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Abstract: TH-PO422

A Newly Recognized Endemic Region of CKD of Undetermined Etiology in South India: The Tondaimandalam Nephropathy

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Parameswaran, Sreejith, JIPMER, Ponidcherry, India
  • Kar, Sitanshu Sekhar, JIPMER, Puducherry, Puducherry, India
  • S, Priyamvada P., JIPMER, Puducherry, Puducherry, India
  • Mohan, Sumit, Columbia University, New York, New York, United States
  • Radhakrishnan, Jai, Columbia University Medical Center, New York, New York, United States

There are some regions with high incidence of unexplained CKD, referred to as CKD of Undetermined etiology (CKDu), predominantly affecting underprivileged farming populations in tropical climates in Sri Lanka & Latin America. Similar CKD cluster was reported from Andhra Pradesh, India. Many patients exhibiting characteristics of CKDu seek treatment at our tertiary care center in South India & we explored whether a similar burden of CKDu exist in our region as well.


All consecutive incident adults with CKD per KDIGO criteria presenting to the renal clinic between 1st January 2015 and 31st December 2018 were prospectively recruited in this observational study. Case definition of CKDu by WHO was used.


Among 2440 patients with CKD, 75.3% were male & mean age 50.8 (±13.6) yrs . 56% patients were from Villupuram & Cuddalore districts of Tamil Nadu state (Figure 1). Approx. 50% patients reported working on sugarcane, peanut & rice paddy farms. 65.7% had family income < INR 5000 (USD$77) per month. Diabetic Nephropathy was the cause of CKD in 21.7%, Hypertensive Nephrosclerosis in 14.5% & Chronic Glomerulosclerosis in 3.1%. The single largest diagnostic category was CKDu - 56.2%. CKDu contributed a significantly higher proportion of kidney disease among farmers, agricultural & other unorganized laborers; the proportion of CKDu was significantly higher among the uneducated patients & in the lower income group.


We define a new endemic area of CKDu (Tondaimandalam) in Tamil Nadu, India, accounting for 56.2% of CKD.


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