Chronic kidney disease and differential health outcomes among men and women in northwest Nicaragua

The region of Guanacastal Sur in Northwest Nicaragua has been plagued by an epidemic of chronic kidney disease (CKD). The etiology of the disease is unknown, but recent research studies have pointed to occupational exposure to agricultural chemicals and chronic dehydration as possible causes. In order to identify risk factors for the epidemic, we conducted an investigation among five communities in the Chichigalpa municipality, where the majority of the population is employed in the surrounding sugar cane fields. We surveyed participants on their occupational history, exposures and practices, and matched the results with blood tests for serum creatinine and hemoglobin A1c (HbA1c) and physical measurements. Our results show that 38% of the screened male population had kidney damage (defined as eGFR<60 mL/min/1.73m2), whereas only 8% of screened women had reduced renal function. Furthermore, the average age of women with kidney disease was 50, while men with GFR<60 mL/min/1.73 m2 were significantly younger, with an average age of 37 (p<0.005). Only a small percentage of participants diagnosed with CKD had comorbidities typically associated with the disease: 2% had signs of diabetes, 11% showed signs of hypertension, and 15% were obese. These results strongly suggest that occupational and environmental factors might have a role in the development of CKD. Potential factors that might explain the observed gender discrepancy in CKD prevalence can be ascribed to differences in the division of labor and exposure to nephrotoxic substances. Further analysis of our data will help to identify risk factors and preventive measures.