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An epidemic of chronic kidney disease in Central America: an overview
  1. Oriana Ramirez-Rubio1,2,
  2. Michael D McClean3,
  3. Juan José Amador2,
  4. Daniel R Brooks2
  1. 1Department of Epidemiology, Universidad Autonoma de Madrid, Preventive Medicine and Public Health, Madrid, Spain
  2. 2Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
  3. 3Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Daniel R Brooks, Department of Epidemiology, Boston University School of Public Health, 715 Albany St., T3E, Boston, MA 02118, USA; danbrook{at}

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For almost 2 decades, large areas of Central America have been impacted by an under-recognised epidemic of chronic kidney disease (CKD) of unknown causes whose victims are disproportionately young men of working age.1–5 Although exact figures are unavailable, based on estimates from our group, the death toll has likely reached at least 20 000. El Salvador, for example, has the highest overall mortality from kidney disease in the world (with Nicaragua and Honduras also included in the 10 highest countries), and CKD is the second leading cause of mortality among men of working age in the country.4 ,6 Furthermore, similar excesses of CKD of unknown cause have been reported in Sri Lanka,7 India8 and Egypt,9 where many of the epidemiological characteristics appear to be similar to the epidemic in Central America.

Despite its scientific and public health importance and its potential global reach, we have found that most health researchers and public health practitioners are unaware of this epidemic. Our goal in this editorial is to provide a brief overview of the epidemiological, aetiological and public health dimensions of the epidemic. We are part of a multidisciplinary and multinational team of researchers whose involvement began in 2009 when we were selected to conduct research to search for the cause(s) of excess CKD by the participants of a mediation process managed by the Compliance Advisor/Ombudsman Office, an independent recourse mechanism for the World Bank10 aimed at responding to complaints from project-affected communities with the goal of providing a mechanism for representatives of the communities to sit at the table with recipients of World Bank private sector loans and address issues raised in the complaints. The participants included a sugar cane company in Nicaragua and a group of more than 2000 sick ex-workers and their families. During …

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  • Contributors ORR: developed the concept for the content of the article, performed the literature search and wrote the first draft of the article; MM and JJA: contributed to the content and modified later drafts of the article; DB: developed the concept for the content of the article, contributed to the content and later drafts of the article, and is the guarantor of the article.

  • Funding Funding for the research conducted by Boston University was the result of a mediation process convened by the Compliance Advisor/Ombudsman (CAO), the independent accountability mechanism for social and environmental issues of IFC/MIGA of the World Bank Group, between Nicaragua Sugar Estates Limited (NSEL) and Asociacion de Chichigalpa por la Vida (ASOCHIVIDA). The funds were provided by the CAO and the Comite Nacional de Productores de Azucar (CNPA), of which NSEL is a member. The CAO managed all funds and maintained the contract to conduct the research, with the agreement of both parties involved in the mediation. ORR is also funded by the Enrique Najera predoctoral grant awarded by the Spanish Society of Epidemiology and the Instituto de Salud Carlos III. The views expressed in this article do not necessarily represent those of CAO or any other body.

  • Competing interest None.

  • Provenance and peer review Commissioned; externally peer reviewed.