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<record>
<TEI>
<teiHeader>
<fileDesc>
<titleStmt>
<title xml:lang="en">CKD of Uncertain Etiology: A Systematic Review</title>
<author>
<name sortKey="Lunyera, Joseph" sort="Lunyera, Joseph" uniqKey="Lunyera J" first="Joseph" last="Lunyera">Joseph Lunyera</name>
<affiliation>
<nlm:aff id="aff1">Duke Global Health Institute,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mohottige, Dinushika" sort="Mohottige, Dinushika" uniqKey="Mohottige D" first="Dinushika" last="Mohottige">Dinushika Mohottige</name>
<affiliation>
<nlm:aff id="aff2"></nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Isenburg, Megan Von" sort="Isenburg, Megan Von" uniqKey="Isenburg M" first="Megan Von" last="Isenburg">Megan Von Isenburg</name>
<affiliation>
<nlm:aff id="aff4">Duke Medical Center Library,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Jeuland, Marc" sort="Jeuland, Marc" uniqKey="Jeuland M" first="Marc" last="Jeuland">Marc Jeuland</name>
<affiliation>
<nlm:aff id="aff1">Duke Global Health Institute,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut=", and" id="aff5">Sanford School of Public Policy</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="aff7">Institute of Water Policy, Lee Kwan Yew School of Public Policy, National University of Singapore, Singapore</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Patel, Uptal D" sort="Patel, Uptal D" uniqKey="Patel U" first="Uptal D." last="Patel">Uptal D. Patel</name>
<affiliation>
<nlm:aff id="aff1">Duke Global Health Institute,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="aff2"></nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="aff3">Pediatrics,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut="; and" id="aff6">Duke Clinical Research Institute, Duke University, Durham, North Carolina</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Stanifer, John W" sort="Stanifer, John W" uniqKey="Stanifer J" first="John W." last="Stanifer">John W. Stanifer</name>
<affiliation>
<nlm:aff id="aff1">Duke Global Health Institute,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="aff2"></nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut="; and" id="aff6">Duke Clinical Research Institute, Duke University, Durham, North Carolina</nlm:aff>
</affiliation>
</author>
</titleStmt>
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<idno type="wicri:source">PMC</idno>
<idno type="pmid">26712810</idno>
<idno type="pmc">4791820</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791820</idno>
<idno type="RBID">PMC:4791820</idno>
<idno type="doi">10.2215/CJN.07500715</idno>
<date when="2015">2015</date>
<idno type="wicri:Area/Pmc/Corpus">000007</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000007</idno>
</publicationStmt>
<sourceDesc>
<biblStruct>
<analytic>
<title xml:lang="en" level="a" type="main">CKD of Uncertain Etiology: A Systematic Review</title>
<author>
<name sortKey="Lunyera, Joseph" sort="Lunyera, Joseph" uniqKey="Lunyera J" first="Joseph" last="Lunyera">Joseph Lunyera</name>
<affiliation>
<nlm:aff id="aff1">Duke Global Health Institute,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mohottige, Dinushika" sort="Mohottige, Dinushika" uniqKey="Mohottige D" first="Dinushika" last="Mohottige">Dinushika Mohottige</name>
<affiliation>
<nlm:aff id="aff2"></nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Isenburg, Megan Von" sort="Isenburg, Megan Von" uniqKey="Isenburg M" first="Megan Von" last="Isenburg">Megan Von Isenburg</name>
<affiliation>
<nlm:aff id="aff4">Duke Medical Center Library,</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Jeuland, Marc" sort="Jeuland, Marc" uniqKey="Jeuland M" first="Marc" last="Jeuland">Marc Jeuland</name>
<affiliation>
<nlm:aff id="aff1">Duke Global Health Institute,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut=", and" id="aff5">Sanford School of Public Policy</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="aff7">Institute of Water Policy, Lee Kwan Yew School of Public Policy, National University of Singapore, Singapore</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Patel, Uptal D" sort="Patel, Uptal D" uniqKey="Patel U" first="Uptal D." last="Patel">Uptal D. Patel</name>
<affiliation>
<nlm:aff id="aff1">Duke Global Health Institute,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="aff2"></nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="aff3">Pediatrics,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut="; and" id="aff6">Duke Clinical Research Institute, Duke University, Durham, North Carolina</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Stanifer, John W" sort="Stanifer, John W" uniqKey="Stanifer J" first="John W." last="Stanifer">John W. Stanifer</name>
<affiliation>
<nlm:aff id="aff1">Duke Global Health Institute,</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="aff2"></nlm:aff>
</affiliation>
<affiliation>
<nlm:aff wicri:cut="; and" id="aff6">Duke Clinical Research Institute, Duke University, Durham, North Carolina</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Clinical Journal of the American Society of Nephrology : CJASN</title>
<idno type="ISSN">1555-9041</idno>
<idno type="eISSN">1555-905X</idno>
<imprint>
<date when="2015">2015</date>
</imprint>
</series>
</biblStruct>
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</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<sec>
<title>Background and objectives</title>
<p>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.</p>
</sec>
<sec>
<title>Design, setting, participants, & measurements</title>
<p>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.</p>
</sec>
<sec>
<title>Results</title>
<p>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.</p>
</sec>
<sec>
<title>Conclusions</title>
<p>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.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article">
<pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Clin J Am Soc Nephrol</journal-id>
<journal-id journal-id-type="iso-abbrev">Clin J Am Soc Nephrol</journal-id>
<journal-id journal-id-type="hwp">clinjasn</journal-id>
<journal-id journal-id-type="pmc">cjn</journal-id>
<journal-id journal-id-type="publisher-id">CJASN</journal-id>
<journal-title-group>
<journal-title>Clinical Journal of the American Society of Nephrology : CJASN</journal-title>
</journal-title-group>
<issn pub-type="ppub">1555-9041</issn>
<issn pub-type="epub">1555-905X</issn>
<publisher>
<publisher-name>American Society of Nephrology</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">26712810</article-id>
<article-id pub-id-type="pmc">4791820</article-id>
<article-id pub-id-type="publisher-id">07500715</article-id>
<article-id pub-id-type="doi">10.2215/CJN.07500715</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Articles</subject>
<subj-group>
<subject>Chronic Kidney Disease</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>CKD of Uncertain Etiology: A Systematic Review</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Lunyera</surname>
<given-names>Joseph</given-names>
</name>
<xref ref-type="aff" rid="aff1">*</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mohottige</surname>
<given-names>Dinushika</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup></sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Isenburg</surname>
<given-names>Megan Von</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup></sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jeuland</surname>
<given-names>Marc</given-names>
</name>
<xref ref-type="aff" rid="aff1">*</xref>
<xref ref-type="aff" rid="aff5">
<sup>§</sup>
</xref>
<xref ref-type="aff" rid="aff7">
<sup></sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Patel</surname>
<given-names>Uptal D.</given-names>
</name>
<xref ref-type="aff" rid="aff1">*</xref>
<xref ref-type="aff" rid="aff2">
<sup></sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup></sup>
</xref>
<xref ref-type="aff" rid="aff6">**</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Stanifer</surname>
<given-names>John W.</given-names>
</name>
<xref ref-type="aff" rid="aff1">*</xref>
<xref ref-type="aff" rid="aff2">
<sup></sup>
</xref>
<xref ref-type="aff" rid="aff6">**</xref>
</contrib>
<aff id="aff1">
<label>*</label>
Duke Global Health Institute,</aff>
<aff id="aff2">Departments of
<label></label>
Medicine and</aff>
<aff id="aff3">
<label></label>
Pediatrics,</aff>
<aff id="aff4">
<label></label>
Duke Medical Center Library,</aff>
<aff id="aff5">
<label>§</label>
Sanford School of Public Policy, and</aff>
<aff id="aff6">
<label>**</label>
Duke Clinical Research Institute, Duke University, Durham, North Carolina; and</aff>
<aff id="aff7">
<label></label>
Institute of Water Policy, Lee Kwan Yew School of Public Policy, National University of Singapore, Singapore</aff>
</contrib-group>
<author-notes>
<corresp id="cor1">
<bold>Correspondence:</bold>
Dr. Joseph Lunyera,
<addr-line>310 Trent Drive, Durham, NC 27705</addr-line>
. Email:
<email>josephlunyera@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub">
<day>07</day>
<month>3</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>28</day>
<month>12</month>
<year>2015</year>
</pub-date>
<volume>11</volume>
<issue>3</issue>
<fpage>379</fpage>
<lpage>385</lpage>
<history>
<date date-type="received">
<day>10</day>
<month>7</month>
<year>2015</year>
</date>
<date date-type="accepted">
<day>12</day>
<month>11</month>
<year>2015</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright © 2016 by the American Society of Nephrology</copyright-statement>
<copyright-year>2016</copyright-year>
</permissions>
<self-uri xlink:title="pdf" xlink:type="simple" xlink:href="CJN.07500715.pdf"></self-uri>
<abstract>
<sec>
<title>Background and objectives</title>
<p>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.</p>
</sec>
<sec>
<title>Design, setting, participants, & measurements</title>
<p>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.</p>
</sec>
<sec>
<title>Results</title>
<p>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.</p>
</sec>
<sec>
<title>Conclusions</title>
<p>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.</p>
</sec>
</abstract>
<kwd-group>
<kwd>chronic kidney disease</kwd>
<kwd>nephrotoxicity</kwd>
<kwd>risk factors</kwd>
<kwd>global health</kwd>
<kwd>low- and middle-income countries</kwd>
<kwd>humans</kwd>
<kwd>occupations</kwd>
<kwd>public health</kwd>
<kwd>renal insufficiency, chronic</kwd>
<kwd>temperature</kwd>
</kwd-group>
<counts>
<page-count count="7"></page-count>
</counts>
<custom-meta-group>
<custom-meta>
<meta-name>cover-date</meta-name>
<meta-value>March 07, 2016</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
</record>

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