# Longitudinal Study of Risk Factors for Mesoamerican Nephropathy among Agricultural Workers in El Salvador, Central America

> **NIH NIH R01** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2021 · $570,158

## Abstract

Project Summary
There is an epidemic of chronic kidney disease (CKD) in Central America, and the prevalence has been
increasing over the past 20 years. El Salvador has the highest overall mortality rate from kidney disease in the
world, and CKD is the second leading cause of mortality among men of working age. Due to its unique
characteristics, the disease is referred to as Mesoamerican Nephropathy (MeN). In the US and Europe, CKD is
common in older populations (age>60), affects men and women equally, and is primarily due to diabetes and
hypertension. In contrast, CKD in certain regions of Central America disproportionately affects younger men and
appears to be unrelated to diabetes or hypertension. Agricultural workers are the most affected, but the specific
cause(s) remains unknown. The goal of the proposed research is to investigate the potential roles of exposure
to the herbicide glyphosate, heavy metals and heat stress on the risk of MeN among sugarcane and corn workers
in El Salvador. The proposed study aims to determine whether glyphosate, heat stress and/or nephrotoxic
metals, alone or in combination, cause kidney injury. We will also investigate whether biomarkers of kidney injury
lead to decreased kidney function over time.
Results of the study may contribute to occupational and environmental heath interventions related to these three
exposures, as well as contribute to the understanding of kidney injury biomarkers, which may be used for early
detection and treatment to mitigate kidney injury and CKD risk. Results may also inform other CKD epidemics
with similar characteristics that have been described in our countries including India and Sri Lanka. Our aims
are: (1) Recruit and establish a cohort of 300 sugarcane and corn workers in El Salvador; (2) Measure heat,
conduct physical examinations of workers, and collect urine and blood samples to 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; (3) Investigate industry, job task, duration of employment,
metals, glyphosate and heat stress, as predictors of kidney function (eGFR) over a 30-month period; (4) Bank
biological samples for future analysis of additional hypotheses as they emerge; and (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. The research team has been planning this longitudinal
cohort study for nearly a year, coordinating with sugar mills, the sugar producers association, a community center
(and leader) in the most affected coastal region of the country where corn cooperatives are highly concentrated,
the leading El Salvadoran nephrologist who first published on this epidemic in 2002, a well-respected
occupational health physician who trains and supports agricultural workers in El Salvador...

## Key facts

- **NIH application ID:** 10117253
- **Project number:** 5R01ES027584-05
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Madeleine Scammell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $570,158
- **Award type:** 5
- **Project period:** 2017-03-01 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10117253

## Citation

> US National Institutes of Health, RePORTER application 10117253, Longitudinal Study of Risk Factors for Mesoamerican Nephropathy among Agricultural Workers in El Salvador, Central America (5R01ES027584-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10117253. Licensed CC0.

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