Mahalingasivam, V;
Caplin, B;
(2019)
CKD of undetermined aetiology: Tens of thousands of premature deaths yet too many unknowns remain.
Nephrology Dialysis Transplantation
, 34
(11)
pp. 1839-1841.
10.1093/ndt/gfz014.
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Abstract
Tens of thousands of working-age adults have been dying from unexplained end-stage renal disease (ESRD) in Central America and South Asia. As the cause of this chronic kidney disease (CKD) remains unknown, the condition(s) (a unified aetiopathology has not been confirmed) has been termed ‘CKD of undetermined aetiology’ (CKDu). ‘CKD of non-traditional aetiology’, ‘chronic interstitial nephritis in agricultural communities’, ‘Mesoamerican nephropathy’, ‘Sri Lankan agricultural nephropathy’ and ‘Uddanam nephropathy’ are also used, but here we use the term CKDu. The first reports of CKDu, almost 20 years ago, were based on observations of an excess of working-age adults from agricultural communities in El Salvador and Sri Lanka receiving dialysis, but without a diagnosis explaining their ESRD [1, 2]. Available population-level data now support a high prevalence of renal dysfunction in the absence of known risk factors in Central America and South Asia [3–5], but the global extent of the problem remains unclear (Figure 1). Lack of access to renal replacement therapy (RRT) in many affected areas means that death from ESRD is common.
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