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Mystery CKD in Central American Workers

Potera, Carol

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AJN, American Journal of Nursing: April 2014 - Volume 114 - Issue 4 - p 17
doi: 10.1097/01.NAJ.0000445673.68693.72
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Walter Arsenio Rivera, 29, poses with his father, Antonio Arsenio Rivera, 58, in the cane fields of Chichigalpa, Nicaragua. Both men suffer from chronic kidney disease. Photo by Ed Kashi for La Isla Foundation/VII.

A chronic kidney disease (CKD) of unknown cause and with unusual characteristics has claimed thousands of lives of agricultural workers in Central America over the past two decades. Members of the Directing Council of the Pan American Health Organization (PAHO) met recently and passed a resolution to speed investigations into the environmental and occupational causes behind this “serious public health problem that requires urgent action.” The PAHO recommendations include improvements to health services for patient care; better surveillance of at-risk communities; and alliances to uncover the condition's causes, which can lead to appropriate, evidence-based interventions. The PAHO resolution, passed in October 2013, supports the similar San Salvador Declaration that was passed the previous April.

The mystery CKD most often affects young men living in low-income agricultural regions along the Pacific coast. However, the cases aren't linked to diabetes and hypertension, the typical causes of CKD, which damage the kidney's filtration system. Rather, this form of CKD damages the renal tubules.

Environmental toxins, such as agricultural chemicals; unsafe working conditions; and inadequate intake of water while working in the heat are suspected factors. According to the Guardian (, workers describe fainting and vomiting in sugar cane fields, where they work without any water for five hours or more in temperatures above 100°F. They also mix and spray agrochemicals without wearing gloves or other protective gear.

El Salvador and Nicaragua have been hit especially hard by this unusual CKD, but high rates are also being seen in Sri Lanka and in India. Precise statistics on incidence and deaths are difficult to collect, although PAHO statistics ( indicate that CKD-related hospitalizations in El Salvador rose 50% from 2005 to 2012, and nearly 1,500 of the 40,000 patients hospitalized were younger than 19 years old. National transplantation centers report that 3,100 patients in El Salvador, 3,000 in Guatemala, and 1,000 in Nicaragua currently receive dialysis. Thousands of people in Central America have died from CKD in the past 10 years, most of them in Nicaragua and El Salvador. Experts believe that the death toll alone in El Salvador is at least 20,000.—Carol Potera

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