ArticleBMJ open2021
Cross-sectional study examining the accuracy of self-reported smoking status as compared to urinary cotinine levels among workers at risk for chronic kidney disease of unknown origin in Guatemala.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 10 citations in OpenAlex.
- The Need for Omics Studies in Chronic Kidney Disease of Unknown Etiology (CKDu): A Narrative Review and Perspective.International journal of molecular sciences · 2026Review
- Novel Lipid Biomarkers of Chronic Kidney Disease of Unknown Etiology Based on Urinary Small Extracellular Vesicles: A Pilot Study of Sugar Cane Workers.Metabolites · 2025Article
- Prenatal environmental tobacco smoke exposure: a predictor of blood selenium levels in children.Frontiers in public health · 2025Article
- Urine cotinine versus self-reported smoking and the risk of chronic kidney disease.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Article
- Exposome and Metabolome Analysis of Sugarcane Workers Reveals Predictors of Kidney Injury.Kidney international reports · 2024Article
- Urinary concentrations of metals before and after volcanic eruption: a natural experiment surrounding the eruption of Volcán de Fuego, 2018.Environmental geochemistry and health · 2023Article
- Prevalence of kidney disease of unknown etiology in agricultural workers, Guatemala.Revista panamericana de salud publica = Pan American journal of public health · 2023Article
- Where do you live and what do you do? Two questions that might impact your kidney health.Frontiers in nephrology · 2022Review
- Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
Abstract
objectivesThere is a lack of information on cotinine levels in rural populations in low-income and middle-income countries like Guatemala. Therefore, there is a need to explore smoking status and biomarkers of tobacco use in epidemiological research in rural, low-income populations, in particular those at-risk for chronic kidney disease of unknown origin (CKDu).
designWe evaluated self-reported smoking status against urinary cotinine levels, the gold standard biomarker of tobacco smoke exposure, among agricultural workers at four separate cross-sectional time points.
settingGuatemala.
participants283 sugarcane workers. PRIMARY OUTCOME MEASURES: Compared self-reported smoking status and urinary cotinine levels in two agricultural worker studies.
resultsSelf-reported smoking prevalence was 12% among workers. According to cotinine levels (≥50 ng/mL), the smoking prevalence was 34%. Self-reported smoking status had 28% sensitivity and 96% specificity. Urinary cotinine levels show that smoking prevalence is underestimated in this worker population.
conclusionsAccording to our findings, smoking status should be objectively measured with biomarkers rather than self-reported in CKDu epidemiological research. Self-reported smoking status is likely an underestimate of the true smoking prevalence among agricultural workers. Research on the CKDu epidemic in Central America and other parts of the world might be underestimating tobacco exposure as a potential contributor to the development of CKDu.
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