U.S. studies will seek cause of mystery kidney disease

Chronic kidney disease is getting a lot of attention worldwide, but the mystery remains.

Boston University’s School of Public Health says its experts are conducting an investigation of chronic kidney disease in the northwestern region of Nicaragua in conjunction with the World Bank and Nicaraguan partners.

The U.S. Centers for Disease Control and Prevention confirmed Thursday that it is a technical consultant with Boston University School of Public Health as lead. Additionally, all studies are in the planning stages, it said by email.

The Centers also is supporting a national health survey in El Salvador aimed at estimating the prevalence of certain diseases, including kidney disease, for the purpose of aiding national public health authorities in planning for future health needs of the population, said a Centers spokesperson.

There also is a study about to be reported from Colorado, and Costa Rica is involved in a study, too. The prestigious  Scientific American magazine just published a summary of the problem.

An estimated annual average of 1,000 Central American men have died over the last two decades of kidney failure, and they are mainly agricultural workers.

There have been Costa Rican deaths in Guanacaste, the center of this country’s sugar cane operation. But the problem is more acute elsewhere in Central America. Ill cane workers staged a protest Jan. 18 in Chichigalpa in front of a sugar mill, and Nicaraguan police killed one man and injured three others, according to news reports.

Since 2002 scientists have known that a disproportionate number of male sugar cane workers have contracted serious kidney disease. Boston University admits that the cause still is unknown.

Boston University will do its study in conjunction with the World Bank and Nicaraguan partners in the northwest section of that country. This area of the country is home to the Ingenio San Antonio, the operational center of the National Sugar Estates, Ltd., the largest of four sugar cane companies in Nicaragua, said the university. Thousands of young men in this region are Ingenio San Antonio employees, and the area also is unique in its geography because it contains several active volcanoes, which may increase the background levels of heavy metals in the environment, the university added.

In their search for causes of an epidemic of chronic kidney disease in Nicaragua, a Boston University-led team conducted a pilot study and gathered insights from local health workers, who cited heat stress, insufficient water intake and medical treatment that may further damage kidneys, the university reported.

In a study published in the journal BMC Public Health, the research team interviewed 10 physicians and nine pharmacists in northwest Nicaragua, where chronic kidney disease has claimed the lives of a disproportionate number of agricultural workers, most of them young adult men, the university said. Researchers have been working in northwestern Nicaragua since 2009, as part of a mediation process that includes the management of a major sugar producer in northwestern Nicaragua and a group of about 2,000 former sugarcane workers and community members who are affected by kidney disease, according to the university.


The Centers for Disease Control and Prevention said that being planned are an occupational risk factors study and a non-occupational risk factors study with two components, one investigating kidney damage at early ages and one exploring the possibility of a genetically determined susceptibility to kidney disease.

Since it was first identified that high rates of kidney failure exist in the young, male, working populations along the Pacific coast of Central America, many theories have surfaced as to the root of the problem. Although prolonged dehydration is agreed upon in the scientific community as a likely candidate, many others have been proposed.

Some of the others include: exposure to pesticides from the sugar cane work many of the afflicted participate in, consumption of a homemade liquor that is popular in the rural regions where the problem is most prevalent and chronic consumption of pain medications possibly linked to the aches and pains of a manual labor workforce. Genetics could also play a part, but researchers seem to agree that environmental factors are most likely to blame.

A.M. Costa Rica has reported that the Caja Costarricense de Seguro Social said that its statistics show that over the last several years the Guanacaste region has accounted for about 12 percent of the nation’s documented kidney failures while it only represents 6 percent of the countries population.

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