Open Access Research article

Chronic kidney disease in Nicaragua: a qualitative analysis of semi-structured interviews with physicians and pharmacists

Oriana Ramirez-Rubio12, Daniel R Brooks2, Juan Jose Amador2, James S Kaufman3, Daniel E Weiner4 and Madeleine Kangsen Scammell5*

  • * Corresponding author: Madeleine Kangsen Scammell

Author Affiliations

1 Department of Preventive Medicine and Public Health, Universidad Autonoma de Madrid, C/Arzobispo Morcillo 4, Madrid, 28029, Spain

2 Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T4E, Boston, MA, 02118, USA

3 Research Service and Department of Medicine, VA New York Harbor Healthcare System, Research Service (151), 423 East 23rd St, New York, NY, 10010, USA

4 Division of Nephrology, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street,, Boston, MA, 02111, USA

5 Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA

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BMC Public Health 2013, 13:350  doi:10.1186/1471-2458-13-350

Published: 16 April 2013



Northwestern Nicaragua has a high prevalence of chronic kidney disease (CKD) of unknown cause among young adult men. In addition, frequent occurrence of urinary tract infections (UTI) among men and a dysuria syndrome described by sugarcane workers as “chistata” are both reported. This study examines health professionals´ perceptions regarding etiology of these conditions and their treatment approaches, including use of potentially nephrotoxic medications.


Nineteen in-person semi-structured interviews were conducted in November 2010 among ten physicians and nine pharmacists practicing in the region.


Health professionals perceived CKD as a serious and increasing problem in the region, primarily affecting young men working as manual laborers. All interviewees regarded occupational and environmental exposure to sun and heat, and dehydration as critical factors associated with the occurrence of CKD. These factors were also considered to play a role in the occurrence of chistata in the region. Health professionals indicated that reluctance among workers to hydrate might be influenced by perceptions of water contamination. Symptoms often were treated with non-steroidal anti-inflammatory drugs (NSAIDs), diuretics and antibiotics. Physicians acknowledged that the diagnosis of UTI usually was not based on microbial culture and opined that the use of potentially nephrotoxic medications may be contributing to CKD.


Interviews provided evidence suggesting that medications such as diuretics, antibiotics and NSAIDs are widely used and sold over the counter for symptoms that may be related to dehydration and volume depletion. These factors, alone or in combination, may be possible contributors to kidney damage. Acute kidney damage coupled with volume depletion and exposures including medications and infectious agents should be further evaluated as causal factors for CKD in this region.