Salvadoran National Health Institute, San Salvador, El Salvador.
MEDICC Rev. 2011 Oct;13(4):14-22. doi: 10.37757/MR2011V13.N4.5.
In El Salvador, end-stage renal disease is the leading cause of hospital deaths in adults, the second cause of death in men and the fifth leading cause of death in adults of both sexes in the general population.
Identify risk factors for chronic kidney disease and urinary markers of renal and vascular damage, measure kidney function and characterize prevalence of chronic kidney disease in persons aged ≥18 years in the Bajo Lempa region of El Salvador.
A cross-sectional analytical epidemiological study was carried out using active screening for chronic kidney disease and associated risk factors in individuals aged ≥18 years in the Bajo Lempa Region, a rural, coastal area in El Salvador. Door-to-door visits and clinical examinations were conducted. Epidemiological and clinical data were collected including: family and personal clinical history of disease; biological, behavioral, social and environmental risk factors; physical measurements; urinalysis for markers of renal and vascular damage; and blood tests (serum creatinine, serum glucose, lipid profile). Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease formula. Chronic kidney disease case confirmation was done three months later. Multiple logistic regression was used for data analysis.
A total of 375 families and 775 individuals (343 men, 432 women) were studied-88.3% of the total resident population in the region. Elevated prevalence of risk factors was observed: diabetes mellitus, 10.3%; hypertension,16.9%; family history of chronic kidney disease, 21.6%; dyslipidemias, 63.1%; overweight, 34%; obesity, 22.4%; metabolic syndrome, 28.8%; use of non-steroidal anti-inflammatory drugs, 74.8%; infectious diseases, 86.9%; agricultural occupation, 40.6% (80.6% in men); and contact with agrochemicals, 50.3% (82.5% in men). Prevalence renal damage markers was 15.8% (greater in men): microalbuminuria 6.3%; proteinuria 5.7%; hematuria 3.5%; proteinuria-hematuria 0.3%. Proteinuria of <1 g/L predominated. Prevalence of chronic kidney disease was 17.9% (25.7% in men; 11.8% in women). Distribution by stages: stage 1, 4.6%; stage 2, 3.5%; stage 3, 6.2%; stage 4, 3.0%; stage 5, 0.6%. In patients with chronic kidney disease, most common was non-diabetic chronic kidney disease (86.3%), followed by chronic kidney disease associated with neither diabetes nor hypertension (54.7%). Prevalence of chronic renal failure was 9.8% (17% in men; 4.1% in women). Multiple logistic regression showed significant association with increasing age, male sex, hypertension and family history of chronic kidney disease.
Elevated prevalence of chronic kidney disease, chronic renal failure and risk factors was found, compared to international reports. Most common was chronic kidney disease of unknown cause, associated with neither diabetes nor hypertension. Associations were found with age, male sex, hypertension and family history of chronic kidney disease, with decline in kidney function beginning at early ages. Male farmers have a dual burden of non traditional (occupational, toxic environmental) and traditional (vascular) risk factors that could act in synergy, contributing to kidney damage.
在萨尔瓦多，终末期肾病是导致成年人住院死亡的主要原因，是男性死亡的第二大原因，也是普通人群中男女两性成年人死亡的第五大原因。
确定慢性肾脏病的危险因素和肾脏及血管损伤的尿液标志物，测量肾功能并描述萨尔瓦多巴霍莱姆帕地区≥18 岁人群中慢性肾脏病的患病率。
在萨尔瓦多巴霍莱姆帕地区进行了一项横断面分析性流行病学研究，对≥18 岁的人群进行慢性肾脏病和相关危险因素的主动筛查。进行上门家访和临床检查。收集流行病学和临床数据，包括：家庭和个人疾病史；生物、行为、社会和环境危险因素；身体测量；尿液分析用于检测肾脏和血管损伤标志物；以及血液检查（血清肌酐、血糖、血脂谱）。使用肾脏病饮食改良公式计算肾小球滤过率。三个月后对慢性肾脏病病例进行确认。采用多因素逻辑回归进行数据分析。
共研究了 375 个家庭和 775 个人（343 名男性，432 名女性），占该地区常驻人口的 88.3%。观察到风险因素的高发率：糖尿病，10.3%；高血压，16.9%；慢性肾脏病家族史，21.6%；血脂异常，63.1%；超重，34%；肥胖，22.4%；代谢综合征，28.8%；使用非甾体抗炎药，74.8%；传染病，86.9%；农业职业，40.6%（男性中为 80.6%）；接触农用化学品，50.3%（男性中为 82.5%）。肾脏损伤标志物的患病率为 15.8%（男性中更高）：微量白蛋白尿 6.3%；蛋白尿 5.7%；血尿 3.5%；蛋白尿血尿 0.3%。以＜1g/L 的蛋白尿为主。慢性肾脏病的患病率为 17.9%（男性中为 25.7%；女性中为 11.8%）。按阶段分布：第 1 期，4.6%；第 2 期，3.5%；第 3 期，6.2%；第 4 期，3.0%；第 5 期，0.6%。在慢性肾脏病患者中，最常见的是非糖尿病性慢性肾脏病（86.3%），其次是既非糖尿病也非高血压相关的慢性肾脏病（54.7%）。慢性肾衰竭的患病率为 9.8%（男性中为 17%；女性中为 4.1%）。多因素逻辑回归显示，与年龄增长、男性、高血压和慢性肾脏病家族史有关。
与国际报告相比，发现慢性肾脏病、慢性肾衰竭和危险因素的患病率较高。最常见的是原因不明的慢性肾脏病，既与糖尿病无关，也与高血压无关。与年龄、男性、高血压和慢性肾脏病家族史有关，肾功能下降始于早期。男性农民承受着非传统（职业、有毒环境）和传统（血管）危险因素的双重负担，这些因素可能协同作用，导致肾脏损伤。
