Table 2.

Regional community-based studies of CKD

Locale(s) StudiedOccupationaNAltitudebPrevalence and PopulationRisk Factors
Nicaragua: Quezalguaque,
León (11)Mostly agriculture771Mostly lowHigh prevalence of reduced eGFR: 20% of men with eGFR<60 ml/min per 1.73 m2 versus 8% of womenResidence at lower altitude associated with lower eGFR
Nicaragua: Five communities (13), León, and ChinandegaSubsistence farming and mining445Low13.4% of men ages 30–41 yr with low eGFR High prevalence of reduced eGFR, with 14% of men but only 3% of women with eGFR below 60Abnormal creatinine levels not common in higher-altitude villages
Banana/sugar384LowAbnormal creatinine levels in 31% and 24% of male and female agricultural workers, respectively, at 100–300 m above sea level; not occurring at higher altitudesBanana/sugarcane independently associated with higher creatinine in men and mining/subsistence farming independently associated in both men and women
Fishing216Low
Services177Low
Coffee92High
Nicaragua: Matagalpa (15)Coffee267Very highVery low prevalence of reduced eGFR, with no individuals below 40 years old having reduced eGFR
El Salvador: Five communities (12)SugarSugar/servicesSugarCoffeeUrban services129159120124132LowLowHighVery highHighHigh overall prevalence of reduced eGFRDiscrepant findings in sugar communities, with kidney disease common at low-altitude sugar communities but rare in the high-altitude sugar community; 18% of men had eGFR below 60 in low-altitude sugar communities versus 0%–2%of men in high-altitude sugar communitiesWomen less affected than men (8% in low-altitude sugarcane versus 1%–3% in other communities)Proteinuria uncommon and low grade
El Salvador: Two communities (10), Jiquilisco, Usulután and Sesori, San MiguelAgriculture29162LowHighStudy included men onlySampling pattern only tested serum creatinine in male coastline residents with 1+ or greater proteinuriaDipstick proteinuria (1+ or greater) noted in 46% of men in low-altitude coastal communities versus 13% of men in high-altitude inland communities
37 of 80 men with laboratory measurements had creatinine≥1.5 mg/dl; of these 37 men, 81% had 1+ proteinuria, and only 19% had 2+ or greater proteinuria
El Salvador: Bajo Lempa region (5)Agriculture775LoweGFR<60 ml/min per 1.73 m2 in 17% of men versus 4% of womenNonsteroidal anti-inflammatory drug use common
Most affected individuals with neither diabetes nor hypertension
Nicaragua: Nine communities (34), León, and ChinandegaVaried997Not stated in the article but likely varied elevationsMen only after too few cases found in women12.4% of population with eGFR below 60Agricultural field labor, consumption of lija (alcohol available in a form susceptible to contamination by toxins), and consumption of >5 L water/d independently associated with the presence of reduced eGFR
Hypertension and diabetes not more common in CKD
  • eGFR, estimated GFR.

  • a Sugarcane cutting is considered the most intensive in terms of physical labor, and services jobs are considered the least physically intensive.

  • b Temperatures are significantly lower at higher altitudes; low altitude suggests elevations from sea level to 100 m, high altitude suggests elevations 500–1000 m above sea level, and very high altitude suggests elevations 1000+ m above sea level.