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Abstract: TH-PO403

Clinical and Pathological Characterization of Patients with ESKD from a Potential Mexican CKD of Undetermined Etiology (CKDu) Hotspot

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • De Arrigunaga, Sofía, Universidad Panamericana, School of Medicine, Mexico City, Mexico
  • Ascencio Martinez, Marco Antonio, Universidad Panamericana, School of Medicine, Mexico City, Mexico
  • Crespo Ortega, Laura, Universidad Panamericana, School of Medicine, Mexico City, Mexico
  • Villarreal, Gregorio, Universidad Panamericana, School of Medicine, Mexico City, Mexico
  • Obrador, Gregorio T., Universidad Panamericana, School of Medicine, Mexico City, Mexico
  • Villa, Antonio, Universidad Panamericana, School of Medicine, Mexico City, Mexico
  • Aguilar-Ramirez, Diego Jehu, University of Oxford, Oxford, United Kingdom
  • Madero, Magdalena, Instituto Nacional de Cardiologia, Mexico, Mexico
Background

Mesoamerican nephropathy (MeN) – the chronic kidney disease of unknown etiology (CKDu) identified in Central American hotspots – affects mostly young, male farmers without traditional risk factors (TRF) for kidney disease. To date, CKDu hotspots have not been described in Mexico. Between 1991 and 2018, 57 patients from a sugarcane region in Tierra Blanca, Veracruz (Mexico) were referred to our Institution for kidney transplantation. The aim of this study was to identify the clinical characteristics and risk factors for CKDu in these patients and compare their histopathological findings with others previously reported.

Methods

Sociodemographic, clinical, laboratory and pathological data were collected from medical records. Patients were categorized as having TRF for CKD (diabetes mellitus and/or hypertension) or not (CKDu). Descriptive statistics were used and multivariate logistic regression models were built to identify CKDu associated risk factors.

Results

The mean age of the 57 patients was 26.9 ± 9.7 years, 70% were male, and 44% farmers. Mean BMI was 23.0 ± 4.17, and 39% had a positive family history for CKD. Thirty (53%) patients met CKDu criteria. In the multivariate logistic regression model, agricultural work and family history of CKD were independent risk factors for CKDu, while high BMI conferred protection.
Of the six patients who underwent kidney biopsy, 5 showed atrophy, mild sclerosis, tubulointerstitial nephritis, and inflammatory infiltrate, all compatible with previously reported MeN findings.

Conclusion

The clinical and pathological characteristics of this group of patients suggest that Tierra Blanca, Veracruz (Mexico) may be a potential CKDu hotspot. This conclusion is further supported by another study done by our group that showed a high prevalence of CKDu in this region. Further research is needed to confirm our findings.

CharacteristicOR (CI 95%)p
Age in years0.99 (0.9 - 1.0)0.75
Sex0.96 (0.2 - 4.5)0.96
BMI (kg/m2)0.81 (0.8 - 1.0)0.03
Agriculture work4.61 (1.0 - 21.3)0.05
Family History of CKD4.56 (1.2 - 17.7)0.03

Table 1. Logistic regression model for CKDu