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Since 2008, the National Center for Chronic Kidney Disease Treatment (UNAERC) has compiled a database of 3,105 individ PowerPoint Presentation
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OBJECTIVES. Map prevalence of dialysis referral by municipality and determine if areas of higher prevalence correspond with areas of known agricultural work / hotter climate Compare dialysis referral rates by sex and geographic location

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OBJECTIVES

  • Map prevalence of dialysis referral by municipality and determine if areas of higher prevalence correspond with areas of known agricultural work / hotter climate
  • Compare dialysis referral rates by sex and geographic location
  • Compare dialysis referral rates by Human Development Indices (HDI’s) and geographic location

Since 2008, the National Center for Chronic Kidney Disease Treatment (UNAERC) has compiled a database of 3,105 individuals enrolling in dialysis

Dialysis prevalence rates (per 100,000 inhabitants) were mapped (by department and municipality) using ArcGIS software and superimposed onto maps of sugar cane plantations and seasonal temperature data

Referral rates by sex were compared between south-western Guatemala and the rest of the country using chi-squared analyses

Dialysis prevalence rates and 2002 HDI’s (by municipality) were compared using one-sided Speaman’s rank order correlation coefficient (Spearman’s rho [rs]) to assess for correlation between geographic and economic indicators and referral patterns

Jha V, Garcia-Garcia G, Iseki K, et al. Chronickidneydisease: global dimensión and perspectives. Lancet. 2013;382(9888): 260-272.

Wesseling C, Crowe J, Hogstedt C, et al. Resolvingthe Enigma of MesoamericanNephropathy: A Research Workshop Summary. Am J KidneyDis. 2014;63(3): 396-404.

Weiner DE, McClean MD, Kaufman JS, Brooks DR. The Central American epidemic of CKD. CJASN. 2013:8(3): 504-511.

Brooks DR, Ramirez-Rubio O, Amador JJ. CKD in Central America: a hotissue. Am J KidneyDis. 2012;59(4): 481-484.

Correa-Rotter R, Wesseling C, Johnson RJ. CKD of UnknownOrigin in Central America: The Case for a MesoamericanNephropathy. Am J KidneyDis. 2014;63(3): 506-520.

BACKGROUND

CONFLICTS OF INTEREST

Rates per 100,000 residents of individuals enrolled in dialysis were highest in southwestern departments bordering the Pacific Ocean (Figure 1).

Locations of sugar cane plantations (Figure 1b) and higher daytime temperatures (Figure 1c) during the sugar cane harvest overlap with dialysis prevalence rates.

MATERIALS AND METHODS

RESULTS

DISCUSSION

The overlap between dialysis prevalence rates, sugar cane cultivation, daytime harvest temperatures, and the predominance of male enrollees in southwestern Guatemala argues that a similar disease process could be occurring in southwestern Guatemala as in Nicaragua and El Salvador.

The linear relationship between municipal dialysis prevalence rates and municipal HDI’s in all regions of the country except the sugar cane producing departments supports the hypothesis that access to dialysis often directly correlates with wealth in parts of Guatemala.

The causes and possible solution of CKD and End Stage Renal Disease in this region merits urgent research.

REFERENCES

Timothy S. Laux, MD Phone: Cell: 914.960.1848

Email Address: laux.timothy@gmail.com

CONTACT

Dr. Rothstein has worked as a consultant for Gambro Corporation and as a paid speaker for Amgen and American Regent. All other authors report no conflicts of interest.

Sex distribution of all dialysis enrollees was significantly (p < 0.001) different between southwestern departments and the rest of the country (Figure 3, PD = p < 0.001, Hemodialysis p = 0.07).

In the southwestern (n=6) departments, 57.3% enrollees were male (58.3% of hemodialysis and 57.1% of PD) compared to 49% in the northern (n=16) departments (49.9% and 48.6%, respectively).

Municipal dialysis prevalence rates increased as municipal HDI increased:

  • At a national level (Figure 2a, rs [n = 258] = 0.50, p < 0.001)
  • In the 16 departments without a border along the Pacific Ocean (Figure 2b, rs [n = 170] = 0.27, p < 0.001)
  • In the capitol region (Figure 2c,rs [n = 16] = 0.39, p = 0.07) though of a smaller magnitude.

No correlation was found between municipal dialysis prevalence rates and HDI (Figure 2d) in the four leading sugar cane producing departments (rs [n = 49] = 0.07, p = 0.32).

Among men, CKD is the leading cause of death in western Nicaragua (95 / per 100,000 residents) and the second leading cause of death in El Salvador.

These CKD cases are clustered along the Pacific Coast at low altitudes and tend to affect younger men with agricultural work backgrounds.

This CKD pattern has been termed Mesoamerican Nephropathy (MeN). MeN’s cause remains unknown.

It is unknown if Guatemala has the same CKD distribution as neighboring Nicaragua and El Salvador.

Timothy S. Laux, MD1; JoaquínBarnoya, MD, MPH1; Douglas R. Guerrero, MD2; Marcos Rothstein, MD1

1. Washington University, St. Louis MO, USA; 2. UnidadNacional de Atención al Enfermo Renal Crónico (UNAERC), Guatemala City, Guatemala

Evidence of Mesoamerican Nephropathy (MeN) in southwestern Guatemala?

  • LIMITATIONS
  • While UNAERC is the largest dialysis provider in Guatemala, those enrolled in dialysis elsewhere are excluded from our analysis.
  • Individuals with End Stage Renal Disease often move to the capital (red dot in Figure 1) to better access dialysis.

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