Chronic Kidney Disease in Central America: The Big Picture

In their November Editorial, Wesseling et al. relay conclusions of the First International Research Workshop on Mesoamerican Nephropathy specifying heat exposure and dehydration as key risk factors or essential cofactors for chronic kidney disease of unknown origin (CKDu).1,2 The Editorial simultaneously downplays substantial research from El Salvador and Sri Lanka, which suggests toxic agrochemicals as key in the disease’s etiology.3,4 The authors also downplay the degree to which industry has sponsored some of the major research carried out to date. The largest study of CKDu in Nicaragua, for example, was organized by the World Bank’s International Finance Corporation (IFC) and funded by a major sugar producer as part of a mediated agreement with complainant workers.5 More recently, the Centers for Disease Control and Prevention has announced three studies into CKDu with funding from the Central American sugar industry, at least one of which is to be led by the same epidemiologist who conducted the IFC study.6 By contrast, governments and the World Health Organization funded the Salvadoran and Sri Lankan studies. The People’s Health Movement (PHM) contends that the Editorial’s envisaged focus for future research and intervention around lifestyle factors is victim blaming and near-sighted, and will result in overly simplistic public health interventions. We note the alternative approaches and applaud the subsequent interventions enacted based on the precautionary principle in both Sri Lanka and El Salvador. Both countries have banned chemicals of concern, and El Salvador has implemented a primary care based prevention program encompassing all risk factors.7,8 PHM considers the conclusions of the Editorial enabling of an erroneous emergent narrative regarding CKDu that feeds into a corporate political agenda, encourages faulty science, and spawns overly simplistic solutions. To not reveal the whole picture shown by research about CKDu is to betray affected communities around the world.