• chronic di
• environmental health
• epidemiology of chronic non communicable diseases
• health behaviour

We read with interest the article titled above on the chronic kidney disease (CKD).1 We agree with authors’ conclusions that the available data and the mortality pattern presented suggest additional factors beyond those hypothesised, including heat stress–dehydration as possible causation of chronic kidney disease of unknown aetiology (CKDu).2 Almost all data to date point towards (1) multifactorial aetiology of CKDu that encompasses broader environmental and occupational components3 and (2) water as the vehicle for disseminating this disease. However, more research is needed before making conclusions on what causes this deadly disease that affect those who live in economically poor, tropical countries.

However, we disagree with the researchers’ conclusion that the CKDu is confined to agricultural communities. The use of unproven and unvalidated terminology, ‘Chronic Interstitial Nephritis of Agricultural Communities’ (CINAC), will also misdirect funding organisations and mislead the public and scientific community. These will have a detrimental effect on the focus of the research, thus, finding cause(s) and solutions to eliminate it. In addition, ‘CINAC’ does not necessarily mean ‘Chronic Interstitial Nephritis of Agricultural Communities’. There are multiple utilities and definitions of CINAC that have been used going …