Kidney disease epidemic stressed Caja’s resources

The national health service says it is concerned by the growing number of individuals afflicted with kidney disfunction.

This is the sugar cane cutter’s disease that affects mainly young men in agricultural work.

Officials in the Caja Costarricense de Seguro Social said it now has to devote more services to the hospitals that are treating this chronic kidney insufficiency.

So far there is no direct cause found for the ailment, but dehydration and extensive labor in the hot sun has been determined to be contributors.

The U.S. National Kidney Foundation said the incidence of the disease in younger men is up to 15 times higher in coastal Central America than in the United States. In Nicaragua and El Salvador, age-adjusted mortality rates from kidney disease are among the highest in the world, said the foundation. The situation is being considered an epidemic.

María del Rocío Sáenz Madrigal, executive president of the Caja, said that her agency needs to review all the programs of promotion, prevention and attention that it is developing in the province of Guanacaste, the principal area where the disease is found.

She said hospitals there have seen a 50 percent increase in the frequently fatal ailment.

Dr.  Sáenz said that a second shift was being added at the Centro de Atención Integral de Cañas for dialysis patients with staff from the  Hospital Enrique Baltodano Briceño de Liberia and that in April a dialysis unit would open in the new tower of the Hospital La Anexión en Nicoya.

By next year, health officials hope to have dialysis available at the Liberia hospital so that patients needing this treatment will not have to travel to Hospital México in La Uruca, San José, the doctor said. The treatment is a way to remove impurities from the blood stream, something that failing kidneys cannot do.

Dr. Sáenz added that the Caja has put into action a health kidney program in Guanacaste to make sure the population knows about the importance of hydration, overexposure to the sun and self-medication.

Still, she said, medical workers and officials in Guanacaste are seeing more and more affected patients, including young men who are heads of families and who run the danger of leaving their children without fathers. She said the medial teams there were considering the epidemic as having major social impact.

The Caja also has long-term scientific studies underway to better isolate the cause.  The Caja’s statistical department notes that the incidence of kidney insufficiency in Guanacaste is 112.9 per 100,000 residents compared to 43.8 per each 100,000 residents in the province of Cartago.

In some area, the rate soars to 1,100 per 100,000 population, said the Caja, noting that the places with the highest incidences were
Cañas, Bagaces, Santa Cruz and Carrillo.

Roy Wong, the coordinator of the long-term

Dialysis involves periodic cleansing of the blood with highly complex equipment.

Dialysis involves periodic cleansing of the blood with highly complex equipment.

Caja study, has cited a clear association with kidney insufficiency and young men who are agricultural workers with demanding working hours in high temperatures. They also generally have a lower education level, he was quoted as saying. Dr. Sáenz said that the study needs to go deeper.

The  National Kidney Foundation in the United States seconds the opinion that the epidemic of kidney disease among young Central American agricultural workers involves heat stress and volume depletion. That is according to research published in its American Journal of Kidney Diseases.

For the study, researchers followed 284 sugarcane workers in seven different jobs from one company in northwestern Nicaragua. Blood and urine samples were collected from participants before and near the end of the six-month harvest season. Those workers who had the most labor-intensive jobs, cane cutters, had increased urinary biomarkers of kidney injury, said the foundation.

While self-reported hydration didn’t seem to offer any protective benefit to sugarcane workers overall, when stratified by job, researchers observed a protective effect of consuming an electrolyte solution among cane cutters and seed cutters. This indicates there are ways to prevent kidney injury among laborers in high-heat settings, they said.

“At this point we don’t know for certain that heat stress and volume depletion are causal, but we can say that electrolyte supplementation appears to reduce risks of kidney damage in occupations that expose workers to heat stress and volume depletion,” said Rebecca Laws. She is a postdoctoral associate at Boston University’s School of Public Health and lead author on the study.

“Most researchers believe the causes are multifactorial, and it is at least in part related to occupation, given the severe toll that kidney disease is taking on heavy manual laborers in the region,” she was quoted as saying in a summary of the research by the kidney foundation.

The magnitude of the disease only became known five years ago, and researchers have been struggling to pinpoint the cause. Women also are affected but in lesser numbers. All studies cite hard labor in the hot sun as causal factors, but some also point out to the use of cheap cane alcohol, called guaro, in Costa Rica. There also is a percentage of bootlegged alcohol in use in the agricultural communities.

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