A national analysis of risk for potential chronic kidney diseases of unknown etiology in Ecuador

An increase of chronic kidney disease (CKD) has affected many tropical countries but with anatypical presentation. This illness, known as Chronic Kidney Disease of Unknown Etiology(CKDu), presents in younger adults without the typical comorbidities for CKD, often amongthose working in agricultural production. The cause of disease is unknown but temperature, heatstress, or dehydration are thought to contribute to the development of this condition. There is noinformation on whether anyone in Ecuador is affected by this illness. We describe CKD rates inEcuador and hypothesize that CKD is impacted by temperature and the agricultural industry inEcuador. Using publicly available data from the Instituto Nacional de Estadísticas y Censosfrom the years 2010—2015, we describe the rate of CKD among adults aged 20—45 in eachprovince, as well as the agricultural industry across Ecuador. We combined this informationwith land surface temperature and used a Poisson mixed effects model to assess the relationshipbetween mean temperature, maximum temperature and agricultural industry with CKD ratesamong adults aged 20—49 in each province. We found that the CKD rate is increasing in thisage group over 2010—2015 (p=0.017), and in 2015, CKD rates were highest in Pastaza. Ourspatial analysis found that both mean temperature and proportion of population in agriculture were positively associated with CKD rate by province in 2014 and 2015. This preliminaryanalysis shows that temperature and agricultural industry are associated with CKD rates amongadults aged 20—49. While this association does not definitively show the presence of CKDu, itprovides evidence to support further investigation of this illness in Ecuador