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is the second leading cause of death in males of working age in the country. In Nicaragua, mortality rates per 100 000 population for chronic renal insufficiency in 2005 varied among the departments (20). The departments of León and Chinandega had the highest mortality rates among males (60 per 100 000 population). The department with the next highest rate among males was Granada (20 per 100 000), while the national rate was 13 per 100 000 (20). Several Central American mortality and prevalence studies have shown that CKD rates are higher among men than among women, but rates among women are also elevated compared to the United States (3, 7-9, 14, 15, 20-22). Currently, CKD surveillance systems in Central America are under development or are nonexistent. This makes it difficult to determine what the most common etiologies are, to estimate the true burden of this condition, and to determine the proportion of persons with CKD who could be classified as CKDnT (3). Several experts and governmental bodies have recommended strengthening surveillance systems capable of monitoring CKD incidence and prevalence at the population level (5, 9, 11, 23). Implementing CKD surveillance systems throughout Central America is essential to advancing knowledge about CKDnT. Experts stressed the importance of creating a standardized case definition for CKDnT both in 2012 at the First International Research Workshop on Mesoamerican Nephropathy and in 2013 at the 52nd Directing Council meeting of the Pan America Health Organization (PAHO) (9, 23). In response to this situation, a group of surveillance experts, subject matter experts in vital records, epidemiologists, and nephrologists from Central America carried out an inclusive process to propose a standardized epidemiologic case definition for CKDnT. METHODS The Council of Ministries of Health of Central America and the Dominican Republic (COMISCA), PAHO, and the U.S. Centers for Disease Control and Prevention (CDC) coordinated a collaborative process to develop or strengthen CKD surveillance and to draft appropriate data collection tools and methods in response to the COMISCA Resolution from its XXXV meeting in 2011 (24) and the PAHO Resolution CD52.R10 on chronic kidney disease in agricultural communities in Central America from 2013 (23). Subject matter experts in three fields key for assembling a CKD surveillance system (surveillance, vital records, and nephrology) were invited from eight countries: Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama. Subject matter experts on surveillance and vital records were appointed by the ministry of health of each country. Nephrologists were designated by the national chapter of each country of the Latin American Society of Nephrology and Hypertension (SLANH).
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