53 participants from 14 countries gathered in Costa Rica, Nov 2012. After the workhop a Declaration was crafted, a Technical Report was published, and CENCAM – a consortium of scientists – was founded.
Main message from the workshop
There is an epidemic of chronic kidney disease of unknown etiology (CKDu) in several parts of Mesoamerica. This public health problem is of such magnitude and severity that urgent, exhaustive and collaborative actions must be put into place to elucidate the cause(s), act on available information to prevent further disease and find permanent solutions for prevention and mitigation.
The general consensus of the workshop was that the strongest causal hypothesis for the epidemic is repeated episodes of heat stress and dehydration during heavy work in hot climates. Co-factors to consider interacting with heat stress or influencing the progression of CKDu, include excess use of nonsteroidal anti-inflammatory drugs (NSAIDs) and fructose consumption in rehydration fluids. Contributing factors for the epidemic could include inorganic arsenic, leptospirosis, pesticides, or hard water. Interventions to reduce heat stress and improve hydration with controlled trials are recommended.
The need for well-designed, interdisciplinary collaborative research is emphasized, with priority attention on biopsy studies to elucidate pathophysiology, prevalence studies to further measure magnitude and identify new population groups at risk, and prospective cohort studies to advance etiologic research. Attention to treatment of existing CKD is also a priority.
A Declaration was signed by workshop participants emphasizing the public health problem and the immediate need for prevention. Support is offered to governments to act now on existing knowledge and to local researchers and multisector actors to advance research through collaborative efforts.
An international research consortium of investigators was established.