Prevalence and Risk Factors for CKD in the General Population of Southwestern Nicaragua

Significance Statement Most studies of Mesoamerican nephropathy have focused on regions in El Salvador and northwest Nicaragua and on agricultural workers, but information regarding prevalence and risk factors for CKD in Nicaragua’s general population is sparse. In a study of community-dwelling individuals in southwestern Nicaragua, the authors screened 1242 participants for CKD (defined as <60 ml/min per 1.73 m2). Risk factors for prevalent CKD included age, diabetes, and hypertension. Current or former workers in the sugarcane industry (but not other types of agriculture) had a twofold-increased odds of CKD. CKD prevalence in southwestern Nicaragua is about 5% among the general population but is not consistent across Nicaragua. Formal CKD surveillance programs in Nicaragua are needed to assess the overall burden of CKD nationally, with a focus on agricultural workers. Background Studies have described Mesoamerican nephropathy among agricultural workers of El Salvador and northwestern Nicaragua. Data on prevalence and risk factors for CKD beyond agricultural workers and in other regions in Nicaragua are sparse. Methods We recruited participants from 32 randomly selected communities in the Department of Rivas’s ten municipalities in two phases. In phase 1, we screened participants using a field-based capillary creatinine measuring system and collected self-reported information on lifestyle and occupational, exposure, and health histories. Two years later, in phase 2, we enrolled 222 new participants, performing serum creatinine testing in these participants and confirmatory serum creatinine testing in phase 1 participants. Results We enrolled 1242 of 1397 adults (89%) living in 533 households (median age 41 years; 43% male). We confirmed CKD (eGFR<60 ml/min per 1.73 m2) in 53 of 1227 (4.3%) evaluable participants. In multivariable testing, risk factors for prevalent CKD included age (odds ratio [OR], 1.92; 95% confidence interval [95% CI], 1.89 to 1.96) and self-reported history of hypertension (OR, 1.95; 95% CI, 1.04 to 3.64), diabetes (OR, 2.88; 95% CI, 1.40 to 5.93), or current or past work in the sugarcane industry (OR 2.92; 95% CI, 1.36 to 6.27). Conclusions Adjusted CKD prevalence was about 5% with repeat confirmatory testing in southwest Nicaragua, lower than in the northwest region. Risk factors included diabetes, hypertension, and current or prior work in the sugarcane industry but not in other forms of agricultural work. Formal CKD surveillance programs in Nicaragua are needed to assess the overall burden of CKD nationally, with a focus on agricultural workers.