MesoAmerican Nephropathy Occupational Exposures (MANOS)

The BUSPH Research Group for the Study of Chronic Kidney Disease (CKD) in Central America launched a longitudinal investigation of Mesoamerican Nephropathy, the MesoAmerican Nephropathy Occupational Study (MANOS), in El Salvador and Nicaragua in January of 2018.

Working in close collaboration with in-country investigators led by Drs. Emmanuel Jarquín and Ramón García-Trabanino (El Salvador) and Dr. Juan José Amador and Ms. Damaris Lopez ER (nursing), MPH, (Nicaragua), we recruited workers from diverse industries in Nicaragua and El Salvador: sugarcane, corn, plantain, road construction and artisanal brick production. We monitored participants for three days during their workweek to measure exposures to heat, agrichemicals, and heavy metals, and asked them many questions about their occupational history, behaviors, health, diet, and hydration practices. A total of 569 workers (279 from El Salvador and 290 from Nicaragua) were recruited into the MANOS cohort and completed baseline monitoring in the workplace.

With the data collected, we will evaluate the relationships between occupational exposures and kidney injury and function to help inform intervention strategies and prevent future disease. Our Specific Aims are to:

AIM 1: Recruit and establish a cohort

AIM 2: Characterize exposure to metals and glyphosate at baseline, biomarkers of kidney injury, and exposure to heat stress and muscle damage, pre- and post-shift over three consecutive workdays.

AIM 3: Investigate occupational risk factors, metals, glyphosate and heat stress, as predictors of kidney function (eGFR) over a 30-month period (Rounds 1-6).

AIM 4: Bank biological samples for future analysis.

AIM 5: Communicate individual kidney function results to cohort participants, and overall study results to cohort participants, the scientific community, public health officials, and the general public.

We are grateful to be able to collaborate with la Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), an environmentally focused occupational health agency, with whom we are working to carry out the MANOS research in El Salvador. In Nicaragua, we thank SosteNica for their administrative assistance and coordination.

Funding: This study is funded via an Outstanding New Environmental Scientist (ONES) award to Dr. Madeleine Scammell by the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH) R01 ES027584, and the Azucareros del Istmo Centroamericano (AICA), an association of sugar producers in Central America (see BU-AICA gift agreement). Importantly, the donors have no influence over the design or outcomes of the research, and BU is free to publish all findings.

Publications:

Keogh, S. A., Leibler, J. H., Sennett Decker, C. M., Amador Velázquez, J. J., Jarquin, E. R., Lopez-Pilarte, D., Garcia-Trabanino, R., Delgado, I. S., Petropoulos, Z. E., Friedman, D. J., Amador Sánchez, M. R., Guevara, R., McClean, M. D., Brooks, D. R., & Scammell, M. K. (2022). High prevalence of chronic kidney disease of unknown etiology among workers in the Mesoamerican Nephropathy Occupational Study. BMC Nephrology, 23(1), 238.

Scammell MK. (2019).Trust, Conflict, and Engagement in Occupational Health: North American Epidemiologists Conduct Occupational Study in Communities Affected by Chronic Kidney Disease of Unknown Origin (CKDu). Current Environmental Health Reports.

Scammell MK., Sennett CM, Petropoulos ZE, Kamal J, & Kaufman JS (2019). Environmental and Occupational Exposures in Kidney Disease. Seminars in Nephrology, 39(3), 230–243.

Gallo-Ruiz L, Sennett CM, Sánchez-Delgado M, García-Urbina A, Gámez-Altamirano T, Basra K, Laws LL, Amador JJ, Lopez-Pilarte D, Tripodis Y, Brooks DR, McClean MD, Kupferman J, Friedman D, Aragón A, González-Quiroz M, & Scammell MK (2019). Prevalence and Risk Factors for CKD Among Brickmaking Workers in La Paz Centro, Nicaragua. American Journal of Kidney Diseases : The Official Journal of the National Kidney Foundation.