Background Epidemic levels of CKD of undetermined cause, termed Mesoamerican nephropathy in Central America, have been found in low- and middle-income countries. We investigated the natural history of, and factors associated with, loss of kidney function in a population at high risk for this disease.

Methods We conducted a 2-year prospective, longitudinal study with follow-up every 6 months in nine rural communities in northwestern Nicaragua and included all men (n=263) and a random sample of women (n=87) ages 18–30 years old without self-reported CKD, diabetes, or hypertension. We used growth mixture modeling to identify subgroups of eGFR trajectory and weighted multinomial logistic regression to examine associations with proposed risk factors.

Results Among men, we identified three subpopulations of eGFR trajectory (mean baseline eGFR; mean eGFR change over follow-up): 81% remained stable (116 ml/min per 1.73 m²; −0.6 ml/min per 1.73 m² per year), 9.5% experienced rapid decline despite normal baseline function (112 ml/min per 1.73 m²; −18.2 ml/min per 1.73 m² per year), and 9.5% had baseline dysfunction (58 ml/min per 1.73 m²; −3.8 ml/min per 1.73 m² per year). Among women: 96.6% remained stable (121 ml/min per 1.73 m²; −0.6 ml/min per 1.73 m² per year), and 3.4% experienced rapid decline (132 ml/min per 1.73 m²; −14.6 ml/min per 1.73 m² per year; n=3 women). Among men, outdoor and agricultural work and lack of shade availability during work breaks, reported at baseline, were associated with rapid decline.

Conclusions Although Mesoamerican nephropathy is associated with agricultural work, other factors may also contribute to this disease.

背景技术在低收入和中等收入国家中，未发现病因的CKD流行水平在中美洲被称为中美洲肾病。我们调查了该疾病高危人群中肾脏功能丧失的自然史以及与之相关的因素。

方法我们对尼加拉瓜西北部的9个农村社区进行了为期2年的前瞻性纵向研究，每6个月进行一次随访，研究对象为18至30岁的所有男性（n = 263）和女性（n = 87）。没有自我报告的CKD，糖尿病或高血压的老年患者。我们使用增长混合模型来识别eGFR轨迹的子组，并使用加权多项式Lo​​gistic回归来检查与拟议风险因素的关联。

结果在男性中，我们确定的eGFR轨迹三个亚群（平均基线的eGFR;平均表皮生长因子受体变化超过随访）：81％仍保持稳定（每1.73米116毫升/分钟² ; -0.6毫升/分钟每1.73米²每年），尽管基线功能正常（9.5毫升/分钟，每1.73 m ² -1.8.2毫升/分钟，每年1.73 m ² /年），仍有9.5％的患者迅速下降，而有9.5％的基线功能异常（每1.73 m ^2的58毫升/分钟；每年每1.73 m ² -3.8 ml / min ）。在女性中：96.6％保持稳定（每1.73 m ^2为121毫升/分钟；每1.73 m ²每年为-0.6毫升/分钟），并且有3.4％迅速下降（每1.73 m ² 132毫升/分钟）; 每年每1.73 m ² -14.6 ml / min ; n = 3名女性）。在基线人群中报告的男性中，从事室外和农业工作以及在工作休息时缺乏遮阳帘的情况与迅速下降有关。

结论尽管中美洲肾病与农业工作有关，但其他因素也可能导致该疾病。