Epidemiological Transition of Renal Mortality in Chiapas (2000-2024): Autonomy of CKDu and the Rise of Hypertensive Nephropathy-A Time-Series Ecological Study.

摘要

AIM: Chronic kidney disease of non-traditional aetiology (CKDu) has been described in agricultural regions worldwide, yet its contribution to renal mortality in Mexico remains poorly characterised. This study aimed to characterise renal mortality trends in Chiapas and evaluate the autonomy of CKDu relative to metabolic causes. METHOD(S): An ecological time-series study used DGIS mortality microdata for Chiapas, 2000-2024. Renal deaths (n = 46 301) were classified by ICD-10 into DKD, HN, CKDu, ReNe and OthR. Age strata were 0-14, 15-29, 30-44, 45-59 and ≥ 60 years. Age-standardised mortality rates were calculated, APC estimated using log-linear regression, and sociodemographic contrasts assessed using binomial logistic regression (CKDu vs. DKD). Temporal independence between CKDu and diabetes trends was evaluated using trend-correlation and a binomial test for diagnostic substitution. RESULTS: Among individuals aged 15-44 years, CKDu was the leading renal cause of death (44.2%), compared with 27.5% for DKD. CKDu comprised 32.9% of renal deaths in men versus 26.2% in women. The highest mortality growth occurred in men aged 30-44 years (APC 4.01%; p < 0.001). Among agricultural-sector decedents, mortality was more likely to be attributed to CKDu than DKD (OR 1.61). HN showed the fastest overall growth (APC 6.72%). Trend-correlation indicated that 64.5% of CKDu temporal variance was independent of diabetes trends (R2 = 0.3547), with no evidence of diagnostic substitution (p = 0.7). CONCLUSION: Renal mortality in Chiapas shows a dual burden in which CKDu exhibits autonomy, consistent with chronic interstitial nephritis in agricultural communities, and supports surveillance and prevention addressing occupational and environmental determinants.