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Abstract: TH-PO1014

CKD of Unknown Origin (CKDu) Is Associated with Subclinical Rhabdomyolysis

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Madero, Magdalena, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Estado de Mexico, Mexico
  • Johnson, Richard J., University of Colorado, Denver, Colorado, United States
  • Wesseling, Catharina, La Isla Foundation, Ada, Michigan, United States
  • Fernandez Yepez, Ana K., Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Estado de Mexico, Mexico
  • Sanchez-Lozada, L. Gabriela, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Estado de Mexico, Mexico
  • Glaser, Jason R., La Isla Foundation, Ada, Michigan, United States
  • Weiss, Ilana, La Isla Foundation, Ada, Michigan, United States
  • Rodriguez-Iturbe, Bernardo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Estado de Mexico, Mexico
Background


CKDu is a type of chronic kidney disease, unrelated to diabetes and hypertension, mostly described in young sugar cane workers in El Salvador, Nicaragua and Mexico (Mesoamerican Nephropathy). Many etiologies have been assessed, including pesticides, heavy metals, silica, fructose-rich soft drinks, tobacco use, nutritional factors, and strenuous work in hot climate. Occupational heat stress is now an accepted key etiologic factor, but pathophysiologic pathways need further clarification. The role of rhabdomyolysis has been considered but myoglobin levels are unknown and serum creatine kinase (CK) levels during the harvest season are only mildly elevated.

Methods

We determined serum myoglobin (ng/ml, electrochemiluminescence immunoassay), CK (units/L) and creatinine (Scr, mg/dl) before (Pre) and after (Post) a 5 to 12 hour working shift in 109 sugar cane cutters (1 female), 19-78 years old from Tierra Blanca, Veracruz, a previously identified hot spot region for CKDu.

Results

Levels (mean±sem) of myoglobin (Pre=33.2±1.42; Post=60.0±5.02; p<0.0001), CK ( Pre=164.8±9.24; Post=218.9±12.10; p<0.0001) and Scr (Pre=0.98±0.053; Post=1.17±0.058, p<0.0001) increased significantly (paired T test) during the working shift. There was a direct linear correlation between the increment in Scr and both the increments in CK (n=104, r2=0.161; p<0.0001) and myoglobin levels (n=104; r2=0.284; p<0.0001 (Figure).

Conclusion

The serum levels of myoglobin and CK are below the levels usually reported in rhabdomyolysis-related acute kidney injury. Nevertheless, subclinical rhabdomyolysis occurs daily during the harvest season in sugar cane workers and the role of repeated mild episodes of rhabdomyolysis in CKDu deserves to be investigated.

Funding

  • Private Foundation Support