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Institute for Health Research (IdiPAZ), Madrid, Spain Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain

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Correspondence to Dr María Luisa Caballero, Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, Madrid 28046, Spain; [email protected] SV and RR-P contributed equally. Competing interests None. Patient consent Obtained. Ethics approval Hospital Universitario, Burgos. Provenance and peer review Not commissioned; internally peer reviewed.

To cite Veza S, Rodríguez-Perez R, Carretero P, et al. Occup Environ Med 2015;72:237–238. Received 28 January 2015 Revised 11 December 2014 Accepted 3 February 2015 Published Online First 27 January 2015

Occup Environ Med 2015;72:237–238. doi:10.1136/oemed-2014-102564

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Baur X, Budnik LT, von Kirchbach G. Allergic asthma caused by exposure to bacterial alpha-amylase Termamyl®. Am J Ind Med 2013;56:378–80. Vanhanen M, Tuomi T, Hokkanen H, et al. Enzyme exposure and enzyme sensitisation in the baking industry. Occup Environ Med 1996;53:670–6. Sen D, Wiley K, Williams JG. Occupational asthma in fruit salad processing. Clin Exp Allergy 1998;28:363–7. Caballero ML, Gómez M, González-Muñoz M, et al. Occupational sensitization to fungal enzymes used in animal feed industry. Int Arch Allergy Immunol 2007;144:231–9. Baur X. Enzymes as occupational and environmental respiratory sensitizers. Int Arch Occup Environ Health 2005;78:279–86. Vieths S, Jankiewicz A, Wüthrich B, et al. Immunoblot study of IgE binding allergens in celery roots. Ann Allergy Asthma Immunol 1995;75:48–55.

Environmental and occupational factors in CKD 12 March 2015 will mark the 10th anniversary of World Kidney Day (WKD), an initiative of the International Society of Nephrology and the International Federation of Kidney Foundations.1 Since its inception in 2006, WKD has become the most successful effort ever mounted to raise awareness among decision-makers and the general public about the importance of kidney disease. Each year, WKD reminds us that kidney disease is common and harmful, yet treatable. The focus of WKD 2015 is on chronic kidney disease (CKD) in disadvantaged populations.

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CKD is now recognised as a global public health problem and a key determinant of poor health outcomes. While the magnitude of CKD has been better defined in developed countries, increasing evidence indicates that the burden of CKD is as great or even greater in developing countries. Disadvantaged communities—that is, those whose members are of low socioeconomic status, from racial and ethnic minorities and/or indigenous backgrounds—suffer from marked increases in the incidence, prevalence and/or complications of CKD. Diabetes and hypertension are the leading causes of CKD in all developed and many developing countries. By contrast, infectious diseases and environmental and occupational factors continue to play an important role as a cause of endstage renal disease in low-income countries. The elevated prevalence of CKD of unspecified cause in various developing countries reminds us of the relationship between the environment and ill health; among other factors, environmental exposures to heavy metals or other toxins and pollutants may play a significant role in the development of CKD. The elevated prevalence of CKD of unspecified cause that has been reported in male farmers in various developing countries confirms this relationship.2 Indeed, in Nicaragua, increased CKD rates in male farmers aged

Environmental and occupational factors in CKD.

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