Chronic Kidney Disease (CKD), also known as chronic renal disease or chronic renal failure, is a progressive condition marked by the gradual loss of kidney function. The kidneys serve as a filter for the body and once damaged they can no longer remove waste and excess liquid from the blood. The kidneys are crucial for the production of blood and the regulation of blood pressure, too. The most common traditional causes of CKD are diabetes, high blood pressure and obesity. Professional guidelines classify chronic kidney disease into five stages, with stage one being the mildest and stage five the most severe. Stages one and two are classified as reversible kidney damage, while stage three and higher reflect a state of permanent damage. In developing countries, where access to treatment is limited, stages three and four will likely develop into stage five. Without a transplant or effective dialysis, stage five is terminal.
Chronic Kidney Disease of non-traditional causes (CKDnT) is a different form of progressive, decreased kidney function. Whereas CKD is associated with diabetes, obesity and hypertension, patients who develop CKDnT generally do not have these conditions. CKDnT is associated with heavy labor in hot temperatures, particularly among industrial agricultural workers such as those working in sugarcane production. Additionally, CKDnT often affects young men, many under the age of 30, while CKD is generally diagnosed in older patients of both genders. The location of damage within the kidneys also differs between CKD and CKDnT, indicating different causes of this disease.
Many people with CKDnT are asymptomatic in the early stages of the disease. If present, the early symptoms are nonspecific and may include fatigue and loss of appetite. In the advanced stages of the disease, however, the symptoms are severe. For this reason people often do not realize they have CKDnT until they are already very sick and have sustained irreversible kidney damage. Symptoms of severe kidney damage may include the yellowing of the eyes and skin (as the kidneys are no longer able to filter waste), nausea and vomiting or severe muscle cramps. In the the advanced stages of the disease, as the body loses its ability to expel fluid, there may be swelling in the hands and feet and excess fluid in the lungs. This can make it difficult to breath. Without proper end-of-life care, death from kidney failure is often extremely painful. The experience is traumatic not only for the workers but also for their families who are frequently unable to provide the medical services needed due to the high cost of treatment.
There is no cure for CKDnT. In the final stages of the disease, when the kidneys fail, the only life-sustaining treatment is dialysis or transplantation. Unfortunately, both are difficult and expensive processes and are largely unavailable to the thousands of people with CKDnT. The treatment of CKD addresses proximal causes—diabetes, high blood pressure and obesity. Since those suffering from CKDnT do not have the same underlying conditions, the same recommendations are not viable options for them.
“Men in particular show a high prevalence of decreased kidney function of unknown origin, possibly environmental or occupational.”
“Agricultural work on lowland sugarcane and cotton plantations was associated with decreased kidney function in men and women, possibly related to strenuous work in hot environments with repeated volume depletion.”
Article in The Lancet
Article in Scientific American
MEDICC Review dedicated their entire April 2014 edition to CKDnT research.
A report on working conditions of sugar cane workers, made with contribution from La Isla Foundation.
Can Sugarcane Workers Be Saved with Simple Water and Shade?
New York Times
Deadly Illness in Nicaragua Baffles Experts
Al Jazeera English
Al Jazeera America
Silent kidney epidemic ravages Central America sugar belt
LIF helps bring fresh water to communities affected by CKDnT. Dehydration is supported by research to contribute to kidney damage.
LIF and Solidaridad are partnering to solve the CKDnT epidemic.
La Isla’s sole economy is the sugarcane industry, which relies on young men desperate to provide for their families. The minimal wage they earn cutting cane keeps their families afloat. Almost 70% of men working in the industry develop CKDnT.
También es disponible en Español. “Un Ciclo de la Muerte”
LIF ran successful medical examinations and community education during the summer 2012. All this success however is matched by the fact that over 60% of men in these communities have CKD. Continuing studies only confirm that consistency of this rate with each new generation taking to the fields.
También es disponible en Español. “Sola La Caña”
With the world’s eye on Chichigalpa, Nicaragua after a round of media visits over the course of 2012, the epidemic is finally getting the media attention it deserves. OFF AIR explores a deeper and darker reality of intimidation that those affected by the disease face every day.
También es disponible en Español. “Detrás de Las Cámeras”