Chronic kidney disease in Nicaragua: a qualitative analysis of semi-structured interviews with physicians and pharmacists
Open Access
- 15 April 2013
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Public Health
- Vol. 13 (1), 350
- https://doi.org/10.1186/1471-2458-13-350
Abstract
Background: Northwestern Nicaragua has a high prevalence of chronic kidney disease (CKD) of unknown cause among young adult men. In addition, frequent occurrence of urinary tract infections (UTI) among men and a dysuria syndrome described by sugarcane workers as "chistata" are both reported. This study examines health professionals' perceptions regarding etiology of these conditions and their treatment approaches, including use of potentially nephrotoxic medications. Methods: Nineteen in-person semi-structured interviews were conducted in November 2010 among ten physicians and nine pharmacists practicing in the region. Results: Health professionals perceived CKD as a serious and increasing problem in the region, primarily affecting young men working as manual laborers. All interviewees regarded occupational and environmental exposure to sun and heat, and dehydration as critical factors associated with the occurrence of CKD. These factors were also considered to play a role in the occurrence of chistata in the region. Health professionals indicated that reluctance among workers to hydrate might be influenced by perceptions of water contamination. Symptoms often were treated with non-steroidal anti-inflammatory drugs (NSAIDs), diuretics and antibiotics. Physicians acknowledged that the diagnosis of UTI usually was not based on microbial culture and opined that the use of potentially nephrotoxic medications may be contributing to CKD. Conclusions: Interviews provided evidence suggesting that medications such as diuretics, antibiotics and NSAIDs are widely used and sold over the counter for symptoms that may be related to dehydration and volume depletion. These factors, alone or in combination, may be possible contributors to kidney damage. Acute kidney damage coupled with volume depletion and exposures including medications and infectious agents should be further evaluated as causal factors for CKD in this region.Keywords
This publication has 38 references indexed in Scilit:
- The Central American Epidemic of CKDClinical Journal of the American Society of Nephrology, 2013
- Decreased Kidney Function Among Agricultural Workers in El SalvadorAmerican Journal of Kidney Diseases, 2012
- Acute kidney injury: a springboard for progression in chronic kidney diseaseAmerican Journal of Physiology-Renal Physiology, 2010
- Decreased Kidney Function of Unknown Cause in Nicaragua: A Community-Based SurveyAmerican Journal of Kidney Diseases, 2010
- Asymptomatic Renal Colonization of Humans in the Peruvian Amazon by LeptospiraPLoS Neglected Tropical Diseases, 2010
- Heat stress assessment among workers in a Nicaraguan sugarcane farmGlobal Health Action, 2009
- A pilot field evaluation on heat stress in sugarcane workers in Costa Rica: What to do next?Global Health Action, 2009
- A prospective comparative study of gentamicin‐ and amikacin‐induced nephrotoxicity in patients with normal baseline renal functionFundamental & Clinical Pharmacology, 2009
- Nefropatía terminal en pacientes de un hospital de referencia en El SalvadorRevista Panamericana de Salud Pública, 2002
- Analgesic Use and Chronic Renal DiseaseNew England Journal of Medicine, 1989