Dr. Catharina Wesseling, the regional director for the Program on Work and Health (SALTRA) in Central America, which pioneered the initial studies of the region's unsolved outbreak, put it this way, "Nephrologists and public health professionals from wealthy countries are mostly either unfamiliar with the problem or skeptical whether it even exists."
Dr. Wesseling was being diplomatic. At a 2011 health summit in Mexico City, the United States beat back a proposal by Central American nations that would have listed CKDu as a top priority for the Americas.
"The idea was to keep the focus on the key big risk factors that we could control and the major causes of death: heart disease, cancer and diabetes. And we felt, the position we were taking, that CKD was included."
The United States was wrong. The delegates from Central America were correct. CKDu is a new form of illness. This kidney ailment does not stem from diabetes, hypertension or other diet-related risk factors. Unlike the kidney disease found in diabetes or hypertension, the kidney tubules are a major site of injury in CKDu, suggesting a toxic etiology.
CKDu is now the second leading cause of mortality among men in El Salvador. This small, densely populated Central American country now has the highest overall mortality rate from kidney disease in the world. Neighboring Honduras and Nicaragua also have extremely high rates of kidney disease mortality. In El Salvador and Nicaragua, more men are dying from CKDu than from HIV/AIDS, diabetes, and leukemia combined. In one patch of rural Nicaragua, so many men have died that the community is called "The Island of the Widows."
In addition to Central America, India and Sri Lanka have been hit hard by the epidemic. In Sri Lanka, over 20,000 people have died from CKDu in the past two decades. In the Indian state of Andhra Pradesh, more than 1,500 have been treated for the ailment since 2007. Given the rarity of dialysis and kidney transplantation in these regions, most who suffer from CKDu will die from their kidney disease.
In an investigation worthy of the great Sherlock Holmes, a scientific sleuth from Sri Lanka, Dr. Channa Jayasumana, and his two colleagues, Dr. Sarath Gunatilake and Dr. Priyantha Senanayake, have put forward a unifying hypothesis that could explain the origin of the disease. They reasoned that the offending agent had to have been introduced into Sri Lanka within the last 30 years, since the first cases appeared in the mid-1990s. The chemical also needed to be able to form stable complexes with the metals in hard water and to act as a shield, protecting those metals from metabolism by the liver. The compound would also need to act as a carrier and be able to deliver the metals to the kidney.
Originally Published: Alternet