ArticleThe Science of the total environment2025
Environmental exposure assessment in the international prospective study of Chronic Kidney Disease of UnceRtain Etiology (CKDu) in Agricultural Communities (CURE) research consortium: Design and protocol development.
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Article in The Science of the total environment, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Occupational heatstroke-induced acute kidney injury: a narrative review of mechanisms, biomarkers, and the timing of blood purification initiation.Renal failure · 2026Review
- A Pilot Study to Explore the Application of Silicone Wristband-Based Chemical Exposure Assessment to Kidney Disease Epidemiology in Agricultural Workers.Environmental health perspectives · 2026Article
- Environmental exposures and pediatric kidney health.Pediatric research · 2026Review
- CKDPediatric nephrology (Berlin, Germany) · 2026Article
- Rationale and Design of the International Prospective Study of CKD of Uncertain Etiology in Agricultural Communities.Kidney international reports · 2025Article
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Authors and funding
44 authors.
Marvin González-QuirozDepartment of Environmental and Occupational Health, UT School of Public Health San Antonio, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Centre for Kidney and Bladder Health, University College London, London, UK. Electronic address: gonzalezquir@uthscsa.edu.
Anna AceitunoRTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709-2194, USA. Electronic address: aaceituno@rti.org.
Shuchi AnandStanford University School of Medicine, Medicine, Division of Nephrology, 780 Welch Road, Suite 106, Palo Alto, CA 94304, USA. Electronic address: sanand2@stanford.edu.
Alexander van GeenGeochemistry, Lamont-Doherty Earth Observatory (LDEO), Columbia Climate School, New York, NY, USA. Electronic address: avangeen@ldeo.columbia.edu.
Lawrence S EngelUniversity of North Carolina, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, USA. Electronic address: larry.engel@unc.edu.
Emmanuel JarquinAgency for Agricultural Development and Health (AGDYSA), Col. Las Rosas, P. Las Margaritas 15, San Salvador, San Salvador, SV 01101, El Salvador. Electronic address: emmrijarquin@gmail.com.
Clemens RuepertUniversidad Nacional de Costa Rica, Regional Institute for Studies on Toxic Substances, Heredia, Heredia CR 86-3000, Costa Rica. Electronic address: clemens.ruepert@una.cr.
Nicole Villegas-GonzálezEscuela de Tecnologías en Salud, Universidad de Costa Rica, Sede de Guanacaste, Liberia 315000, Costa Rica. Electronic address: nicole.villegas@ucr.ac.cr.
Mariela Arias-HidalgoEscuela de Medicina, Universidad de Costa Rica, Sede Rodrigo Facio, 11501-2060 San José, Costa Rica. Electronic address: mariela.ariashidalgo@ucr.ac.cr.
Nora FranceschiniUniversity of North Carolina, Epidemiology, School of Public Health, 137 E. Franklin Street, suite 306 CB#8050, Chapel Hill, NC 27514-3628, USA. Electronic address: noraf@unc.edu.
Daylin Anchía-PastránUniversidad Nacional de Costa Rica, Regional Institute for Studies on Toxic Substances, Heredia, Heredia CR 86-3000, Costa Rica. Electronic address: daylin.anchia.pastran@una.cr.
Karla Solano-DiazUniversidad Nacional de Costa Rica, Regional Institute for Studies on Toxic Substances, Heredia, Heredia CR 86-3000, Costa Rica. Electronic address: karla.solano.diaz@una.cr.
Andrea Corrales-VargasUniversidad Nacional de Costa Rica, Regional Institute for Studies on Toxic Substances, Heredia, Heredia CR 86-3000, Costa Rica. Electronic address: andrea.corrales.vargas@una.cr.
Jennifer CroweUniversidad Nacional de Costa Rica, Regional Institute for Studies on Toxic Substances, Heredia, Heredia CR 86-3000, Costa Rica. Electronic address: jennifer.crowe@una.cr.
Idalina Cubilla-BatistaHospital Regional Dr. Rafael Estevez, Avenida Alejandro Tapia Final Aguadulce, Coclé, Panama. Electronic address: idacubilla@gmail.com.
Hildaura AcostaUniversidad de Panamá, Vicerrectoría de Investigación y Postgrado, Facultad de Medicina, Centro de Investigación e Información de Medicamentos y Tóxicos (CIIMET), Panamá, Panama. Electronic address: hildaura.depatino@up.ac.pa.
Adriana MikeUniversidad de Panamá, Centro de Investigación e Información de Medicamentos y Tóxicos (CIIMET), Panamá, Panama. Electronic address: adriananmc@gmail.com.
Carolina Guzmán-QuiloUniversidad de San Carlos de Guatemala, Departamento de Toxicología, Facultad de Ciencias Químicas y Farmacia, 3a calle 6-47 zona 1, ciudad de Guatemala 01001, Guatemala. Electronic address: guzmanquilocarolina@gmail.com.
Aurora AragónWuqu' Kawoq, 2da Avenida 3-48 Barrio Pacatabaj, Tecpán, Chimaltenango, GT 04006, Guatemala. Electronic address: auroraragon@gmail.com.
Indiana López-BonillaWuqu' Kawoq, 2da Avenida 3-48 Barrio Pacatabaj, Tecpán, Chimaltenango, GT 04006, Guatemala. Electronic address: indianalopezb@gmail.com.
Peter RohloffWuqu' Kawoq, 2da Avenida 3-48, Barrio Pacatabaj, Tecpán, Chimaltenango 04006, Guatemala. Electronic address: peter@wuqukawoq.org.
Madeleine K ScammellBoston University School of Public Health, Department of Environmental Health, 715 Albany St., Boston, MA 02118, USA. Electronic address: mls@bu.edu.
Ramón Garcia-TrabaninoAgency for Agricultural Development and Health (AGDYSA), Col. Las Rosas, P. Las Margaritas 15, San Salvador, San Salvador, SV 01101, El Salvador; Centro de Hemodiálisis, C. Gabriela Mistral 211, San Salvador, San Salvador, SV 01101, El Salvador. Electronic address: rgt@anhaes.org.
Juan Amador VelázquezBoston University School of Public Health, Department of Epidemiology, Boston, MA, USA. Electronic address: juanjoseamador3011@gmail.com.
Daniel R BrooksBoston University, 715 Albany Street, Department of Epidemiology, Boston, MA 02215-1300, USA. Electronic address: danbrook@bu.edu.
Sumit MohanColumbia University Medical Center, Division of Nephrology, Department of Medicine, and Department of Epidemiology, 622 W 168th St PH4-124, New York, NY 10032, USA. Electronic address: sm2206@cumc.columbia.edu.
Jai RadhakrishnanColumbia University Medical Center, Division of Nephrology, Department of Medicine, and Department of Epidemiology, 622 W 168th St PH4-124, New York, NY 10032, USA. Electronic address: jr55@cumc.columbia.edu.
Balaji GummidiGeorge Institute for Global Health, UNSW, New Delhi, India; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India. Electronic address: bgummidi@georgeinstitute.org.in.
Vivekanand JhaGeorge Institute for Global Health, UNSW, New Delhi, India; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India; School of Public Health, Imperial College, London, UK. Electronic address: vjha@georgeinstitute.org.in.
Whitney ColladoColumbia University Mailman School of Public Health, Department of Environmental Health Sciences, New York, NY, USA. Electronic address: wc2837@cumc.columbia.edu.
Vivek BhallaStanford University School of Medicine, Medicine, Division of Nephrology, 3180 Porter Drive, Stanford, CA 94305, USA. Electronic address: vbhalla@stanford.edu.
David J FriedmanBeth Israel Deaconess Medical Center, Renal Division, 330 Brookline Ave, RN 227B, Boston, MA 02215, USA. Electronic address: dfriedma@bidmc.harvard.edu.
Sushrut S WaikarSection of Nephrology, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, EBRC5, Boston, MA 02118, USA. Electronic address: swaikar@bu.edu.
Karen KeslerRTI International, P O Box 12194, 3040 Cornwallis Rd., Research Triangle Park, NC 27709, USA. Electronic address: kkesler@rti.org.
Lillian TrochinskiRTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709-2194, USA. Electronic address: ltrochinski@rti.org.
P Lee FergusonDepartment of Civil and Environmental Engineering, Duke University, Durham, NC 27708, USA. Electronic address: lee.ferguson@duke.edu.
Patrick J ParsonsDivision of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY 12237, USA; Department of Environmental Health Sciences, College of Integrated Health Sciences, University at Albany, 1 University Pl, Rensselaer, NY 12144, USA. Electronic address: patrick.parsons@health.ny.gov.
Heileen Hsu-KimDuke University, Department of Civil & Environmental Engineering, Box 90287, Durham, NC 27708, USA. Electronic address: hsukim@duke.edu.
Carin HusetPublic Health Laboratory, Minnesota Department of Health, Saint Paul, MN 55101, USA. Electronic address: carin.huset@state.mn.us.
Susan Summer JenkinsDepartment of Nutrition, Gillings School of Global Public Health, USA; Department of Pharmacology, UNC School of Medicine, University of North Carolina at Chapel Hill, USA. Electronic address: susan_sumner@unc.edu.
Susan R MendleyNational Institute of Diabetes and Digestive and Kidney Diseases, Division of Kidney, Urologic and Hematologic Disease, 2 Democracy Plaza, 6707 Democracy Blvd, Bethesda, MD 20892-5458, USA. Electronic address: susan.mendley@nih.gov.
Jill F LebovRTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709-2194, USA. Electronic address: jlebov@rti.org.
Bonnie R JoubertNational Institute of Environmental Health Sciences, Division of Extramural Research and Training, Durham, NC, USA. Electronic address: bonnie.joubert@nih.gov.
Ana Navas-AcienColumbia University Mailman School of Public Health, Department of Environmental Health Sciences, New York, NY, USA. Electronic address: an2737@cumc.columbia.edu.
Funding
Wadsworth Center's Human Health and Exposure Analysis Resource (WC-HHEAR)U2CES026542 · NIEHS · WADSWORTH CENTER · PI KANNAN, KURUNTHACHALAM, KANNAN, KURUNTHACHALAM · 2015 to 2025
$15.6MUntargeted Analysis ResourceU2CES026533 · NIEHS · UNIVERSITY OF MINNESOTA · PI PETERSON, LISA A · 2015 to 2025
$14.0MChronic Kidney Diseases of Uncertain Etiology (CKDu) in Agricultural Communities (CURE) Research Consortium - SDCCU24DK130043 · NIDDK · RESEARCH TRIANGLE INSTITUTE · PI DANIEL R BROOKS, Karen Kesler · 2021 to 2026
$10.4MUntargeted Analysis ResourceU2CES030857 · NIEHS · RESEARCH TRIANGLE INSTITUTE · PI FENNELL, TIMOTHY RAYMOND · 2019 to 2025
$8.1MResearch CoreU2CES030851 · NIEHS · DUKE UNIVERSITY · PI FERGUSON, P. LEE, STAPLETON, HEATHER M · 2019 to 2025
$6.0MDiscovery Science Collaborative for CKDuU01DK130060 · NIDDK · STANFORD UNIVERSITY · PI VIVEK BHALLA, David J Friedman · 2021 to 2026
$5.7MThe Chorotega CKDu Epidemiology Field StudyU01DK130044 · NIDDK · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Mariela Arias-Hidalgo, LAWRENCE STUART ENGEL · 2021 to 2026
$2.9MCKDu in Salvadoran and Nicaraguan Agricultural CommunitiesU01DK130057 · NIDDK · BOSTON UNIVERSITY MEDICAL CAMPUS · PI Madeleine Scammell · 2021 to 2026
$2.8MExploring risk factors and predictors of endemic CKDu in agricultural regions of four Central America countriesU01DK130046 · NIDDK · UNIVERSIDAD NACIONAL, COSTA RICA · PI Jennifer Crowe, MARVIN GONZALEZ-QUIROZ · 2021 to 2026
$2.8MIndia - Factors of CKDu in Uddanam Study (India-FOCUS)U01DK130058 · NIDDK · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI Vivekanand Jha, Sumit Mohan · 2021 to 2026
$2.6MNIDDK NIH HHS U01 DK130044NIDDK NIH HHS U01 DK130046NIDDK NIH HHS U01 DK130057NIDDK NIH HHS U01 DK130058NIDDK NIH HHS U01 DK130060NIDDK NIH HHS U24 DK130043NIEHS NIH HHS U2C ES026533NIEHS NIH HHS U2C ES026542NIEHS NIH HHS U2C ES030851NIEHS NIH HHS U2C ES030857
Abstract
backgroundChronic kidney disease of unknown etiology (CKDu) is a major health concern among outdoor manual workers in rural Central America and South Asia. The CURE study is a prospective longitudinal cohort designed to investigate CKDu's environmental risk factors through standardized exposure assessments, questionnaires, and biological and environmental sample collection.
methodsThis manuscript details the development of a standardized exposure assessment protocol within the CKDu CURE Consortium. The study recruits adults (18-45 years) from CKDu hotspots across five countries, ensuring proportional representation across three eGFR categories (20-59, 60-89, ≥90 mL/min/1.73m
resultsExposure assessment includes demographics, healthcare access, nephrotoxic medications, infectious pathogens, and agricultural work conditions (e.g., heat stress, hydration, diet, agrochemicals, toxicants). Biological and environmental samples (water, dust, soil, wristbands) are collected considering seasonal variations. Omics analyses, including metabolomics, will investigate environmental and biological interactions. Statistical analyses will assess relationships between exposures and CKDu onset or progression, incorporating environmental mixture analyses.
conclusionCURE will provide critical insights into CKDu risk factors, supporting future research and prevention strategies. A comprehensive exposure assessment will enhance understanding of environmental contributors, guiding interventions at individual, workplace, and community levels to mitigate CKDu's impact.
Indexed as
Environmental ExposureOccupational ExposureRenal Insufficiency, ChronicAdolescentAdultAgricultureChronic Kidney Diseases of Uncertain EtiologyFemaleHumansLongitudinal StudiesMaleMiddle AgedProspective StudiesRisk FactorsYoung AdultChronic kidney diseaseCKDuEnvironmental exposuresMetalsPesticidesPolycyclic aromatic hydrocarbonsResearch consortiumTrace elements
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