Abstract

In El Salvador, a form of chronic kidney disease (CKD) of nontraditional causes (CKDnt) affecting farmers is being reported. Its behavior has been epidemic and is responsible for tens of thousands of deaths. This article summarizes the results obtained from a series of studies conducted to identify the epidemiology and clinical behavior of this disease, proposing a case definition and an etiopathogenic hypothesis. Methods included a survey of CKD in agricultural communities studying 2,388 people ≥ 18 years and 1,755 < 18, a descriptive clinical study followed by histopathological assessment conducted in 46 possible cases of CKDnt ≥ 18 years, and a national survey to study the prevalence of CKD and associated risk factors in 4,817 participants ≥ 20 years followed by a nested case-control study. In the agricultural communities, the prevalence of CKD in adults was 18% (men: 23.9%, women: 13.9%), 26.8% in agricultural workers (non-agricultural 13.8%), CKDnt accounted for 51.9% of cases. CKD in the population < 18 years was 3.9% (mean estimated glomerular filtration rate > 160 mL/1.73m²). The national CKD prevalence was 12.6% (urban: 11.3%; rural: 14.4%; males: 17.8%, females 8.5%), and CKDnt was only 3.8%; with associations between CKD and exposure to agrochemicals. The clinical study revealed the presence of markers of kidney damage (A3 albuminuria: 80.4%; β2-microglobulin: 78.2%), urine electrolyte anomalies (100% hypermagnesuria, 45.7% hypernatriuria, 43.5% osmotic polyuria), abnormal osteotendinous reflexes (45.7%), sensorineural hearing loss (56.5%), and damage of the tibial arteries by Doppler imaging (66.7%). Biopsies revealed a chronic tubulointerstitial nephropathy. The etiopathogenesis of CKDnt is possibly multifactorial, including environmental contamination by agrochemicals, heat stress, and dehydration.

Author Details

Authors

• Raúl Herrera Valdés¹
• Miguel Almaguer López¹
• Carlos M. Orantes Navarro²
• Laura López Marín¹
• Elsy G. Brizuela Díaz³
• Héctor Bayarre Vea⁴
• Juan C. Amaya Medina⁵
• Luis C. Silva Ayçaguer⁶
• Xavier F. Vela Parada⁷
• Susana Zelaya Quezada⁷
• Patricia Orellana de Figueroa²
• Magaly Smith González⁸
• Yudit Chávez Muñoz⁹
• Xenia A. García Ortiz⁵
• Raymed Bacallao Méndez⁸

Departments

• ¹ Nephrology Institute, Havana, Cuba,
• ² National Institute of Health, Ministry of Health,
• ³ Metropolitan Health Region, San Salvador, El Salvador,
• ⁴ National School 
of Public Health, Havana, Cuba,
• ⁵ San Juan de Dios National Hospital, San Miguel, 
El Salvador,
• ⁶ National Medical Sciences Information Center, Havana, Cuba, 

• ⁷ Renal Health Research Unit, National Health Institute, Ministry of Health, 
San Salvador, El Salvador,
• ⁸ Renal Physiopathology Department, and 

• ⁹ Anatomical Pathology Department, Nephrology Institute, Havana, Cuba

Address

Raúl Herrera Valdés, MD MSc PhD DrSc
Nephrology Institute, Havana, Cuba
Email: raul.herrera@
infomed.sld.cu

Citation