Kidney health among adolescents living in a high-risk region for CKDu.

backgroundAn epidemic of chronic kidney disease of uncertain origin (CKDu) imposes devastating mortality and morbidity in Central America, where the disease is termed Mesoamerican Nephropathy (MeN). MeN typically presents in young men working in heat-intensive manual jobs, notably agriculture, although the full disease etiology is unclear. Kidney health among young people in the region, particularly among females and those not employed in agriculture, is poorly characterized, limiting prevention efforts.

methodsWe analyzed questionnaire and biospecimen data collected in 2023 from adolescents and young adults residing in five regions in Nicaragua, a country heavily impacted by the MeN epidemic (n = 568). Poor kidney health was defined as estimated glomerular filtration rate (eGFR) of < 90, <75, and < 60 mL/min/1.73 m², per international guidelines. We characterized an early MeN high-risk profile as eGFR < 75 mL/min/1.73 m² absent comorbid high BMI, diabetes, or hypertension. Employment, sociodemographic, and environmental predictors of low eGFR were assessed using inverse‑frequency weighted multivariable and bootstrapped LASSO‑penalized logistic regression.

resultsMedian eGFR was 106.7 mL/min/1.73 m² (IQR 16.3). The prevalence of eGFR < 90, <75, and < 60 mL/min/1.73 m² was 17.8% (n = 101), 4.1% (n = 23), and 1.1% (n = 6), respectively. EGFR < 75 mL/min/1.73 m² was more common in males than females (6.3% vs. 2.0%; p = 0.001). The MeN high‑risk profile was identified in 1.6% of participants (9/568), all males. Sugarcane employment in the last year was associated with higher odds of eGFR < 90 mL/min/1.73 m² (aOR 2.03; 1.10, 3.88; LASSO mOR 1.35; 1.00, 3.82). High BMI was associated with eGFR < 90 mL/min/1.73 m² (aOR 1.54; 1.16, 2.06; LASSO mOR 1.22; 1.00, 2.07). Other exposures, including residential drinking water source, low socioeconomic status, and non‑sugarcane heat‑intensive labor, were not significantly associated with low eGFR.

conclusionsWe observed evidence of poor kidney health among Nicaraguan adolescents and young adults. A MeN high-risk profile was observed exclusively among young males and included individuals without occupational heat exposure. Our findings suggest elevated prevalence of multiple profiles of kidney dysfunction among young people in the region not fully explained by occupational exposures. Further surveillance of kidney health among young people may shed light on early life risk factors for this devastating disease.