C A MCKAY1, K M DWYER2, S BRUMBY3, A M DUJON4
1Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Australia, 2Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Australia, 3The National Centre for Farmer Health, Western District Health Services, Hamilton, Australia, 4International Associated Laboratory Cancer Ecology & Evolution, School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Australia
Aim: To highlight the key risk factors contributing to development of Chronic Kidney Disease of Unknown Origin (CKDu) in the disease-endemic countries of Sri Lanka, El Salvador, Nicaragua and India, and describe directions for future research.
Background: CKDu, described internationally in farming populations and with a prevalence in young males, causes renal dysfunction in the absence of traditional risk factors typically associated with other kidney pathologies. First described in the literature in the 1990s, the causes contributing to the development of CKDu are still unclear – with the diagnosis remaining one of exclusion. Hypothesised risk factors for the disease include agricultural occupation, agrochemical exposure, male sex, heat stress, poor water quality, and heavy metal exposures.
Studies investigating these putative risk factors have varied in design and outcome, requiring an appropriate synthesis of the evidence available for each risk factor.
Methods: We conducted a systematic literature review, using meta-analysis and meta-regression modelling, in order to investigate the key risk factors associated with CKDu development and describe between-study variation.
Results: From 18 studies published within the 2007-2009 period, we identified that agricultural occupation, agrochemical exposure, age, sex, and family history were significantly associated with the development of CKDu. Meta-regression modelling supported the hypothesis of a disease with an agricultural origin and a high prevalence in males, increasing with agrochemical exposure.
Conclusion: This research illustrates the need for thorough longitudinal studies investigating the mechanism by which those risk factors contribute to the CKDu disease burden. It also describes the need for a standardised approach to investigations of the disease. This provides a framework for further research, reducing the burden of CKDu in the future.
Claire McKay is an Undergraduate Honours student with the Deakin University School of Medicine, completing an epidemiological project investigating the role of various putative risk factors in the development of Chronic Kidney Disease of Unknown Origin (CKDu) and how these may contribute to the landscape of Australian Kidney disease. Prior to entry to the Bachelor of Health and Medical Sciences (Hons), she completed a Bachelor of Science majoring in Human Biology, also with Deakin University. Her major research interests include rural health, data science and human medicine.