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Abstract: TH-PO424

Incident CKD over 4 Years in a Population-Based Study of Apparently Healthy Young Adults at Risk of Mesoamerican Nephropathy (MeN)

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Gonzalez, Marvin Antonio, UCL, London, United Kingdom
  • Camacho, Armando Benito, Research Center on Health, Work and Environment at National Autonomous University of Nicaragua, Leon, León, Nicaragua
  • Nitsch, Dorothea, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • Pearce, Neil, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • Caplin, Ben, UCL, London, United Kingdom
Background

MeN has led to the death of tens of thousands of young adults across rural Central America. We recently reported eGFR decline of over 30mL/min/1.7m2 over 2 years among substantial numbers of apparently healthy young adults from rural communities in northwest Nicaragua1. The consequences of this early loss of eGFR is not known.

Methods

The original 350 participants (a rural, population-based sample, aged 18-30 years, male:female ratio 3:1, without reported diabetes, hypertension or CKD) from the study have been followed-up annually for a further 2 years. An additional 417 men and women (ratio 1:1) were recruited in October 2018. Serum creatinine was measured at UNAN-León after each study visit and eGFR was calculated by CKD-EPI formula. de novo CKD was defined as those participants from the original cohort with an eGFR≥60mL/min/1.7m2 at baseline who developed an eGFR <60mL/min/1.7m2 on at least two serial measurements without recovery.

Results

Across all participants (mean age 24.8 years) at baseline 87% of men and 95% of women had an eGFR≥90mL/min/1.7m2, but despite excluding those self-reporting CKD, 2.9% of males had an eGFR<60mL/min/1.7m2.

In the original cohort, 90% participants attended ≥2 of the 7 study visits. eGFR varied substantially visit-to-visit such that 42% of men (Figure) and 54% of women had an eGFR<90mL/min/1.7m2 at some point during the 4-year follow-up. Furthermore, among men (but not women), 11% had an eGFR<60mL/min/1.7m2 (at ≥1 visit), 3.8% developed de novo CKD, and 0.8% (n=2) died from kidney failure over the follow-up.

Conclusion

Within person eGFR varies substantially in this population at high-risk of MeN. This likely reflects important biological effects, as well as analytical variation, making longitudinal studies critical for disease insight. Nonetheless there is both a substantial loss of eGFR and unprecedented rates of incident CKD among young men in the region.

1. Gonzalez-Quiroz et al. JASN 2018

Local eGFR measurements over the study period in men

Funding

  • Private Foundation Support