What is CKDu?

What is CKDu?

CKDu or Chronic Kidney Disease of Unknown aetiology/Uncertain cause is a type of chronic kidney disease that mainly affects marginalized agricultural communities in specific areas of the world, in which a large number of people develop an unexplained, deadly disease.

Other regional kidney epidemics have occurred throughout the world.

Figure 1. Regional Nephropathy

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

Balkan endemic nephropathy is perhaps the most prominent historical example. The current CKDu epidemic is occurring chiefly in Sri Lanka and Central America, although additional hotspots are being identified nearly daily. In Central America, CKDu is also known as Mesoamerican Nephropathy.

Figure 2. Chronic kidney disease age-standardized mortality rate trends in all ages population, by sex in Central American countries, from 1997 to 2013

Reference:
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

The cause(s) of CKDu are still to be established and current hypotheses are evaluating various possible etiologies, including:

  1. environmental or occupational exposures (heat, pesticides, water),
  2. infections (occult and overt),
  3. other factors (genetic susceptibility, malnutrition),
  4. 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(1)

In certain countries of Latin America, this issue has become a stark public health crisis. 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.(2)

Thus CKDu is a devastating and deadly phenomenon in affected regions.

  1. 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
  2. (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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