Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA.
Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Ave., MC 802, Chicago, IL, 60612, USA.
BMC Nephrol. 2023 Jun 6;24(1):157. doi: 10.1186/s12882-023-03213-2.
Epidemics of chronic kidney disease of undetermined causes (CKDu) among young male agricultural workers have been observed in many tropical regions. Western Kenya has similar climatic and occupational characteristics as many of those areas. The study objectives were to characterize prevalence and predictors of CKDu, such as, HIV, a known cause of CKD, in a sugarcane growing region of Kenya; and to estimate prevalence of CKDu across occupational categories and evaluate if physically demanding work or sugarcane work are associated with reduced eGFR.
The Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol was followed in a cross-sectional study conducted in Kisumu County, Western Kenya. Multivariate logistic regression was performed to identify predictors of reduced eGFR.
Among 782 adults the prevalence of eGFR < 90 was 9.85%. Among the 612 participants without diabetes, hypertension, and heavy proteinuria the prevalence of eGFR < 90 was 8.99% (95%CI 6.8%, 11.5%) and 0.33% (95%CI 0.04%, 1.2%) had eGFR < 60. Among the 508 participants without known risk factors for reduced eGFR (including HIV), the prevalence of eGFR < 90 was 5.12% (95%CI 3.4%, 7.4%); none had eGFR < 60. Significant risk factors for reduced eGFR were sublocation, age, body mass index, and HIV. No association was found between reduced eGFR and work in the sugarcane industry, as a cane cutter, or in physically demanding occupations.
CKDu is not a common public health problem in this population, and possibly this region. We recommend that future studies should consider HIV to be a known cause of reduced eGFR. Factors other than equatorial climate and work in agriculture may be important determinants of CKDu epidemics.
在许多热带地区，年轻男性农业工人中出现了原因不明的慢性肾脏病（CKDu）的流行。肯尼亚西部具有与许多这些地区相似的气候和职业特征。本研究的目的是描述在肯尼亚一个种植甘蔗的地区，CKDu 的流行情况和预测因素，如已知的慢性肾脏病病因 HIV；并评估职业类别中 CKDu 的流行程度，以及评估体力劳动或甘蔗工作是否与降低 eGFR 相关。
本研究采用横断面研究设计，在肯尼亚西部基苏木县实施，遵循弱势人群估算肾小球滤过率的流行病学研究（DEGREE）方案。采用多变量逻辑回归来确定降低 eGFR 的预测因素。
在 782 名成年人中，eGFR<90 的患病率为 9.85%。在 612 名无糖尿病、高血压和大量蛋白尿的参与者中，eGFR<90 的患病率为 8.99%（95%CI 6.8%，11.5%），0.33%（95%CI 0.04%，1.2%）的患者 eGFR<60。在 508 名无已知降低 eGFR 风险因素（包括 HIV）的参与者中，eGFR<90 的患病率为 5.12%（95%CI 3.4%，7.4%）；没有人 eGFR<60。eGFR 降低的显著危险因素是次区域、年龄、体重指数和 HIV。eGFR 降低与甘蔗产业、作为甘蔗切割者的工作或体力劳动之间没有关联。
在该人群中，CKDu 不是一个常见的公共卫生问题，在该地区也可能不是。我们建议，未来的研究应将 HIV 视为降低 eGFR 的已知病因。除赤道气候和农业工作外，其他因素可能是 CKDu 流行的重要决定因素。
