Read the full text of the above article... Despite limited resources, we documented widespread decreased kidney function in coastal communities related to years of work on coastal sugarcane/cotton plantations. The high prevalence of eGFR <60 mL/min/1.73 m2 in the coastal communities, 18% of men aged 20-60 years, indicates the severity of the epidemic in a region where there is little to offer to patients and where CKD often progresses to ESRD and death. It is noteworthy that decreased eGFR also is related to cardiovascular morbidity and mortality. The risk of premature death from cardiovascular disease at CKD stages 3-4 is higher than that for reaching ESRD.38, 39 This study from El Salvador, as well as the recent Nicaraguan studies,23, 24, 25 provides important clues for etiologic studies, particularly heat stress.
It is urgent to assess the causes of this severe public health problem with properly designed etiologic and clinical research. A thorough medical workup including kidney biopsies and histopathologic examinations from a small group of affected individuals in rather early stages of CKD is needed to confirm the interstitial nature of the disease and provide clues with regard to pathogenesis. Etiologic research would use random samples from a proper study base and repeated measurements of all pertinent exposures with emphasis on heat exposure, environmental and water pollutants (particularly pesticide residues and heavy metals), and amount of water intake during work and rest.
Precautionary preventive actions must be implemented already at this stage, providing sufficient water and rest for workers in hot environments. There is a threat that global warming will dramatically increase populations exposed to hard work in hot climates. If heat stress is a causal factor for CKD, this disease will be an added health risk related to climate change.