Is CKDnT a new phenomenon?

Ramon Uriel Munguia, a 27-year-old former sugarcane worker in Chichigalpa, Nicaragua, is sick with CKDnT, the same disease that killed his father. Munguia’s dinosaur t-shirt recalls the word ‘extinction,’ a word Chichigalpinos use when describing the generations of men and women who have already succumbed to CKDnT.
(Photo: Ed Kashi)

When did CKDnT start happening? Why have we not heard about it sooner?

We cannot know what we do not measure.

Those affected by CKDnT are generally from the most vulnerable and underserved populations in their countries. Recently, disease surveillance services have improved and our understanding of the drivers of morbidity and mortality among these populations has increased, markedly within the last 20 years.

The DEGREE Initiative is important because it allows us to better understand how these populations are affected, increasing the visibility of their needs.

40 Years of CKDnT

The World Health Organization (WHO) first standardized the name ‘chronic kidney disease of unknown aetiology’ (CKDnT) in Sri Lanka in 2008.

But the disease has likely been happening for at least four decades in Central America, according to an important study conducted in Guanacaste, Costa Rica, the predominant cane-growing region of Costa Rica where men make up the majority of the workforce. 1

Age-adjusted chronic kidney disease (CKD) mortality rates per 100,000 men and women in Guanacaste versus the rest of Costa Rica by 5-year periods, 1970–2012. 2

Increased visibility

Disease surveillance has improved in the developing world in recent decades. Death by infectious diseases has been reduced. General life expectancy has been extended.

Chronic diseases are now more visible to public health investigators than ever before. It remains to be seen whether we are witnessing a truly new phenomenon or one that has been with us for many years. It is likely that CKDnT is only now becoming more apparent due to more demanding work practices for manual laborers, increased disease surveillance, and the changing climate.

Changes in climate and work practices may have exacerbated the CKDnT epidemic

Intensity: work practices in sugarcane have become more intense as the industry has “modernized,” with workers cutting 6-9 tons per day per person. Agricultural chemical inputs have increased. We are assessing the impact.

Scale: In many parts of Central America, land where sugarcane is cultivated has tripled over the past 15 years.

Warming: Extreme heat wave events in cane-growing regions have increased as global temperatures have warmed.

Evidence suggests that prevalence and mortality rates of CKDnT are climbing worldwide. Our research aims to investigate this possibility and reverse the trend.

La Isla Network is working to uncover what is driving both the disease and its apparent growth over time.

Learn more about what we do.



  1. Catharina Wesseling, Berna van Wendel de Joode, Jennifer Crowe, Ralf Rittner, Negin A Sanati, Christer Hogstedt, Kristina Jakobsson. “Mesoamerican nephropathy: geographical distribution and time trends of chronic kidney disease mortality between 1970 and 2012 in Costa Rica.” Occupational & Environmental Medicine. July 2015.
  2. Ibid.