{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:29:48Z","timestamp":1790364588405,"version":"4.1.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T00:00:00Z","timestamp":1698710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"UK Medical Research Council","doi-asserted-by":"publisher","award":["MR\/V033743\/1"],"award-info":[{"award-number":["MR\/V033743\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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 \u223ceGFR(healthy)] in an at-risk population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two community-based cohorts (adults aged 18\u201330\u00a0years, n\u2009=\u2009351 and 420) from 11 rural communities in Northwest Nicaragua were followed up over 7 and 3\u00a0years respectively. We examined associations with both (i) incident CKD and (ii) the time point of departure from \u223ceGFR(healthy), using a hidden Markov model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u223ceGFR(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 \u223ceGFR(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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyad151","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T08:36:03Z","timestamp":1697618163000},"source":"Crossref","is-referenced-by-count":17,"title":["Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy"],"prefix":"10.1093","volume":"53","author":[{"given":"Marvin","family":"Gonzalez-Quiroz","sequence":"first","affiliation":[{"name":"Department of Renal Medicine, University College London , London, UK"},{"name":"Wuqu\u2019 Kawoq Maya Health Alliance , Chimaltenango, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brianna","family":"Heggeseth","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Statistics, and Computer Science, Macalester College , St Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Camacho","sequence":"additional","affiliation":[{"name":"Research Centre on Health, Work and Environment, National Autonomous University of Nicaragua, Le\u00f3n (UNAN-Leon) , Le\u00f3n, Nicaragua"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Oomatia","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, University College London , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali M","family":"Al-Rashed","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, University College London , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Statistics, and Computer Science, Macalester College , St Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"McCreight","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Statistics, and Computer Science, Macalester College , St Paul, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Jewell","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Aragon","sequence":"additional","affiliation":[{"name":"Wuqu\u2019 Kawoq Maya Health Alliance , Chimaltenango, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothea","family":"Nitsch","sequence":"additional","affiliation":[{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9938-7852","authenticated-orcid":false,"given":"Neil","family":"Pearce","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine , London, UK"},{"name":"Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9544-164X","authenticated-orcid":false,"given":"Ben","family":"Caplin","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, University College London , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,31]]},"reference":[{"key":"2024021116094630700_dyad151-B1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.kint.2018.08.019","article-title":"The International Society of Nephrology\u2019s International Consortium of Collaborators on Chronic Kidney Disease of Unknown Etiology: report of the working group on approaches to population-level detection strategies and recommendations for a minimum dataset","volume":"95","author":"Caplin","year":"2019","journal-title":"Kidney Int"},{"key":"2024021116094630700_dyad151-B2","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1126\/science.344.6180.143","article-title":"Mesoamerica\u2019s mystery killer","volume":"344","author":"Cohen","year":"2014","journal-title":"Science"},{"key":"2024021116094630700_dyad151-B3","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.2215\/CJN.13841215","article-title":"Climate change and the emergent epidemic of CKD from heat stress in rural communities: the case for heat stress nephropathy","volume":"11","author":"Glaser","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"2024021116094630700_dyad151-B4","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1053\/j.ajkd.2018.04.014","article-title":"Acute kidney injury in sugarcane workers at risk for Mesoamerican Nephropathy","volume":"72","author":"Kupferman","year":"2018","journal-title":"Am J Kidney Dis"},{"key":"2024021116094630700_dyad151-B5","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1136\/oemed-2019-105986","article-title":"Workload and cross-harvest kidney injury in a Nicaraguan sugarcane worker cohort","volume":"76","author":"Hansson","year":"2019","journal-title":"Occup Environ Med"},{"key":"2024021116094630700_dyad151-B6","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.ekir.2017.10.006","article-title":"Kidney diseases in agricultural communities: a case against heat-stress nephropathy","volume":"3","author":"Herath","year":"2018","journal-title":"Kidney Int Rep"},{"key":"2024021116094630700_dyad151-B7","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1053\/j.ajkd.2011.11.039","article-title":"Decreased kidney function among agricultural workers in El Salvador","volume":"59","author":"Peraza","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"2024021116094630700_dyad151-B8","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"2024021116094630700_dyad151-B9","doi-asserted-by":"crossref","first-page":"R690","DOI":"10.1152\/ajpregu.00237.2020","article-title":"Renal functional reserve: from physiological phenomenon to clinical biomarker and beyond","volume":"319","author":"Jufar","year":"2020","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"2024021116094630700_dyad151-B10","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1111\/j.1523-1755.2005.00365.x","article-title":"Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"67","author":"Levey","year":"2005","journal-title":"Kidney Int"},{"key":"2024021116094630700_dyad151-B11","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1681\/ASN.2018020151","article-title":"Decline in kidney function among apparently healthy young adults at risk of Mesoamerican Nephropathy","volume":"29","author":"Gonzalez-Quiroz","year":"2018","journal-title":"J Am Soc Nephrol"},{"key":"2024021116094630700_dyad151-B12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12882-016-0422-4","article-title":"Rationale, description and baseline findings of a community-based prospective cohort study of kidney function amongst the young rural population of Northwest Nicaragua","volume":"18","author":"Gonz\u00e1lez-Quiroz","year":"2017","journal-title":"BMC Nephrol"},{"key":"2024021116094630700_dyad151-B13","volume-title":"The Theory of Stochastic Processes","author":"Cox","year":"1965"},{"key":"2024021116094630700_dyad151-B14","first-page":"2845","article-title":"Disease progression modeling using Hidden Markov Models","volume":"2012","author":"Sukkar","year":"2012","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"key":"2024021116094630700_dyad151-B15","first-page":"3599","article-title":"Efficient learning of continuous-time hidden Markov models for disease progression","volume":"28","author":"Liu","year":"2015","journal-title":"Adv Neural Inf Process Syst"},{"key":"2024021116094630700_dyad151-B16","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1177\/0272989X12466731","article-title":"Identification of a multistate continuous-time nonhomogeneous Markov chain model for patients with decreased renal function","volume":"33","author":"Begun","year":"2013","journal-title":"Med Decis Making"},{"key":"2024021116094630700_dyad151-B17","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1053\/j.ajkd.2013.03.009","article-title":"Lifetime incidence of CKD stages 3-5 in the United States","volume":"62","author":"Grams","year":"2013","journal-title":"Am J Kidney Dis"},{"key":"2024021116094630700_dyad151-B18","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1053\/j.ajkd.2009.12.012","article-title":"Decreased kidney function of unknown cause in Nicaragua: a community-based survey","volume":"55","author":"Torres","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"2024021116094630700_dyad151-B19","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1681\/ASN.2019050521","article-title":"Prevalence and risk factors for CKD in the general population of Southwestern Nicaragua","volume":"31","author":"Ferguson","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"2024021116094630700_dyad151-B20","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.envres.2015.07.007","article-title":"Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador\u2014a cross-shift study of workers at risk of Mesoamerican Nephropathy","volume":"142","author":"Garcia-Trabanino","year":"2015","journal-title":"Environ Res"},{"key":"2024021116094630700_dyad151-B21","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.micinf.2015.08.005","article-title":"Mesoamerican Nephropathy: a neglected tropical disease with an infectious etiology?","volume":"17","author":"Murray","year":"2015","journal-title":"Microbes Infect"},{"key":"2024021116094630700_dyad151-B22","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.kint.2019.11.009","article-title":"Chronic interstitial nephritis in agricultural communities is a toxin-induced proximal tubular nephropathy","volume":"97","author":"Vervaet","year":"2020","journal-title":"Kidney Int"}],"container-title":["International Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ije\/article-pdf\/53\/1\/dyad151\/56658081\/dyad151.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ije\/article-pdf\/53\/1\/dyad151\/56658081\/dyad151.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,11]],"date-time":"2024-02-11T11:10:14Z","timestamp":1707649814000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ije\/article\/doi\/10.1093\/ije\/dyad151\/7334502"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,31]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ije\/dyad151","relation":{},"ISSN":["0300-5771","1464-3685"],"issn-type":[{"value":"0300-5771","type":"print"},{"value":"1464-3685","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2,1]]},"published":{"date-parts":[[2023,10,31]]},"article-number":"dyad151"}}