To date, at least for Central American CKDu, suspected causes include a combination of exposure to high heat and humidity, inadequate hydration, high physical demands and, possibly, concomitant use of nephrotoxic nonsteroidal anti-inflammatory agents. In Central America, CKDu is hypothesized to be associated with occupational and environmental exposures affecting young men working in lowland agricultural settings, most notably sugarcane harvesters. Clusters of a similar CKD have also been reported in Sri Lanka, India, Saudi Arabia, Egypt, Senegal, and, more recently, in the United States (U.S.). This chronic impairment of kidney function not associated with known risk factors or a specific histological diagnosis has been termed “CKD of undetermined cause” (CKDu), “CKD of non-traditional cause” (CKDnt) or “Mesoamerican nephropathy” (MeN), given the initial description of CKDu in Central America. Their prognosis is poor due to delays in diagnosis and limited availability of therapy (i.e., dialysis or renal transplantation). These unusual cases predominantly affect male agricultural workers, often in their 30s and 40s, and are associated with high mortality. However, over the past 10–15 years, CKD cases have been described in low- and middle-income countries that do not fit this “usual” CKD pattern. CKD cases identified in high-income countries are typically associated with lifestyle-related risk factors, such as type II diabetes and hypertension. Categories G3a-G5 correspond to decreased eGFR (i.e., eGFR < 60 ml/min/1.73m 2). Based on the eGFR, a CKD case definition has been established by the ‘Kidney Disease: Improving Global Outcomes CKD Work Group’, which categorizes CKD into five stages (G1-G5) and two substages (G3a and G3b) based on eGFR. The hallmark measurement for renal insufficiency is the glomerular filtration rate (GFR), which is usually estimated (eGFR) from the serum creatinine level, obtained in whole blood samples. The POC device performed well in the field, with some adjustment in methods when temperature readings were out of range.Ĭhronic kidney disease (CKD) is a global health problem that can be caused by diabetes, hypertension, glomerulonephritis, congenital abnormalities, or obstruction of the urinary tract, among other known diseases. Implementation of DEGREE and the new CKDu module was straightforward and well understood. The POC device would disable testing when outdoor temperatures were above 85 ☏ or below 65 ☏ this was adjustable. We observed high correlations between POC and IDMS creatinine (r = 0.919) and BUN (r = 0.974). ResultsĪdministration of DEGREE and CKDu questionnaires averaged 10 and 5 min, respectively, with all questions easily understood. Anthropometrics and paired blood samples for POC and laboratory assay were completed outdoors over two periods (November–December 2017, April–May 2018).

DEGREE and CKDu questionnaires were completed indoors. Methodsįifty workers were interviewed in Houston (TX). To field test the Disadvantaged Populations eGFR Epidemiology (DEGREE) protocol, outdoor point-of-care (POC) testing for serum creatinine, and a new risk factor module on chronic kidney disease of undetermined origin (CKDu) in U.S.

Creatinine istat results