Abstract In the last four decades, increasing numbers of young people, in clusters of vulnerable farming communities in several Central American countries, have developed a severe form of kidney failure of uncertain etiology thus termed chronic kidney disease of nontraditional causes, or CKDnT, in this publication.
This type of chronic kidney disease, primarily a form of chronic interstitial nephritis, has reached epidemic proportions, devastating entire communities and overwhelming health systems. CKDnT is characterized by progressive renal insufficiency, often diagnosed at a very late stage, in the absence of early symptoms, necessitating renal replacement therapy if the patient is to survive This document presents a background to this epidemic, including its epidemiology and main hypothetical risk factors of CKDnT.
It also includes a description of clinical and pathological characteristics, the case definitions for CKDnT surveillance, and the methodological basis and approaches for public health surveillance. Chronic kidney disease linked to heat stress could become a major health epidemic for millions of workers around the world as global temperatures increase over the coming decades, doctors have warned.
More research into the links between heat and CKDu — chronic kidney disease of uncertain cause — is urgently needed to assess the potential scale of the problem, they have said. Unlike the conventional form of chronic kidney disease CKD , which is a progressive loss of kidney function largely seen among elderly people and those afflicted with other conditions such as diabetes and hypertension, epidemics of CKDu have already emerged primarily in hot, rural regions of countries such as El Salvador and Nicaragua, where abnormally high numbers of agricultural workers have begun dying from irreversible kidney failure.
CKDu has also started to be recorded as affecting large numbers of people doing heavy manual labour in hot temperatures in other parts of Central America as well as North America, South America, the Middle East, Africa and India. Kidneys are responsible for fluid balance in the body, which makes them particularly sensitive to extreme temperatures. Still, even with smaller research investments and fewer clinical trials, a number of promising discoveries have emerged over the years out of studies, including CRIC, which has provided new insights into genetic markers and cardiovascular events.
In its latest phase, researchers will turn to artificial intelligence and persistent monitoring for the first time to study CKD. Using this new data, as well as historical data, the team will employ sophisticated bioinformatics approaches to spot unseen traits and patterns of CKD that traditional approaches may have missed.
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Health information is provided for educational purposes and should not be used as a source of personal medical advice. Access myPennMedicine. A marked increase in the fraction of patients over 70 years of age was also noted between — and —, consistent with the ageing of the general population [ 14 ]. This analysis casts some doubt on the conclusion of Coresh, Stevens and Levey [ 7 ] that the prevalence of CKD is indeed rising, after accounting for age differences and serum creatinine measurements in the population.
Similar observations have been previously reported for the periods between and [ 9 ]. However, as pointed out in the accompanying editorial by Coresh, Stevens and Levey [ 7 ], the prevalence of CKD at any given stage at any one point in time point prevalence is determined by the incidence of CKD and also by how rapidly individual patients migrate from one stage to the next as the disease progresses towards ESRD [ 18 ]. The phenomenon of a changing pace of progression could be a possible explanation for these observations, as suggested by Hallan et al.
More research is needed to better define the true prevalence of CKD in the community at large. While the overall prevalence rate of CKD can be disputed, published estimates of the number of individuals affected with CKD still raise concerns [ 20 ]. A purported It is therefore worth examining the characteristics of the stage 3 CKD population more carefully.
The observed male:female ratio for CKD 0. Many studies have demonstrated a stepwise increase in the risk of cardiovascular events with decrements in eGFR, and concomitant proteinuria would be expected to enhance this risk even further.
Finally, the estimation of CKD prevalence in other populations having characteristics diet, body habitus, environment, ethnicity different from those used to generate the MDRD estimating equation and having different gender- and age-dependent changes in eGFR could also materially influence the accuracy of CKD prevalence, as has already been shown for China [ 34 ].
Furthermore, sampling errors a single serum creatinine measurement have contributed to these overestimations in prospective population-wide surveys. Enhanced access to ESRD treatment is a plausible, yet unproven, explanation for the rising and now stable numbers of treated ESRD patients in many developed nations.
The observed higher level of renal function at the onset of RRT would be consistent with enhanced access being a major driving force behind the previous increase in treated ESRD [ 13 ].
As we learn more about the natural history of CKD from longitudinal, community-based studies it has become increasingly apparent that the CKD classification system developed in , while representing a conceptual advance, now needs revision.
Much additional epidemiologic research is needed to more carefully define the true prevalence of CKD that confers specific disadvantages e. We welcome the recent position statement of the NKF that acknowledges the problems of oversimplifying the definition of CKD and look forward to an improved version [ 35 ]. Should a new and improved system of defining and categorizing CKD emerge from debates such as this, we would expect that more realistic estimates of CKD prevalence in the population as a whole would ensue.
The senior author R. See related article by Paul E. Fact or fiction of the epidemic of chronic kidney disease—let us not squabble about estimated GFR only, but also focus on albuminuria. Nephrol Dial Transplant ; — Google Scholar. Google Preview. Oxford University Press is a department of the University of Oxford.
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