Background Mesoamerican nephropathy is a leading contributor to premature mortality in Central America. Efforts to identify the cause are hampered by difficulties in distinguishing associations with potential initiating factors from common exposures thought to exacerbate the progression of all forms of established chronic kidney disease (CKD). We explored evidence of disease onset or departure from the healthy estimated glomerular filtration rate distribution [departure from ∼eGFR(healthy)] in an at-risk population. Methods Two community-based cohorts (adults aged 18–30 years, n = 351 and 420) from 11 rural communities in Northwest Nicaragua were followed up over 7 and 3 years respectively. We examined associations with both (i) incident CKD and (ii) the time point of departure from ∼eGFR(healthy), using a hidden Markov model. Results CKD occurred in men only (male incidence rate: 0.7%/year). Fifty-three (out of 1878 visits, 2.7%) and 8 (out of 1067 visits, 0.8%) episodes of probable departure from ∼eGFR(healthy) occurred in men and women, respectively. Cumulative time in sugarcane work and symptoms of excess occupational sun exposure were associated with incident CKD. The same exposures were associated with probability of departure from ∼eGFR(healthy) in time-updated analyses along with measured and self-reported weight loss, nausea, vomiting and cramps, as well as non-steroidal anti-inflammatory drug use. Conclusions CKD burden in this population is high and risk factors for established disease are occupational. Additionally, a syndrome suggesting an alternative exposure is associated with evidence of disease onset supporting a possible separate unknown initiating factor for which further investigation is needed. Interventions to reduce the impact of occupational risks should be pursued meanwhile.

中文翻译：

---

早期肾功能丧失的人群水平检测：对具有中美洲肾病风险的年轻成人队列进行 7 年随访

背景 中美洲肾病是中美洲过早死亡的主要原因。由于难以区分与潜在引发因素和被认为会加剧所有形式的慢性肾病 (CKD) 进展的常见暴露因素之间的关联，因此查明病因的努力受到阻碍。我们探索了高危人群中疾病发作或偏离健康估计肾小球滤过率分布的证据[偏离〜eGFR（健康）]。方法 对来自尼加拉瓜西北部 11 个农村社区的两个社区队列（18-30 岁的成年人，n = 351 和 420）分别进行了 7 年和 3 年的随访。我们使用隐马尔可夫模型检查了与 (i) CKD 事件和 (ii) 偏离 ~eGFR（健康）的时间点之间的关联。结果 CKD 仅发生于男性（男性发病率：0.7%/年）。男性和女性分别有 53 次（在 1878 次就诊中，占 2.7%）和 8 次（在 1067 次就诊中，0.8%）可能偏离 ~eGFR（健康）的情况发生。甘蔗工作的累积时间和过度职业性阳光照射的症状与 CKD 事件相关。在实时更新的分析中，相同的暴露与偏离~eGFR（健康）的可能性以及测量和自我报告的体重减轻、恶心、呕吐和痉挛以及非甾体抗炎药的使用有关。结论 该人群的 CKD 负担较高，且已确诊疾病的危险因素是职业性的。此外，表明替代暴露的综合征与疾病发作的证据相关，支持可能存在单独的未知起始因素，需要进一步调查。同时应采取干预措施减少职业风险的影响。