Chronic Kidney Disease Among Young Men in Nicaragua Poses Health Mystery

A strange thing is happening in a small, industrial region of Nicaragua. Young men are dying, by the thousands, of chronic kidney disease – an illness that usually hits the older population – and no one can figure out why.

Researchers have been trying to solve the public health quagmire of the northwestern section of Nicaragua, a sugarcane region, for about two years. But the mystery has them stumped.

“We know something is happening,” said Daniel Brooks, a professor of epidemiology at Boston University School of Public Health, one of the leaders of the study on Nicaragua's chronic kidney disease problem. “But it’s a puzzle we haven’t been able to figure out – and it is devastating this community.”

According to the National Kidney Foundation, about 23 million Americans have chronic kidney disease, though it’s treatable if found early. The rate in Nicaragua is 10 times higher, researchers say, though a bigger problem is how quickly the disease advances – the condition of most patients is so serious, they are unlikely to survive.

“Once someone gets it, it’s basically a death sentence,” Brooks said.

Chronic kidney disease severely damages the kidneys, triggering the accumulation of dangerous levels of fluid and waste in the body. It is usually caused by diabetes, or high blood pressure, and usually strikes people over 53.

But in this region of Nicaragua, it is killing young working men, ages 15 to 49. The blame was first placed on the sugar cane companies, where many believe laborious work was taking a devastating bodily toll on its workers.

A group of workers even filed a complaint with the World Bank’s Office of the Compliance Advisor/Ombudsman, hoping a mediator could resolve the matter. Some began boycotting Nicaraguan sugar cane products, including the popular Nicaraguan rum Flor de Caña, demanding the company shell out money for its allegedly poor labor practices.

A months-long investigation by BU’s School of Public Health– working with the World Bank – into the health and safety procedures of Ingenio San Antonio (ISA), which is owned by Nicaragua Sugar Estates Limited, found no apparent workplace violations – though other investigations are continuing. The investigators looked into the chemicals used and the conditions employees worked in.

The sugar company has denied they are responsible, and blames the allegation on a group of people only interested in monetary compensation.

“The aforementioned campaign is based on the assumption that former ISA workers acquired the chronic kidney failure disease as a result of working for the company,” Nicaragua Sugar Estates Limited said in a statement. “This campaign is unfounded because chronic kidney failure is a multi-causal disease that is prevalent throughout the world.”

The company also says it follows the same agricultural practices “used throughout the world.”

And while the issue has pitted the profitable sugar company against some of its workers, and the community, one question remains unanswered: Why are so many young men dying?

Similar chronic kidney disease issues are happening up and down the Pacific Coast in Central America, and a similar problem is happening in Sri Lanka – all involving young men in agricultural work, said Brooks, of BU School of Public Health.

The biggest problem with kidney issues, he said, is treatment is so expensive. Those with chronic kidney disease require dialysis, or a kidney transplant, which requires sophisticated equipment not readily available in rural, underdeveloped countries.

Future studies will test children, through urine samples and blood test, to determine if they are predisposed to the disease.

“We’re not sure how widespread this is – whether it’s the tip of the iceberg, or a problem in pocket areas,” Brooks said. “But it is a mystery.”

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