Thousands Are Dying of Chronic Kidney Disease in Central
America: The Malady of the Sugar Cane Presented by: Community
Health International Medical Projects for Sustainability (CHIMPS)
Salud Comunitaria Internacional, Proyestos Mdicos para
Sostenibilidad Mission : To cultivate sustainable public health
interventions in partnership with underserved communities in
developing countries through collaborative education Slide 2
Reuters Video Slide 3 Deaths from Chronic Kidney Disease Increased
between 2005 and 2009 Deaths in 2009 and increase in mortality rate
over 4 years from 2005- 09 Map/data from:
http://www.publicintegrity.org/ Slide 4 El Salvador has highest
mortality from Chronic Kidney Disease (CKD) in world! Jesus Sosa
Mancia, a CKD patient in Bajo Lempa, at home visit by a medical
team from the national health ministry. Sasha Chavkin/ICIJ CKD 2 nd
leading cause of death in men ages 20-60 in El Salvador Slide 5
Social Cost is Enormous & Increasing Renal dialysis and
transplant limited availability, costly Families left without
financial supportisla de viudas in Nicaragua Loss of large portion
of population in their most economically productive years Slide 6
Silent Disease Until Kidneys Fail Hard to prevent as symptoms do
not develop until kidneys failing Generalized skin itching Weakness
Fatigue and inability to carry out activities of daily living Blood
& urine tests can detect it earlier Slide 7 Slide 8 Damage is
primarily to kidney tubules Two main causes of kidney tubule
damage: Decreased blood flow most commonly from dehydration
Exposure to toxins No evidence that this form of CKD is related to
hypertension, obesity or diabetes as in the US Slide 9 Limited
Investigations Started in 2009 Mainly found in sugar cane &
cotton workers but also in construction, mining, shipping
Associated with lower elevation communities (cane workers at higher
elevations without CKD) Similar disease in Sri Lanka, India, Egypt
Funeral in Costa Rica of sugar cane worker Slide 10 Epidemic
heavily focused in communities on Pacific side From Brooks DR,
Ramirez-Rubrio O, Amadar JJ. CKD in Central America: A Hot Issue.
Am J Kidney Dis 2012; 59:481-484. Slide 11 Kidney Injury Associated
with Years of Work Peraza S et al, Decreased kidney function among
agricultural workers in El Salvador Am J Kidney Dis 2012;
59:531-540 Slide 12 Possible factors studied that are not single
causes of this epidemic of CKD Heavy metals: lead, cadmium Arsenic
(common in volcanic soil/cotton ) Agrichemicals properly
manufactured/applied Leptosporosis Medications: pain meds (NSAIDs)
and certain antibiotics Alcohol Slide 13 Several Factors Combined
May Cause Chronic Kidney Disease Heat exposure and exhaustion paid
by weight of cane cut Pesticides Direct contact Water contamination
Predisposition due to Intrauterine stress Acute kidney injury in
childhood ? Genetic factors Slide 14 Causes from Perspective of
Workers and Central American Doctors Dr. Carlos Orantes. There are
3 factors: prohibited pesticides, combinations of pesticides and no
protection from pesticides Lack of any regulation for worker
protection from chemicals Concern about water contamination by
agra- chemicals Photo from:
http://desinformemonos.org/2012/10/miles-de-muertes-en-nicaragua-http://desinformemonos.org/2012/10/miles-de-muertes-en-nicaragua-
a-causa-de-un-ingenio-azucarero/nicaragua-central-america-mystery-disease/
Slide 15 Prevention And Interventions From Levey AS, Stevens LA,
Coresh J. Conceptual Model of CKD: Applications and And
Implications. AJKD 2009; 53: S4-S16 Slide 16 What has been done to
control this epidemic in effected countries? Sri Lankan govt &
WHO conducting large study In CA, only 2 scientific conferences,
one in 2005 and fall of 2012 In ES, MOH focus on PAHO to make major
health concern; Nefrolempa pilot study on coast MOH of El Salvador
with El Salvador & Cuban physicians reviewing pilot study
results Slide 17 Rise in Latino Immigrants in End Stage Kidney
Disease in US Increase in Latino immigrants needing dialysis in US
University Medical Center in Las Vegas spent $24 million on
emergency dialysis treatment for 80 patients in 2010most
undocumented and without medical insurance. Slide 18 What can we do
from US? 1/ 4 th of US sugar imported from CA Educate the
public/members of your groups about the CKD epidemic Look at
sources of sugar you buy. Urge Puget Consumer Co-op, Trader Joe,
Whole Foods, Safeway, etc to find out Do growers have workers with
CKD? Do workers have breaks & hydration? Are workers protected
from pesticides? Put pressure on World Bank/IMF to force growers to
change work conditions: Compliance Advisor/Ombudsman Office
(http://www.cao-ombudsman.org/) Slide 19 Demand Funding for
Rigorous Research to Find Main Causes Need a large and well
designed case-control study Urge research and forums by: Pan
American Health Organization World Health Organization CDC, NIH
Support surveillance for kidney injury in workers and longitudinal
studies Studies done to date funded by Cuba, Sweden Slide 20
Conduct Education About Prevention with Latino Communities in US
& CA Protection from agrichemicals when working Avoidance of
medications that cause kidney injury Promote good hydration while
working Avoidance of water and food contamination by chemicals that
can harm kidneys Slide 21 Sources of more information
http://www.guardian.co.uk/world/2012/oct/14/kidney-disease-
killing-sugar-cane-workers-central-america
http://www.guardian.co.uk/world/2012/oct/14/kidney-disease-
killing-sugar-cane-workers-central-america
http://openchannel.nbcnews.com/_news/2012/10/16/13866856-
mystery-kidney-disease-decimates-central-america-sugarcane-
workers?lite (video)
http://openchannel.nbcnews.com/_news/2012/10/16/13866856-
mystery-kidney-disease-decimates-central-america-sugarcane-
workers?lite Ramirez-Rubrio O, McClean MD, Amador JJ, Brooks DR. An
epidemic of chronic kidney disease in Central American, an
overview: J Epidemiol Community Health 2013; 67: 1-3 Brooks DR,
Ramirez-Rubrio O, Amadar JJ. CKD in Central America: A Hot Issue.
Am J Kidney Dis 2012; 59:481-484. Peraza S et al, Decreased kidney
function among agricultural workers in El Salvador. Am J Kidney Dis
2012; 59:531-540 Orantes CM et al. Chronic kidney disease and
associated risk factors in the Bajo Lempa region of El Salvador:
Nefrolempa study 2009. MEDICC Review 2011, 14-22.
