O-132 7-year followup in a young adult population at risk of mesoamerican nephropathy

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Introduction Mesoamerican Nephropathy is a leading contributor to premature mortality in Central America, but the primary cause remains unclear. Early disease is challenging to identify given variation in eGFR both within and between healthy individuals and absence of haematuria or proteinuria. We explored the incidence of CKD (stage 3–5) as well as evidence of early kidney injury in the at-risk population from Northwest Nicaragua. Method We conducted a community-based longitudinal study of two cohorts of adults aged 18–30 (n=351 and 420) over 7- and 3-years respectively. We estimated the time point of departure from a healthy eGFR distribution to indirectly capture timing of early kidney injury. We then examined exposure associations with (i) time to CKD and (ii) early kidney injury. Result CKD occurred in men only (male incidence rates of 0.8%/year and 0.6%/year in the two cohorts). 53 men (14%) and 8 women (3%) developed early kidney injury. Cumulative time in sugarcane work and symptoms of excess occupational sun exposure associated with incident CKD. Measured and self-reported weight loss, nausea, vomiting and cramps along with excess occupational sun exposure and non-steroidal anti-inflammatory use associated with early kidney injury. Conclusion The burden of CKD in this population is high and risk factors for established disease are occupational. A clinical syndrome suggesting an alternative exposure is associated with early kidney injury, supporting separate initiating and exacerbating factors. Further investigating episodes of early kidney injury will facilitate efforts to uncover the initiating factor. Meanwhile interventions to reduce the impact of exacerbating factors should be vigorously pursued.

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