Salvatore Viscomi, MD, is the chief executive officer of Carna Health.

Salvatore Viscomi, MD

Heat Stress, Environmental Exposures, and the Growing Burden of CKDu

A silent epidemic is devastating communities of young, working-age adults around the world. Coined as 

chronic kidney disease of unknown origin (CKDu)

, it is emerging in agricultural workers, miners, and other laborers exposed to factors like extreme heat, dehydration, pesticides, and toxic environmental conditions.

According to the International Society of Nephrology, most patients affected by CKDu are males between the ages of 20 and 60 who often live in rural or agricultural settings and may be exposed to extreme working conditions, with many experiencing a rapid loss of kidney function.

“It's a complex answer. I think a lot of the risk factors are known in terms of if you're working in certain parts of the world and you're doing these things that put you at a high risk of CKDu.. but it's really multiple small, acute insults to the kidneys that accumulate over time,” Salvatore Viscomi, MD, chief executive officer of Carna Health, explained to 

Specifically, Viscomi cites clusters of CKDu seen among young individuals working in physically demanding, outdoor jobs, particularly agricultural laborers such as sugarcane cutters, as well as miners, military personnel, and bricklayers. Geographically, he says cases have been reported in Central America, Sri Lanka, Nepal, India, and Africa, with emerging instances in the United States, particularly in hot climates like California, Florida, and Texas, suggesting that CKDu is a global issue not confined to traditional hotspots.

While occupation is a clear risk factor, Viscomi stresses that genetics, environmental toxins, and lifestyle factors may also contribute. For example, he says pesticides that accumulate in water sources and nephrotoxic herbal remedies common in parts of Africa play a role, also pointing to the use of medications such as ibuprofen by laborers to manage pain, which can compound kidney damage.

“The first thing is awareness that this exists,” Viscomi said. “I think many people, many physicians, are unaware of this phenomenon.”

In addition to being aware of potential risk factors, Viscomi emphasizes the importance of practical interventions like hydration, shade, and avoidance of peak heat hours. Workplace-based screening with point-of-care testing could also allow for early detection and targeted interventions, helping to prevent progression to kidney failure.

Looking ahead, Viscomi highlights the need for more research into risk stratification and pathophysiology, as well as the potential role of digital health tools to monitor hydration and body heat. He reiterates that while advanced technology may help, the most effective interventions may be the simplest, including providing shade, hydration, and awareness to those most at risk.

Editors’ note: Viscomi is CEO of Carna Health.

International Society of Nephrology. What is CKDu? Accessed September 3, 2025. 

https://www.theisn.org/initiatives/what-is-ckdu/#distribution-in-the-world

Claudel SE, Chan M, Scammell MK, et al. Challenges and Opportunities: Studying CKDu in the United States. 

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Salvatore Viscomi, MD, warns CKDu is a growing global health crisis, driven by heat stress, toxins, and occupational risks in vulnerable populations.

Crisis Point: Curbing the Chronic Kidney Disease Epidemic

Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is the moment where a crisis will worsen or begin to get better, the question remains: where are we now?

CKD’s Emergence As A Public Health Crisis: Next Steps for Halting the Silent Spread

In recognition of National Kidney Month, this episode addresses the growing burden of 

 and its emergence as the biggest public health crisis of our time.

CKD is estimated to affect 35 million adults in the US alone, but despite its widespread impact, it often flies under the radar. In many patients, the disease progresses silently and goes undetected until it reaches advanced stages when symptoms appear but treatment options are limited. While there has been no single cause of the CKD crisis, the growing prevalence of risk factors like diabetes, hypertension, and obesity has intensified the threat posed by CKD, setting the stage for a surge in cases that could overwhelm healthcare systems and disrupt countless lives.

Current estimates suggest 9 out of 10 people with kidney disease are unaware they have it, and 1 in 3 of those with severely reduced kidney function but who are not yet on dialysis are unaware they have kidney disease.

In addition to the need for better public awareness to facilitate early detection and treatment of CKD, patient-focused multidisciplinary care is also essential for improving outcomes. The burden of CKD cannot fall on nephrologists alone. Addressing this crisis requires a collaborative effort across the entire health care system but must be tailored in a way that ensures complete, equitable care for the patient.

Be sure to check out part 1 of this episode, which delves into the complex challenges surrounding CKD, exploring the various factors contributing to its growth, the importance of early detection and intervention, and the need for heightened public awareness.

In part 2, the conversation shifts to the importance of collaborative, multidisciplinary care that maintains a focus on patients’ wants and needs as well as the future of CKD care.

Brief descriptions of the speakers featured in this project are provided below:

, chief medical officer of the American Kidney Fund

, associate clinical professor of medicine in the division of nephrology at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation

, chief executive officer of Carna Health

, a patient advocate who was diagnosed with CKD during pregnancy, eventually requiring dialysis and a kidney transplant

 to see other episodes on improving health equity in eye care, disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.

American Kidney Fund. Quick kidney disease facts and stats. Accessed March 5, 2025. 

https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats

In part 2 of this episode of Crisis Point, 3 nephrology experts and a patient advocate discuss strategies to address the CKD crisis.

Crisis Point: The Silent Rise and Growing Threat of Chronic Kidney Disease

CKD’s Emergence as A Public Health Crisis: How We Got Here and How to Turn the Tide

CKD is estimated to affect 35 million adults in the US alone, but despite its widespread impact, it often flies under the radar. For many patients, the disease progresses silently and goes undetected until it reaches advanced stages when symptoms appear but treatment options are limited.

While there has been no single cause of the CKD crisis, the growing prevalence of risk factors like diabetes, hypertension, and obesity has intensified the threat posed by CKD, setting the stage for a surge in cases that could overwhelm healthcare systems and disrupt countless lives.

Several changes will be necessary to change the trajectory of CKD and mitigate the public health crisis it poses. Among these is the need for heightened public awareness. Given the silent nature of CKD, early detection and treatment are difficult to obtain if patients are not aware of the disease and their risk for it.

Effective interventions for CKD are most effective when the disease is caught early, preventing the need for dialysis or transplantation. While kidney disease is not reversible, it is treatable. Most recently, the US Food and Drug Administration approved semaglutide (Ozempic) to reduce the risk of kidney disease worsening, kidney failure, and death due to cardiovascular disease in adults with 

Part 1 of this episode of Crisis Point delves into the complex challenges surrounding CKD, exploring the various factors contributing to its growth, the importance of early detection and intervention, and the need for heightened public awareness.

 chief medical officer of the American Kidney Fund

 associate clinical professor of medicine in the division of nephrology at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation

 a patient advocate who was diagnosed with CKD during pregnancy, eventually requiring dialysis and a kidney transplant

Brooks A. FDA Approves Semaglutide (Ozempic) for Type 2 Diabetes, Chronic Kidney Disease. 

. January 28, 2025. Accessed March 5, 2025. 

https://www.hcplive.com/view/fda-approves-semaglutide-ozempic-type-2-diabetes-chronic-kidney-disease

In part 1 of this episode of Crisis Point, 3 nephrology experts and a patient advocate discuss CKD’s emergence as a public health crisis.

Salvatore Viscomi, MD

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