Kidney disease in Nicaragua linked to adolescents and young women, and those without occupational heat exposure
· Medical Xpressedited by Sadie Harley, reviewed by Andrew Zinin
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Chronic kidney disease of unknown origin (CKDu) is an ongoing global health concern and public health challenge. Often described as a silent health threat, it can progress without the classic metabolic symptoms of kidney disease, such as obesity and diabetes. It is typically not diagnosed until it reaches an advanced stage and is often fatal. Although the disease's progression remains poorly understood, CKDu has primarily affected young men doing heat-intensive manual labor in equatorial agricultural communities.
Now, a new study led by researchers at Boston University School of Public Health (BUSPH) indicates that other populations in these regions also face a greater risk of kidney dysfunction, and at younger ages.
Published in the journal BMC Nephrology, the study found that young adults and adolescents in Nicaragua had an elevated risk of developing both metabolic and non-metabolic (CKDu) kidney disease compared with similar populations in the United States.
Notably, the findings showed a greater prevalence of poor kidney health among girls and young women than previously known. This population is often excluded from CKDu research because girls and young women are rarely diagnosed with the disease. Their elevated risk was also strongly associated with high body mass index (BMI), indicating an elevated risk of metabolic kidney disease.
Although the researchers identified poor kidney health among heat-exposed young men working in sugarcane fields, most participants who showed signs of poor kidney health did not work in heat-intensive environments. Both findings were unexpected.
"We were surprised to see that there appears to be multiple pathways to kidney disease in this region among young people and that exposure to extreme heat, while important, is not the sole driver of poor kidney health here," says the study's senior and corresponding author, Jessica Leibler, an associate professor of environmental health at BUSPH.
"We were also interested to see how prevalent poor kidney health was among girls and young women. We believe we identified early and important signals of kidney disease risk that may allow for early interventions in this region."
For the study, a team of BUSPH researchers collaborated closely with Nicaragua-based colleagues to analyze survey and biospecimen data from adolescents and young adults living in five regions of Nicaragua in 2023.
The researchers measured participants' estimated glomerular filtration rates to distinguish between non-metabolic characteristics associated with CKDu (also referred to as Mesoamerican Nephropathy in Nicaragua) risk and metabolic kidney disease risk. They also assessed participants' history of high BMI, diabetes and hypertension, as well as employment, sociodemographic factors and environmental exposures.
Although the researchers did not observe significant links between poor kidney health and drinking water, low socioeconomic status or heat-intensive work outside sugarcane fields, the patterns they did observe suggest that risk factors for kidney disease are present at younger ages.
"Our findings suggest that there may be non-occupational factors affecting kidney health in this region, such as genetic susceptibilities or environmental exposures, and that young people—including girls and women—should be involved in surveillance efforts," says co-lead author Selene Vences Brown, a Ph.D. student in environmental health at BUSPH. "To date, kidney disease screening is focused on men working in sugarcane production."
CKDu primarily occurs in Central America and South Asia, but there are other hot spots in rural agricultural communities across the globe, from Africa to Thailand, and also Texas.
The disease can have significant effects on families and communities, says co-lead author Yirong Yuan, a Ph.D. student in biostatistics at BUSPH. "CKDu also inflicts social and economic consequences, leading to financial instability for families and contributing to intergenerational poverty."
The team is continuing to study early-life, metabolic and occupational risk factors among young people in Nicaragua. Yuan is currently analyzing longitudinal kidney health data to identify patterns and trajectories in kidney health among these populations.
The work demonstrates collaboration across research disciplines, with doctoral students in environmental health and biostatistics co-leading the manuscript, Leibler says.
"I'd love for this collaborative approach to become more commonplace for doctoral studies, as it reflects sharing of expertise that is vital for impactful public health research," she says.
Vences Brown also reflects on the value of local engagement throughout the project: "We are very grateful to our Nicaragua-based colleagues, whose dedication and commitment to this research were critical to the project's success."
More information
Selene Vences Brown et al, Kidney health among adolescents living in a high-risk region for CKDu, BMC Nephrology (2026). DOI: 10.1186/s12882-026-05070-1
Key medical concepts
Estimated Glomerular Filtration Rate
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NephrologyCommon illnesses & PreventionWomen's healthChildren's health Provided by Boston University Who's behind this story?
Sadie Harley
BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →
Andrew Zinin
Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →
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