The epidemic of chronic kidney disease of unknown etiology in Mesoamerica: A call for interdisciplinary research and action

摘要

During the last 20 years, several regions in Central America and Mexico have seen a dramatic increase of a rapidly progressive chronic kidney disease, unexplained by diabetes and hypertension.1"3 This regional epidemic of chronic kidney disease of unknown origin (CKDu) is also being referred to as the Mesoamerican nephropathy or MeN.4 It has been estimated that this largely unknown epidemic has caused the premature death of at least 20 000 men.3 In MeN-affected areas in Nicaragua3 and Costa Rica (C. W., unpublished data, September 2011), chronic kidney disease mortality is up to fivefold the national rates. In El Salvador, kidney disease was the second most common cause of death among males in 2009.5 MeN primarily, but not only, affects young and middle-aged male laborers in the agricultural sector, in particular sugarcane workers.Commonly victims of chronic kidney disease are not aware of their illness until the disease is in the final stages and their only treatment option is renal replacement therapy through dialysis or kidney transplantation. In developing nations, however, very few patients with end stage renal disease have access to renal replacement therapy, and most die without proper treatment. The increase in CKD of conventional origin alone is a great burden for the health systems of developing countries, but in combination with the increase of CKDu in Mesoamerica it is overwhelming local health care systems to the point of collapse.