Evaluating Kidney Disease Characteristics, Prevalence, and Risk Factors in León, Nicaragua: A Population-Based Study

Abstract

Background: Chronic kidney disease (CKD) is increasingly prevalent worldwide. Several low and middle income countries, including Nicaragua, are particularly affected by CKD of unknown etiology (CKDu). CKDu disproportionately affects young people who lack traditional risk factors for CKD, and it may be due to heat stress, environmental exposures, nephrotoxic medications, or genetic conditions. The purpose of this study is to define the prevalence of CKD, CKD diagnosis awareness in those affected, and determine risk factors for CKD from traditional risk factors and CKDu in Nicaragua. Methods: Surveys and testing of urine and serum for CKD markers were performed in participants 15-59 years old in households of the León municipality in northwest Nicaragua. Surveys included data on demographics, health behaviors, occupation, and medical history. Those with CKD were subdivided into CKD with traditional risk factors and suspected CKDu. Statistical analysis includes proportions, non-parametric comparison tests, and multinomial logistic regression models. Results: CKD prevalence in 1795 study participants is 8.6%, and awareness of CKD among those affected was low (22%). Of those with CKD, 30% were suspected to have CKDu, which was associated with male sex, decreased socioeconomic status, water source of river or well, agricultural occupation, lower BMI, and smoking. Use of nephrotoxic medications and family history of CKD were associated with CKD from traditional risk factors. Conclusions: CKD from both traditional risk factors and CKDu is a significant burden in this region. Our study supports some previous hypotheses of CKDu etiology and emphasizes the importance of CKD screening.