Mesoamerican Nephropathy CKD (Chronic Kidney Disease) – Frequently Asked Questions

What is Chronic Kidney Disease (CKDu)?
The origin of chronic kidney disease (CKDu) is unknown and has unfortunately been documented in several countries around the world, particularly those with hot and humid climates such as Sri Lanka, India, Egypt and Central America. Mesoamerican Nephropathy (MeN) chronic kidney disease (one form of CKDu) has been identified in the Pacific Ocean coastal low lands of the mesoamerican region, including southern Mexico, Guatemala, El Salvador, Nicaragua, Honduras and Costa Rica. People affected by the epidemic are mainly young and middle-aged male laborers in the agricultural sector, including sugarcane workers. The disease has also been found to be prevalent in other occupations such as mining, construction, and ports.

Does CKDu exist only in Nicaragua’s sugar production zones?
Costa Rica, El Salvador and Nicaragua are the main countries with affected populations. Based on both anecdotal evidence and published reports cited in Microbes and Infection, Nicaragua and El Salvador bear a disproportionate burden of this disease and now rank among countries with the highest kidney-related mortality in the world. In Nicaragua, the disease primarily affects young men from poor, rural areas, the majority of whom are agricultural workers. CKDu has also been reported in other agricultural communities around the world.

Does any link exist between CKDu and sugarcane cultivation?
A 2014 study published in the American Journal of Kidney Disease reported “At present, Mesoamerican nephropathy is a medical enigma yet to be solved,” which was supported by a subsequent study published in the same publication in 2015.

What is Ingenio San Antonio (ISA) doing to address the prevalence of CKDu among its workforce?
We have participated in and made several changes to our operations based on scientific advancements and consensus-building discussions regarding underlying risk factors and potential causes of CKDu. Over the last several years, ISA has been at the forefront in Nicaragua of a cross-industry effort aimed at eradicating CKDu (Mesoamerican Nephropathy), which affects workers across many industries around the world. Specifically, ISA has collaborated with international research groups from Boston University and the Baylor School of Medicine to study the presence of CKD in our region. In partnership with these institutions, and based on their independent recommendations, ISA has developed Nicaragua’s most comprehensive programs to prevent, control, monitor and measure the incidence of CKD among our workforce. ISA has also established training programs so that other companies and organizations can learn from and utilize these best practices.

What specific health and safety programs does Ingenio San Antonio (ISA) utilize to address the CKDu epidemic?
Ingenio San Antonio’s comprehensive program, which is in part based on recommendations made by medical studies of CKDu, utilizes what we believe are the country’s most stringent and rigorous health and safety procedures. Notwithstanding, we know there is more we can do so we continue to collaborate with the industry and academia to further study this illness and improve our practices to achieve further progress.

We have participated in and made several changes to our operations based on scientific advancements and consensus-building discussions regarding underlying risk factors and potential causes of CKDu. Specifically, over the last several years, ISA has been at the forefront in Nicaragua of a cross-industry effort aimed at eradicating CKDu. We have also collaborated with international research groups from Boston University and the Baylor School of Medicine to study the presence of CKD in our region. In partnership with these institutions, and based on their independent recommendations, ISA has developed our country’s most comprehensive programs available today to prevent, control, monitor and measure the incidence of CKD among our workforce. We recognize this is a start and we welcome emerging guidance from the medical and occupational health communities so we can do more to prevent and eradicate disease. ISA has also established training programs so that other companies and organizations can learn from and utilize these best practices as they evolve to meet current understanding.

ISA’s health and safety practices include programs that reduce the risk of heat stress among our workers, based on a series of recommendations by Boston University. Our operational protocols have been updated to include Nicaragua’s more advanced practices in terms of hydration, rest and shade and ISA has continually investing to expand the number of health and security personnel in the fields to ensure policies are followed. All employees, as well as management, receive regular training from medical personnel to learn about relevant health risks and how to prevent them. ISA was the first in our country to establish a mobile health clinic to provide preventative care and attention, with two more clinics expected to be added in 2016.

Are Ingenio San Antonio’s (ISA) health and safety practices reviewed by independent experts?
Ingenio San Antonio’s health and safety programs are certified and audited by numerous domestic and international institutions on a regular basis. International and domestic certifications and auditing institutions include (but are not limited to):

  • Quality Assurance Management System – ISO9001: 2008
  • Food Safety Management System, HACCP (Hazard Analysis and Critical Control Points)
  • Food Safety Management System, FSSC22000 (Food Safety System Certification).
  • Jewish Food Safety Management System – KOSHER
  • Occupational Health and Safety Management System – OHSAS18001: 2007
  • Sustainability Management System ISCC (International System & Carbon Certification)
  • Supplier Guiding Principles of Coca Cola Company
  • Environmental Management System – ISO 14001: 2004
  • National Council of Labor Hygiene and Safety of Nicaragua
  • Ministry of Labour (MITRAB) , Nicaraguan Institute of Social Security (INSS), Ministry of Health MOH)

Who is Ingenio San Antonio?
Ingenio San Antonio is a sugar mill, established in 1890 that, amongst other businesses, sells molasses to several companies, including Compañía Licorera de Nicaragua, which produces Flor de Caña

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