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NLM Director’s Comments Transcript
Chronic Kidney Disease Mystery in Central America: 06/02/2014

Picture of Dr. Lindberg
Abstract illustration of kidneys from a conference poster.
Photo: Courtesy of
the National Library of Medicine.

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.listen

I’m Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine, for Donald Lindberg, M.D, the Director of the National Library of Medicine.

Here is what’s new this week in MedlinePlus.

As the number of Central American young adults with chronic kidney disease increase, a medical mystery percolates about the disease’s underlying causes, finds an article recently published in Science.

Science reports the first cases of agricultural workers in southern Mexico, Nicaragua, Costa Rica, El Salvador, and Panama with chronic kidney disease (CKD) occurred in 2002 and continue to increase annually. Some estimates are 20,000 young adults in Central America have died prematurely from CKD.

Science notes the Pan American Health Organization found at least 2500 people died from CKD in El Salvador last year. CKD now is the principle cause of death in Salvadoran hospitals.

Overall, a pediatrician at the Baylor College of Medicine in Houston tells Science (and we quote): ‘the international global health community needs to take this very seriously. What we’re seeing is not business as usual. This is a serious outbreak and we need all hands on deck’ (end of quote).

Science reports the Pan American Health Organization adds the disease is spreading in the lowlands of Central America’s Pacific Coast mostly among agricultural workers, especially young adults who cut sugar cane. Science finds the disease is three times more likely to impact men than women.

Moreover, CKD affects young adults in Central America compared to the rest of the world where CKD often is a disease of older citizens. Also in contrast with the rest of the world, CKD cases in Central America may not be linked to its two identified causes — diabetes and high blood pressure.

To compound the mystery, Science reports CKD has not been found among agricultural workers in Cuba, the Dominican Republic, or Brazil, despite the fact agricultural workers are a similar age and work in a comparable climate. Science reports some public health officials believe (but do not have the evidence to demonstrate) the contrast could be the result of better agricultural working conditions, or may be linked to enhanced access to medical care in the unaffected nations.

Science notes the medical mystery additionally is fueled by an array of possible CKD causes recently identified by public health officials. Some possible CKD culprits include: dehydration, heat stress, pathogens, agrochemicals, heavy metals, a biochemical disorder, negative reactions to nonsteroidal anti-inflammatory medications, antibiotics, low birth weight, and genetic susceptibility. However, Science notes there is little evidence that differentiates any of these suspects (or their interaction) as the leading cause of CKD.

Science adds a widely asserted theory suggests strenuous work in hot climates depletes body fluids, which overtax kidney cells. As a result, some current research focuses on the link between heat stress, soft drink consumption by agricultural workers, and CKD’s formation. 

Still, a Salvadoran medical worker tells Science (and we quote), ‘we need other hypotheses’ (end of quote). Three future research projects (that include the U.S. Centers for Disease Controls and Prevention) focus on how working conditions vary by occupation, genetic susceptibilities, and if kidney damage occurs before young adults in Central America enter the workforce.

In the interim, let’s hope future research will provide insights into CKD’s Central America medical mystery — and a generation of young adults can work without jeopardizing their health.

 MedlinePlus.gov’s chronic kidney disease health topic page explains CKD occurs when your kidneys are damaged and cannot filter blood properly. The result is a build up of waste in the body that is harmful to one’s health. MedlinePlus.gov’s chronic kidney disease health topic page adds CKD treatments include medicines to lower blood pressure, control blood glucose, and decrease blood cholesterol.

An overview of CKD (that discusses its treatment and diagnosis) is provided by American Academy of Family Physicians within the ‘overviews’ section of MedlinePlus.gov’s chronic kidney disease health topic page. Incidentally, this and many other CKD resources on MedlinePlus.gov’s chronic kidney disease health topic page are available in Spanish.

An overview of the medicines for CKD (from the National Kidney Disease Education Program) is provided in the ‘treatment’ section of MedlinePlus.gov’s chronic kidney disease health topic page. The National Kidney Foundation provides a guide to living with kidney disease in the ‘coping’ section of MedlinePlus.gov’s chronic kidney disease health topic page.

MedlinePlus.gov’s chronic kidney disease health topic page additionally provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about CKD as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s chronic kidney disease health topic page type ‘CKD’ in the search box on MedlinePlus.gov’s home page, then, click on ‘chronic kidney disease (National Library of Medicine).’ MedlinePlus.gov also has comprehensive health topic pages on kidney diseases and kidney failure.

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A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.

It was nice to be with you. I look forward to meeting you here next week.