What is CKDu?

What is CKDu?

Chronic Kidney Disease of Unknown origin (CKDu) is a form of chronic kidney disease that mostly affects agricultural communities in Central America, South Asia, Africa, and possibly other parts of the world(1). Most recently, reports of affected individuals in California and Texas have been published.

Patients affected by CKDu do not usually have common risk factors or underlying conditions that lead to CKD (Chronic Kidney Disease), such as

  • diabetes,
  • hypertension,
  • CVD (cardiovascular disease),
  • glomerulonephritis, or
  • structural renal disease.

The cause(s) of CKDu are still to be established and current hypotheses are evaluating various possible etiologies, including environmental exposures (heat, pesticides, water), infections (occult and overt), other factors, or possible interactions between these in susceptible individuals.

Most of the patients affected by CKDu are males between the ages of 20 and 60 who often live in rural or agricultural settings and may be exposed to extreme working conditions. In initial surveys conducted in Central America, up to 20-30% of adults in ‘endemic communities’ showed a high prevalence of decreased kidney function of unknown origin, possibly environmental or occupational(2) . In certain countries of Latin America, this issue has become a real public health problem. It has been reported that hospitalizations for CKD in El Salvador increased 50% between 2005 and 2012, making CKD the leading cause of hospitalization in the country*. Nearly 1,500 of these hospitalized patients were under 19 years old (out of a total 40,000 hospitalized patients of all ages during the same period). According to data reported by national transplant coordinators, nearly 3,100 patients currently receive dialysis in El Salvador, over 3,000 in Guatemala, 1,800 in Panama and 1,000 in Nicaragua(3).

Figure 1. Chronic kidney disease age-standardized mortality rate trends in all ages population, by sex in Central American countries, from 1997 to 2013

Pan American Health Organization. (2019, October 9). Epidemic of Chronic Kidney Disease in methodological basis and approaches for public health surveillance. Retrieved from http://iris.paho.org/xmlui/handle/123456789/34132

Figure 2. From Sri Lanka

Anand, S et al. CJASN 2019

Figure 3. Description of CKDu

Adapted from: Martin-Cleary, et al CKJ 2014; courtesy Pablo Garcia

Figure 4. Image of a biopsy

Nanayakkara, S et al. Environ Health Prev Med 2012; Wijkstrom J et al. AJKD 2013 & Plos One 2018; Badurdeen, Z et al. Clin Neph 2016; Fischer, R et al. KI2018; Anand, S et al. CJASN 2019

  1. CKD of Unknown Cause: A Global Epidemic? Pearce, Neil et al. Kidney International Reports, Volume 4, Issue 3, 367 - 369
  2. Cecilia Torres et al. (2019, October 9). Decreased Kidney Function of Unknown Cause in Nicaragua: A Community-Based Survey. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S027263860901587X
  3. (2019, October 9). Kidney disease of unknown causes in agricultural communities in Central America is declared a serious public health problem https://www.paho.org/hq/index.php?option=com_content&view=article&id=9062:2013-kidney-disease-agricultural-communities-central-america-serious-public-health-problem&Itemid=1926&lang=en

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