Trends in chronic kidney disease-attributable mortality in chichigalpa, Nicaragua from 2002-2012

Background: Chronic kidney disease of unknown etiology (CKDu) has emerged as a devastating epidemic in northwest Nicaragua and other Pacific-coast lowlands throughout Central America. Studies indicate that men are preferentially affected and that an occupational history of sugarcane fieldwork is a significant risk factor. Design: This study investigates mortality due to CKD in the Chichigalpa Municipality from June 2002-June 2012. Data were recorded from 2420 death certificates and confirmed when possible by adapted WHO-standardized Verbal Autopsy Questionnaires administered to family members of deceased individuals. Data were analyzed with SPSS v19 and compared to corresponding US and Nicaraguan mortality statistics from WHO and CDC databases. Results: Mortality due to CKD in Chichigalpa (187.1 per 100,000) was almost 8 times higher than the national Nicaraguan rate (23.5 per 100,000). CKD accounted for 46.0% of total male deaths and 73.3% of deaths to males aged 34-54. Individuals who died of CKD had significantly shorter lifespans than those who died of other causes (95%CI=10.7-14.5 years). Males were significantly more likely to die from CKD (OR=7.17, 95%CI=5.54-9.27) and had significantly shorter lifespans than females (95%CI=8.3-12.1 years). Industrial agricultural workers were significantly more likely to die from CKD (p<0.001) and had significantly shorter lifespans than the rest of the population (p<0.001). Conclusion: These findings substantiate reports of high CKDu-attributable mortality and increased burden of disease on young and middle-aged males and industrial agricultural workers in the region. Findings will be used in ongoing efforts to mobilize government and non-government resources aimed at disease prevention and management.