental, occupational, and economic conditions of the affected communities and to strengthen surveillance and CKD-relevant health services... The resolution of PAHO also highlighted the relevance of multisectorial actions outside of the health sector—for instance, agriculture, trade, environment, occupational safety, affected communities, academia, and civil society, among others—to coordinate efforts, mobilize resources, prioritize the sustainability of actions to promote evidence-based public policies, and to reach the high level of commitment to reduce environmental risk factors to mitigate, on an urgent basis, the health, social, and economic consequences of this disease... An effective and urgent response to address and ultimately stop the epidemic is a moral duty not only for Central America but for the whole Pan American community.

No MeSH data available.


Related in: MedlinePlus