Faculty of Chemistry and Pharmacy, University of El Salvador, Ciudad Universitaria, San Salvador, El Salvador.
Am J Kidney Dis. 2012 Apr;59(4):531-40. doi: 10.1053/j.ajkd.2011.11.039. Epub 2012 Feb 1.
An epidemic of chronic kidney disease of unknown cause has emerged along the Pacific coast of Central America, particularly in relatively young male sugarcane workers. In El Salvador, we examined residence and occupations at different altitudes as surrogate risk factors for heat stress.
Cross-sectional population-based survey.
SETTING & PARTICIPANTS: Populations aged 20-60 years of 5 communities in El Salvador, 256 men and 408 women (participation, 73%): 2 coastal communities with current sugarcane and past cotton production and 3 communities above 500 m with sugarcane, coffee, and service-oriented economies.
Participant sex, age, residence, occupation, agricultural history by crop and altitude, and traditional risk factors for CKD.
Serum creatinine (SCr) level greater than the normal laboratory range for sex, estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, and proteinuria categorized as low (protein excretion ≥ 30-< 300 mg/dL) and high grade (≥ 300 mg/dL).
Of the men in the coastal communities, 30% had elevated SCr levels and 18% had eGFR < 60 mL/min/1.73 m2 compared with 4% and 1%, respectively, in the communities above 500 m. For agricultural workers, prevalences of elevated SCr levels and eGFR < 60 mL/min/1.73 m2 were highest for coastal sugarcane and cotton plantation workers, but were not increased in sugarcane workers at 500 m or subsistence farmers. Women followed a weaker but similar pattern. Proteinuria was infrequent, of low grade, and not different among communities, occupations, or sexes. The adjusted ORs of decreased kidney function for 10-year increments of coastal sugarcane or cotton plantation work were 3.1 (95% CI, 2.0-5.0) in men and 2.3 (95% CI, 1.4-3.7) in women.
The cross-sectional nature of the study limits etiologic interpretations.
Agricultural work on lowland sugarcane and cotton plantations was associated with decreased kidney function in men and women, possibly related to strenuous work in hot environments with repeated volume depletion.
中美洲太平洋沿岸出现了一种原因不明的慢性肾病流行，尤其在年轻男性甘蔗工人中较为常见。在萨尔瓦多，我们研究了不同海拔高度的居住和职业，将其作为热应激的替代风险因素。
基于人群的横断面调查。
萨尔瓦多 5 个社区的 20-60 岁人群，包括 256 名男性和 408 名女性（参与率为 73%）：沿海的 2 个社区有当前的甘蔗和过去的棉花种植，海拔较高的 3 个社区有甘蔗、咖啡和面向服务的经济。
参与者的性别、年龄、居住地、职业、按作物和海拔划分的农业史，以及慢性肾脏病的传统危险因素。
沿海社区的男性中，30%的人血清肌酐（SCr）水平升高，18%的人估计肾小球滤过率（eGFR）<60mL/min/1.73m2，而海拔较高的社区中分别为 4%和 1%。对于农业工人，沿海地区的甘蔗和棉花种植园工人的 SCr 水平升高和 eGFR<60mL/min/1.73m2 的患病率最高，但在海拔 500m 或自给自足的农民中没有增加。女性则呈现出较弱但相似的模式。蛋白尿不常见，程度较轻，且在社区、职业或性别之间没有差异。沿海地区甘蔗或棉花种植园工作每增加 10 年，男性和女性肾功能下降的调整后的 OR 值分别为 3.1（95%CI，2.0-5.0）和 2.3（95%CI，1.4-3.7）。
该研究的横断面性质限制了病因学解释。
在低地甘蔗和棉花种植园从事农业工作与男性和女性的肾功能下降有关，可能与在炎热环境中反复脱水的艰苦工作有关。
