Epidemic of Chronic Kidney Disease in Agricultural Communities in Central America. Case definitions, methodological basis and approaches for public health surveillance
Abstract
In the last four decades, increasing numbers of
young people, in clusters of vulnerable farming
communities in several Central American countries,
have developed a severe form of kidney failure of
uncertain etiology (thus termed chronic kidney
disease of nontraditional causes, or CKDnT, in this
publication). This type of chronic kidney disease,
primarily a form of chronic interstitial nephritis, has
reached epidemic proportions, devastating entire
communities and overwhelming health systems. A
recent analysis estimated that more than 60,000
renal failure (a proxy of CKDnT) deaths (41% among
those younger than 60 years of age) occurred between
1997 and 2013 in Central America. CKDnT
is characterized by progressive renal insufficiency,
often diagnosed at a very late stage, in the absence
of early symptoms, necessitating renal replacement
therapy if the patient is to survive...This document presents a background to this epidemic,
including its epidemiology and main hypothetical
risk factors of CKDnT. It also includes a description
of clinical and pathological characteristics,
the case definitions for CKDnT surveillance, and the
methodological basis and approaches for public
health surveillance.
The Pan American Health Organization (PAHO) Resolution
on Chronic Kidney Disease in Agricultural
Communities in Central America has recommended
a set of priorities to address this epidemic; this document specifically addresses the request for a
framework for systematic surveillance of CKD and
CKDnT to be developed in the region, particularly for
affected countries. This document presents a surveillance
framework which includes: (a) passive surveillance,
with the main components based on mortality
registries and on a population registry of dialysis
or end-stage kidney disease; (b) active surveillance
that could be based mainly on sentinel surveillance
in communities and in selected occupations; and
(c) population-based surveillance, through repeated
cross-sectional surveys such as the WHO STEPS,
which is a stepwise approach to surveillance for
non-communicable diseases (NCDs).
Subject
Category of PAHO Strategic Plan 2014-2019
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