The kidney disease epidemic

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There is growing international attention being paid to an epidemic of chronic kidney disease which is killing men of prime working age in El Salvador and other Central American countries.   The World Health Organization reported last year:

Central American countries have reported a growing number of cases of chronic kidney disease that are not related to traditional causes such as diabetes and hypertension. Cases are concentrated among young men living in low-income agricultural communities along the Pacific coast. The disease appears to be associated with factors including environmental contaminants (most likely agrochemicals) and occupational risks (poor working conditions and insufficient water intake while working in high temperatures), among others. 

Precise data on cases is difficult to collect, but experts believe that thousands of Central Americans have died from the disease over the past 10 years, most of them in Nicaragua and El Salvador. 

Available data are for general chronic kidney disease (CKD), that is, CKD due to both traditional and nontraditional causes. They indicate 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.

Recently National Public Radio in the US aired a story on the epidemic which noted the lack of good information about this costly disease:

 Despite years of research all over the world, scientists still can't definitively pinpoint the cause. 

"We don't know. That's the unfortunate part, and we do desperately need to find some answers," says Reina Turcios-Ruiz, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention's office in Guatemala City. 

This form of kidney failure, known as insuficiencia renal cronica in Spanish (or chronic kidney disease of unknown origin in English), is now found from southern Mexico to Panama, Turcios-Ruiz says. But it occurs only along the Pacific coast. 

The disease is killing relatively young men, sometimes while they're still in their early 20s. Researchers at Boston University have attributed about 20,000 deaths to this form of kidney failure over the past two decades in Central America. 

As the disease progresses, agricultural laborers, who may earn a couple of thousand dollars a year, if they're lucky, end up in need of dialysis that costs tens of thousands of dollars annually.

This month Medicc Review devotes its entire issue to the epidemic. In an opinion piece in that issue titled  Chronic Kidney Disease in Our Farming Communities: Implications of an Epidemic, Dr. María Isabel Rodríguez writes:

 The illness is still more complex because it has deep roots in families and communities whose social conditions open the door to the disease, aided by environmental and occupational determinants.... 

 For farming families already poor, the costs associated with the disease are just as unbearable, simply submerging those affected deeper into poverty. To  halt  the  CKD  epidemic  raging  in  our  farming  communities,  global/regional awareness and resolutions must be transformed into mobilization and cooperation. Otherwise, in a world of possibilities, we will fail—as nations, health systems, governments, and international agencies. And failure is not an option.

Wealthy nations like the US which buy the sugar from the cane fields of El Salvador and market the agricultural chemicals used on those fields need to take steps to assist El Salvador, Nicaragua and the other Central American countries in identifying and mitigating this epidemic.