Environmental exposure assessment in the international prospective study of Chronic Kidney Disease of UnceRtain Etiology (CKDu) in Agricultural Communities (CURE) research consortium: Design and protocol development
Year: 2025
Type: article
Study design: Study Protocol
Abstract: Background Chronic kidney disease of unknown etiology (CKDu) is a major health concern among outdoor manual workers in rural Central America and South Asia. The CURE study is a prospective longitudinal cohort designed to investigate CKDu's environmental risk factors through standardized exposure assessments, questionnaires, and biological and environmental sample collection. Methods This manuscript details the development of a standardized exposure assessment protocol within the CKDu CURE Consortium. The study recruits adults (18–45 years) from CKDu hotspots across five countries, ensuring proportional representation across three eGFR categories (20–59, 60–89, ≥90 mL/min/1.73m 2 ) and excluding participants with diabetes or other known CKD causes. The CURE study is committed to promptly returning clinically and environmentally relevant test results to participants after analysis. Results Exposure assessment includes demographics, healthcare access, nephrotoxic medications, infectious pathogens, and agricultural work conditions (e.g., heat stress, hydration, diet, agrochemicals, toxicants). Biological and environmental samples (water, dust, soil, wristbands) are collected considering seasonal variations. Omics analyses, including metabolomics, will investigate environmental and biological interactions. Statistical analyses will assess relationships between exposures and CKDu onset or progression, incorporating environmental mixture analyses. Conclusion CURE will provide critical insights into CKDu risk factors, supporting future research and prevention strategies. A comprehensive exposure assessment will enhance understanding of environmental contributors, guiding interventions at individual, workplace, and community levels to mitigate CKDu's impact.
Authors: Marvin González-Quiroz, Anna Aceituno, Shuchi Anand, Alexander van Geen, Lawrence S. Engel, Emmanuel Jarquin, Clemens Ruepert, Nicole Villegas-González, Mariela Arias-Hidalgo, Nora Franceschini, Daylin Anchía-Pastrán, Karla Solano-Diaz, Andrea Corrales-Vargas, Jennifer Crowe, Idalina Cubilla-Batista, Hildaura Acosta, Adriana Mike, Carolina Guzmán-Quilo, Aurora Aragón, Indiana López-Bonilla, Peter Rohloff, Madeleine K. Scammell, Ramón Garcia-Trabanino, Juan Amador Velázquez, Daniel R. Brooks, Sumit Mohan, Jai Radhakrishnan, Balaji Gummidi, Vivekanand Jha, Whitney Collado, Vivek Bhalla, David J. Friedman, Sushrut S. Waikar, Karen Kesler, Lillian Trochinski, P. Lee Ferguson, Patrick J. Parsons, Heileen Hsu-Kim, Carin Huset, Susan Summer Jenkins, Susan R. Mendley, Jill F. Lebov, Bonnie R. Joubert, Ana Navas-Acien
Institutions: The University of Texas at San Antonio Health Science Center, University College London, RTI International, Stanford Medicine, Stanford University, Lamont-Doherty Earth Observatory, University of North Carolina at Chapel Hill, Universidad Nacional, Universidad de Costa Rica, Universidad de Panamá, Universidad de San Carlos de Guatemala, Boston University, Columbia University Irving Medical Center, Manipal Academy of Higher Education, The George Institute for Global Health, George Institute for Global Health, The George Institute for Global Health, Imperial College London, Columbia University, Beth Israel Deaconess Medical Center, Boston Medical Center, Duke University, New York State Department of Health, Wadsworth Center, University at Albany, State University of New York, Minnesota Department of Health, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Environmental Health Sciences
Language: English
Subfield: Health, Toxicology and Mutagenesis
Field: Environmental Science
Domain: Physical Sciences
Open Access status: hybrid
Estimated APC paid: $4,250
Awards: Minnesota HHEAR Targeted Analysis Laboratory, Wadsworth Center's Human Health and Exposure Analysis Resource (WC-HHEAR), India - Factors of CKDu in Uddanam Study (India-FOCUS), Discovery Science Collaborative for CKDu, Human Health Exposure Analysis Resource Core: Untargeted Analysis, CKDu in Salvadoran and Nicaraguan Agricultural Communities, Exploring risk factors and predictors of endemic CKDu in agricultural regions of four Central America countries, The Chorotega CKDu Epidemiology Field Study, Chronic Kidney Diseases of Uncertain Etiology (CKDu) in Agricultural Communities (CURE) Research Consortium - SDCC, Duke Environmental Analysis Laboratory
OpenAlex ID: W4410615241