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Immediate action to address the epidemic of chronic kidney disease in Central America

on Wed, 06/25/2014 - 01:01
An immediate and coordinated action and response despite the causes of the epidemic are not entirely clear from the public health and other related sectors to address the epidemic of chronic kidney disease that currently is sweeping across Central America, is the main call of the paper “The epidemic of chronic kidney disease in Central America” published in The Lancet Global Health on June 25th, 2014. I'm proud to be co-author of this paper with Pedro Ordunez, Carla Saenz, Evelina Chapman, Ludovic Reveiz and Francisco Becerra, all from the Pan American Health Organization (PAHO)
Chronic kidney disease not related to traditional causes (CKDnT) such as hypertension and diabetes, is affecting mainly young male agricultural workers, and also women and non-agricultural workers living in farming communities of Central American countries. El Salvador and Nicaragua shows the highest magnitude of mortality due CKDnT with a clear trend to increase according to the paper. 
The data visualization below, which is also referenced in the publication, illustrates the situation and trends of mortality due to chronic kidney disease (N18 ICD-10) and renal failure (N17-N19 ICD-10) in countries of the Americas. It allows you to explore the age-standardized mortality rate per 100,000 populations breakdown by both causes of death, year and sex.
Authors use the code N18 from WHO's International Classification of Diseases 10th revision as the best proxy for measuring CKDnT mortality. 
Other Central American countries, such as Panama, Belize and Guatemala exhibit mortality rates higher that 8.4 per 100,000 populations (the 60 percentile of mortality rates) in both sexes for 2007.
The publication also highlights that the two main postulated hypotheses for the high incidence and excess mortality: 1) the use of pesticides; and 2) heat stress along with dehydration, are strongly related to a lack of a regulatory system to control agrochemical use and the poor compliance with rules and standards to protect the labor force’s health.
Member States of the Pan American Health Organization (PAHO), the World Health Organization (WHO) regional office for the Americas, recognized the CKDnT epidemic in Central America as a serious public health problem and approved a resolution for ethically imperative urgent action, even if the causes of CKDnT have not been identified.


Ordunez P, Saenz C, Martinez R, Chapman E, Reveiz L, Becerra F. The epidemic of chronic kidney disease in Central America. The Lancet Global Health 2014. Early Online Publication 25 June 2014 doi:10.1016/S2214-109X(14)70217-7

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