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Kidney Week

Abstract: TH-PO1056

Survey of Migrant Dialysis Patients Discloses a Majority with Paraquat or Other Agrochemical Exposure: A Potential Etiology for CKDu

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Holliday, Michael, Baylor College of Medicine, Houston, Texas, United States
  • Dominguez, Jose Rafael, Baylor College of Medicine, Houston, Texas, United States
  • Bustamante, Edlyn Geraldine, Harris Health System, Houston, Texas, United States
  • Espina, Ilse M., Baylor College of Medicine, Houston, Texas, United States
  • Shah, Maulin, Baylor College of Medicine, Houston, Texas, United States
  • Anumudu, Samaya Javed, Baylor College of Medicine, Houston, Texas, United States
  • Awan, Ahmed A., Baylor College of Medicine, Houston, Texas, United States
  • Sheikh-Hamad, David, Baylor College of Medicine, Houston, Texas, United States
Background

Chronic kidney disease of unknown etiology (CKDu) is a global epidemic of renal disease. Prior studies have reported associations of CKDu with Leptospira, heat and heavy metal exposures, and agricultural chemical use. From a screen of migrant workers with ESRD at a Houston safety net hospital, we identified Gramoxone (paraquat herbicide) exposure as a possible etiologic factor. Further, we found that repetitive administration of low dose paraquat to mice resulted in renal pathology similar to that of CKDu. We expanded our survey to an outpatient safety net dialysis unit that primarily serves migrants with ESRD.

Methods

155 patients were screened at our outpatient dialysis unit. Of these, 38 met inclusion criteria and were surveyed. Exclusion criteria included known causes of primary or secondary renal disease (e.g. diabetes, hypertension, SLE, IgA, etc.). Included patients were also negative for viral hepatitis, HIV, ANA, ANCA, or monoclonal gammopathies.

Results

Average patient age at presentation was 40 (range 24-60) and 36 of 38 surveyed patients were male. 58% (22) were from Mexico, 37% (14) from El Salvador, and one each from Guatemala and Honduras. Before immigration, 27 (71%) lived in a farm/village and 11 (29%) lived in urban area. 76% (29) reported living in hot climate and 74% (28 patients) had worked in agriculture for an average of 10+/-6 years prior to immigration. 16% (6) of patients had rare use of NSAID. 29% (11 patients) reported use of Gramoxone (paraquat-based herbicide) by name, while 22 (58%) patients reported prior herbicide and/or pesticide exposure but could not identify agents; the average duration of exposure was 10+/-5 years. 58% (22) consumed well water, and of patients with herbicide/pesticide exposure, 18 (82%) consumed well water.

Conclusion

Patients with CKDu encountered at a Houston safety net hospital consist of migrant workers, predominantly male and young. Before immigrating to the US, most of the patients lived in hot mountainous climate, in a farm/village. They did not consume sweetened drinks and their main hydration solution consisted of well water. We found no clear identifiable risk factors for uCKD, except for chronic exposure to paraquat/Gramaxone in farm workers and consumption of well water.

Funding

  • Private Foundation Support