Our Studies

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OUR PROGRAMS

La Isla Foundation is working to get better data on the causes of the CKD (Chronic Kidney Disease) epidemic in La Isla, Candelaria, and other communities within Chichigalpa, Nicaragua. This effort will give us a more definitive roadmap for prevention and treatment of the disease and for advocacy options for the afflicted communities.

La Isla Foundation joined with the National Autonomous University of Nicaragua-Leon (UNAN-León) to conduct a prevalence study of CKD in La Isla and Candelaria, the two communities most devastated by the epidemic. With funding and logistical support from the Foundation, four medical school professors at UNAN-León, together with a team of more than 30 medical students, carried out the prevalence study to measure the nature and scope of the kidney failure epidemic in those areas. They found that 65 percent of the men randomly selected for screening had CKD. Half of these men were in the advanced stages of the disease, where they would need dialysis or a kidney transplant to have a chance of survival. Women also had high rates of CKD, but at much lower levels than the men.

•Approximately 70% of the men and over 30% of the women of La Isla suffer from CKD
•Approximately 33% of all men in La Isla are in severe or end- stage CKD
•Nearly 17% of men age 20-29 have irreversible kidney damage
•Nearly 60% of men age 40-49 have irreversible kidney damage

Almost all of the men with CKD were current or former laborers in the large sugar-cane plantation and mill nearby owned by Ingenio San Antonio, one of the oldest businesses in Nicaragua. Sugar is cut, processed, and packaged on site, and also used to make rum sold under the brand name Flor de Cana. The researchers theorized that there were several possible causes for the CKD epidemic, including exposure to intense heat and agricultural pesticides on the plantation, inadequate water consumption by the workers, poor diet and nutrition among the workers and their families, and the existence of environmental and biological contaminants in the soil and water. The study followed earlier findings also suggesting these factors as possible causes of the epidemic.

Building on the work we have done with the prevalence study, we have planned a major CKD causality study.

STUDIES:

On The Horizon

To prepare the health brigades, we have teamed with psychologists at National Autonomous University of Nicaragua-Leon (UNAN-León) to conduct a comprehensive Knowledge, Attitudes, and Practices (KAP) study of the community with regard to health and nutrition. With funding from La Isla Foundation, the two-month-long KAP study was begun in July 2009.

The goal of the study is to determine the level of awareness, attitudes, and social practices in relation to CKD in La Isla. An improved understanding of the psychological conditions related to this disease will lead to better strategies for prevention and treatment, and will improve the quality of life for those who are affected by the disease. The psychological effect of CKD on a patient’s behavior and mental health can vary depending on factors such as the age of the patient, social and family environments, religious beliefs, and economic factors. People with the illness tend to suffer a decrease in aspirations and interests and have a negative view of the future. Despondency leads to difficulty adhering to treatment, and often to abandonment of meaningful activities with the family and community.

Adaptation to this disease is fundamental for a patient’s recovery and a return to normal living conditions. This provides a better environment for psychological rehabilitation and improves the quality of life. To achieve this it is necessary to document the current knowledge, attitudes, and practices of those with CKD in order to prepare an intervention plan that focuses on individual realities.

Chronic Renal Insufficiency Causality Study

To determine the causes of the CKD (Chronic Kidney Disease) epidemic more definitively, La Isla Foundation is working with researchers at National Autonomous University of Nicaragua-Leon (UNAN-León) to develop a causality study of CKD in the Chichigalpa region. The study will contribute to the prevention, early detection, and appropriate diagnosis of CKD The study will be carried out in two stages.

First, researchers will identify relevant environmental and biological contaminants in the region, such as pesticides and heavy metals including lead, mercury, arsenic, and cadmium. Based on information regarding pesticide imports and use in these areas, analyses of different environmental elements (soil, water, dust, food) and their levels of contamination will be made. Rural communities demonstrating high incidence rates but different economic activities will be chosen. The main sources of water will be identified, and pesticide and heavy metal levels will be evaluated. Samples of soil from gardens and dust from inside houses will be collected, from people both with and without CKD. All of the sampled locations will be coordinated on a map using GPS. Pathways of exposure will be suggested.

All data collected will be analyzed using gas chromatography (GC) with mass spectrometry (MS). This equipment is used extensively in the medical, pharmacological, environmental, and law enforcement fields to detect chemical substances in several compartments.

In the second stage of the study, doctors in the region will be trained and equipped to perform biopsies for early detection of CKD. Together with pathologists, three specialists in nephrology will be trained to perform renal biopsies on those with early stages of CKD. Two experts will be sought from foreign universities that have signed cooperation agreements with UNAN-León, to give instruction. Infrastructure will be built up. Cases will be referred to the hospital for biopsies, which will be taken using fine needle aspiration and will be analyzed in the Department of Pathology with the aid of immunofluorescence and electron microscopy.

We are laying the groundwork for this effort by comissioning a human rights study by the National Autonomous University of Nicaragua-Leon (UNAN-León) of the working conditions facing sugar-cane workers in the Chichigalpa municipality. The purpose of the investigation will be to analyze national and international regulatory frameworks in place to guarantee the human rights of current and former agricultural workers from Chichigalpa who have CKD.

The different steps will include:

•To understand the national and international standards for human rights that have been approved by the State in order to protect the rights of the workers.
•To determine the policies best suited for the Nicaraguan government and its agencies to allow for the protection of the human rights of the workers.
•To generate a situational diagnostic assessment of the present status of the workers' rights.
•To prepare a proposal and recommendations for public organizations and institutions in Nicaragua to help improve the status of the workers.

The study will be done through qualitative analysis. In-depth interviews will be conducted with members of national institutions charged with enforcing and protecting the workers' rights. The same technique will be used with non-governmental institutions, associations, and organizations that help protect the workers’ human rights and their perceptions of whether, and to what extent, the rights of those suffering from CKD have been violated. Focus groups will also be conducted with people suffering from CKD and their families in order to attain a comprehensive understanding of the human effects of the disease.

Chronic Kidney Disease Prevalence Study