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Kidney Week

Abstract: PO0614

CKD of Unknown Origin (CKDuo): Is the Problem Dehydration, Water Contamination, or Both?

Session Information

  • CKD Mechanisms - 1
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

  • 2103 CKD (Non-Dialysis): Mechanisms


  • Campese, Vito M., Keck School of Medicine of USC, Los Angeles, California, United States
  • Fornoni, Alessia, University of Miami, Miami, Florida, United States
  • Zhong, Yan, Keck School of Medicine of USC, Los Angeles, California, United States

An increasing number of people of Central America develop CKDuo. The disease is characterized by chronic tubulo-interstitial nephritis. Occasionally, it presents as an acute kidney injury (AKIuo). The cause(s) remain unknown. Some sustain that dehydration is responsible. Others believe the disease is caused by water contaminated with heavy minerals or agrochemicals. To prevent dehydration, workers in these regions ingest 8-12L of water/day. Hence, even if concentrations of toxins are in “acceptable range”, the cumulative intake may reach toxic levels. If this hypothesis is correct, purified water should reduce the incidence of the disease. In 2017 a Nicaraguan sugarcane factory (SER) adhered to the Adelante initiative, consisting of reducing working hours, exposure to heat and dehydration. In 2017-18, these measures had no impact on the incidence of AKIuo.


During the 2019 season, SER adopted the policy of providing highly purified drinking water to > 6000 workers (1L/hour during working hours). The effects on AKIuo were monitored. Comparisons were made of the monthly incidence of AKIuo during years 2017, 2018 and 2019, by One-way ANOVA.


With the introduction of purified water, the incidence of AKI decreased from 4.0±1.3 cases in 2017 and 3.4±2.1 in 2018 to 2.0±1.5 cases/1000 workers/month in 2019 (P< 0.02).(Fig.1)


Although preliminary, these data support the hypothesis that contaminated water may play a major role in AKIuo. This raises enormous public health issues. If dehydration is responsible, the remedies are hydration and less heat exposure. If toxins and agrochemical are responsible, the remedy is providing highly purified water to those at risk. The potential impact of these measures on CKDuo remains to be determined.