González-Quiroz Marvin, Pearce Neil, Caplin Ben, Nitsch Dorothea
Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua.
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Clin Kidney J. 2018 Aug;11(4):496-506. doi: 10.1093/ckj/sfx136. Epub 2017 Dec 8.
The aim of this systematic review is to examine the epidemiological knowledge and gaps in understanding of the potential causes of chronic kidney disease of undetermined cause (CKDu) in Meso-America.
A systematic literature search of epidemiological studies of CKDu was conducted in PubMed, Embase and Web of Science from January 2000 to January 2017. Study quality was assessed by adapting the tool from Higgins for observational studies. Where applicable, the summary prevalence odds ratio (POR) and 95% confidence interval (CI) were calculated using a random effects model.
Twenty-five epidemiological studies were included in the analysis of risk factors for CKDu. The quality assessment of each occupational and community study was medium. The PORs for CKDu were males versus females 2.42 (95% CI 1.76-3.08), family history of CKD (versus none) 1.84 (95% CI 1.37-2.30), high water intake (versus low) 1.61 (95% CI 1.01-2.21) and low altitude (versus highland) 2.09 (95% CI 1.00-3.17). There were no significant associations between CKDu and pesticide exposure (versus no) 1.17 (95% CI 0.87-1.46), alcohol consumption (versus no) 1.34 (95% CI 0.84-1.84), non-steroidal anti-inflammatory drugs (versus no) 0.99 (95% CI 0.60-1.39) and heat stress (versus no) 1.52 (95% CI -0.91 - 3.95).
Our meta-analysis showed positive associations for males (versus females) and family history of CKD, water intake, lowland altitude and CKDu. There were no significant associations with pesticide exposure, non-steroidal anti-inflammatory drugs intake, heat stress and alcohol consumption.
本系统评价的目的是研究中美洲不明原因慢性肾脏病（CKDu）潜在病因的流行病学知识及认知差距。
于2000年1月至2017年1月在PubMed、Embase和科学网对CKDu的流行病学研究进行系统文献检索。采用希金斯用于观察性研究的工具评估研究质量。在适用的情况下，使用随机效应模型计算汇总患病率比值比（POR）和95%置信区间（CI）。
25项流行病学研究纳入CKDu危险因素分析。每项职业和社区研究的质量评估为中等。CKDu的POR分别为：男性与女性相比2.42（95%CI 1.76 - 3.08），慢性肾脏病家族史（有与无相比）1.84（95%CI 1.37 - 2.30），高水摄入量（与低相比）1.61（95%CI 1.01 - 2.21），低海拔（与高地相比）2.09（95%CI 1.00 - 3.17）。CKDu与农药暴露（有与无相比）1.17（95%CI 0.87 - 1.46）、饮酒（有与无相比）1.34（95%CI 0.84 - 1.84）、非甾体抗炎药（有与无相比）0.99（95%CI 0.60 - 1.39）和热应激（有与无相比）1.52（95%CI -0.91 - 3.95）之间无显著关联。
我们的荟萃分析显示男性（与女性相比）、慢性肾脏病家族史、水摄入量、低海拔与CKDu呈正相关。与农药暴露、非甾体抗炎药摄入、热应激和饮酒无显著关联。
