In 2025 we published the first world-wide descriptive study into CKDu prevalence (using low eGFR as a proxy) in Kidney International (see link in publication list).

Over 60,000 working-age adults were surveyed across 43 areas in 14 countries. We found a high general-population burden of impaired kidney function in some areas of Central America and South Asia, predominantly (but not only) in men and almost exclusively in rural areas. 

Chronic Kidney Disease of undetermined causes (CKDu) is prevalent in several Central American countries, Sri Lanka, Egypt, and now India. It’s a fatal progressive loss of kidney function that has killed 40,000 people in the last decade—and no one knows what causes it. CKDu mostly impacts poor, agricultural workers, and is virtually undetectable until its latest stages when kidney failure is inevitable. As villages in Southeastern India grapple with this hidden disease, it has a severe impact on families and their livelihoods. This documentary by Talking Eyes Media, Hidden Under the Indian Sun, follows two women as they encounter this disease in their communities.

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La Isla is a small community located on the outskirts of Chichigalpa, Nicaragua in the Central American lowlands. Its sole economy is the sugarcane industry which relies on young men desperate to provide for their families ensuring an endless supply of labor. The wage they can earn cutting sugar cane makes the work worth it despite the fact that some 70% of men working in the industry develop Chronic Kidney Disease of unknown origin (CKDu).

Research done by both the University of Boston as well as the National Autonomous University of Nicaragua, Leon (UNAN) has so far not yielded answers as to the cause of the disease. Meanwhile roughly 250 men are dying every year leaving their community to take on the nickname "la Isla de Viudas," "the isle of widows." The dying men range in age from 18 to 40s+ which inherently makes them the breadwinners for their families. Without their earning power the widows of the community are left to try to make ends meet for their children in numbing poverty while their sons grow up destined to swing their machetes and set fire to the ground, in the end to produce consumer grade sugar at a low price. The people of La Isla deserve dignity, can you help?

In Sri Lanka’s North Central Province more than 23,500 people have died of Chronic Kidney Disease of undetermined causes (CKDu), earning it the moniker, “the hot zone.” In many communities 15% of the population is affected, mainly farmers working in the sun, using agricultural chemicals. While state funded dialysis centers care for hundreds of patients, many of these rural, affected farmers prefer their traditional Sinhala medicine system, where a combination of dietary and spiritual therapy promises to cure them. Local researchers are now joining with international investigators, but some feel their research into chemical related causes are being blocked by business interests. 

In the Hot Zone follows two men in their fight against CKDu. Terrence, a former lab technician and farmer, is a tireless activist, racing to organize data collection and community outreach programs in order to prevent the onset of the disease affecting his fellow farmers. H.B., who comes from a long line of rice farmers, has put his hope in the Sinhala medicine tradition after he feels that Western Medicine failed in curing him and waits to go home to his family. 

While the causes of CKDu here need to be more thoroughly studied, all actors agree that the collateral damage of the disease is only beginning to be felt. “This is not only a health problem, this is a problem of our civilization, this is a problem of our society, this is a problem of our economy.” says Dr. Jayasumana. As doctors and activists work towards prevention in the affected communities, patients pray for healing. 

A film by Tom Laffay
Cover photo by Ed Kashi