Yang Hsiao-Yu, Wen Kai-Chieh, Chiu Ping-Fang, Chen Wan-Chin, Chang Teng-Hsiang, Chang Che-Jui, Hsu Wei-Hung, Chen Shin-Chien
Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei, Taiwan.
Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.
PLoS Negl Trop Dis. 2025 May 6;19(5):e0013056. doi: 10.1371/journal.pntd.0013056. eCollection 2025 May.
Chronic kidney disease of non-traditional etiology (CKDnt) is a neglected tropical disease prevalent in tropical coastal areas. First reported in the 1990s along the Pacific coast of Central America, its spread to other regions has raised concerns about environmental risk factors, particularly heat stress. However, the relationship between elevated ambient temperatures and CKDnt remains uncertain. The study aimed to identify risk factors for chronic kidney disease (CKD) in regions affected by the CKDnt epidemic and to investigate the relationship between ambient temperatures and CKD risk.
We conducted a systematic review and meta-regression of CKD in agricultural regions where CKDnt is endemic, covering studies published between January 2010 and October 2023, followed by a meta-analysis to estimate the effect of traditional and non-traditional risk factors for CKD. A meta-regression was used to examine the relationship between geological latitude and ambient temperature on CKD.
We screened 1,327 articles, with 28 articles meeting the inclusion criteria. The pooled OR for CKD in the agricultural population compared to the non-agricultural population was 2.12 (95% CI 1.75‒2.58, I2 = 85.1%). Significant non-traditional kidney disease risk factors for CKD included drinking well water (OR = 2.75, 95% CI 2.04‒3.70), malaria (OR = 2.64, 95% CI 1.44‒4.83), low water intake (pooled OR = 2.06, 95% CI 1.17‒3.63), water sources (pooled OR = 1.50, 95% CI 1.11‒2.02), agrochemicals (OR = 1.50, 95% CI 1.26‒1.77), heat exposure (OR = 1.46, 95% CI 1.37‒1.55), alcohol consumption (OR = 1.27, 95% CI 1.11‒1.46), and low BMI. The meta-regression indicates that geographic latitude and temperature are statistically significant moderators of CKD risk, with a higher risk observed in studies conducted at lower latitudes closer to the equator (QM-test = 10.11, df = 1, P < 0.05). Temperature is a significant moderator (QM-test = 44.36, df = 1, P = 0.04) with 1°C increase in the CKDnt epidemic region associated with an 8% increase in CKD risk (OR = 1.08, 95% CI 1.01-1.16).
CKDnt is a multifactorial tropical disease driven by heat exposure, infectious diseases, physically demanding work without adequate hydration, water contamination, and agrochemical exposure. Addressing these factors is essential for developing effective occupational health policies and tailored prevention programs to reduce CKDnt among high-risk agricultural populations in tropical endemic regions.
非传统病因慢性肾脏病（CKDnt）是一种在热带沿海地区流行的被忽视的热带病。20世纪90年代首次在中美洲太平洋沿岸被报道，其传播到其他地区引发了对环境风险因素的担忧，尤其是热应激。然而，环境温度升高与CKDnt之间的关系仍不确定。该研究旨在确定受CKDnt流行影响地区慢性肾脏病（CKD）的风险因素，并调查环境温度与CKD风险之间的关系。
我们对CKDnt流行的农业地区的CKD进行了系统评价和meta回归分析，涵盖2010年1月至2023年10月发表的研究，随后进行meta分析以估计CKD传统和非传统风险因素的影响。采用meta回归分析研究地理纬度和环境温度与CKD之间的关系。
我们筛选了1327篇文章，其中28篇符合纳入标准。农业人群与非农业人群相比，CKD的合并OR为2.12（95%CI 1.75‒2.58，I2 = 85.1%）。CKD的重要非传统肾脏疾病风险因素包括饮用井水（OR = 2.75，95%CI 2.04‒3.70）、疟疾（OR = 2.64，95%CI 1.44‒4.83）、低饮水量（合并OR = 2.06，95%CI 1.17‒3.63）、水源（合并OR = 1.50，95%CI 1.11‒2.02）、农用化学品（OR = 1.50，95%CI 1.26‒1.77）、热暴露（OR = 1.46，95%CI 1.37‒1.55）、饮酒（OR = 1.27，95%CI 1.11‒1.46）和低体重指数。meta回归分析表明，地理纬度和温度是CKD风险的统计学显著调节因素，在靠近赤道的低纬度地区进行的研究中观察到更高的风险（QM检验 = 10.11，df = 1，P < 0.05）。温度是一个显著的调节因素（QM检验 = 44.36，df = 1，P = 0.04），CKDnt流行地区温度每升高1°C，CKD风险增加8%（OR = 1.08，95%CI 1.01 - 1.16）。
CKDnt是一种由热暴露、传染病、没有充足水分补充情况下的体力劳动、水污染和农用化学品暴露驱动的多因素热带病。解决这些因素对于制定有效的职业健康政策和量身定制预防计划以减少热带流行地区高危农业人群中的CKDnt至关重要。
