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 HCPLive.

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.

References

1. International Society of Nephrology. What is CKDu? Accessed September 3, 2025. https://www.theisn.org/initiatives/what-is-ckdu/#distribution-in-the-world

2. Claudel SE, Chan M, Scammell MK, et al. Challenges and Opportunities: Studying CKDu in the United States. Kidney360. doi:10.34067/KID.0000000000000408