CKD of Uncertain Etiology: A Systematic Review

Abstract

Background and objectives: Epidemics of CKD of uncertain etiology (CKDu) are emerging around the world. Highlighting common risk factors for CKD of uncertain etiology across various regions and populations may be important for health policy and public health responses.

Design, setting, participants, & measurements: We searched PubMed, Embase, Scopus and Web of Science databases to identify published studies on CKDu. The search was generated in January of 2015; no language or date limits were used. We used a vote-counting method to evaluate exposures across all studies.

Results: We identified 1607 articles, of which 26 met inclusion criteria. Eighteen (69%) were conducted in known CKDu-endemic countries: Sri Lanka (38%), Nicaragua (19%), and El Salvador (12%). The other studies were from India, Japan, Australia, Mexico, Sweden, Tunisia, Tanzania, and the United States. Heavy metals, heat stress, and dietary exposures were reported across all geographic regions. In south Asia, family history, agrochemical use, and heavy metal exposures were reported most frequently, whereas altitude and temperature were reported only in studies from Central America. Across all regions, CKDu was most frequently associated with a family history of CKDu, agricultural occupation, men, middle age, snake bite, and heavy metal exposure.

Conclusions: Studies examining etiologies of CKDu have reported many exposures that are heterogeneous and vary by region. To identify etiologies of CKDu, designing consistent and comparative multisite studies across high-risk populations may help elucidate the importance of region-specific versus global risk factors.

Keywords: chronic kidney disease; global health; humans; low- and middle-income countries; nephrotoxicity; occupations; public health; renal insufficiency, chronic; risk factors; temperature.

Figure 1.

Flow diagram illustrating included and excluded studies in the systematic review.

Figure 2.

Frequency of measured exposures from studies across different regions. (A) Exposures measured in studies from all regions; (B) exposures measured in studies from South Asia; (C) exposures measured in studies from Central America. BMI, body mass index.