Global prevalence of Chronic Kidney Disease of Unknown Etiology (CKDu) and recommendations for developing and strengthening national surveillance systems

Abstract

Background: Chronic kidney disease of unknown etiology (CKDu) is a disease that is devastating healthcare systems in Central America, Sri Lanka and India, yet population level data about this disease is very sparse.Methodology: We reviewed cross-sectional, cross-shift and ecological studies (n=24) published between 2015 and 2019 as well as prevalence data available prior to 2015. Surveillance systems (SS) in affected countries were assessed based on reports from countries participating in an international workshop held in Costa Rica in March 2019. Finally, barriers, solutions and ethical aspects related to CKDu SS were discussed.Results: Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Mexico, Panama, Sri Lanka, India and Tanzania have different degrees of certainty about the prevalence of CKDu. Lack of comparability between the studies remains a major challenge. Great progress has been made in collecting and analyzing health service records in many countries, and these developments should be supported and strengthened. However, much work is still needed to obtain comparable population prevalence data.Discussion and Conclusions: It remains unclear whether CKDu epidemics represent a global phenomenon or whether there are different regional or national causes for the same outcomes. Compelling evidence supports claims that CKDu is mainly an occupation driven disease, particularly in agricultural communities where informal or temporary contracts create barriers to screening and follow-up. We recommend using the published Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol to harmonize data collected. We also make recommendations for SS at three levels: community, healthcare facility, and national (policy) levels. In CKDu endemic areas, we recommend SS at the workplace and strengthening healthcare facilities to allow CKDu screening as part of primary healthcare. Public health SS of CKDu must be associated with guaranteed universal access to healthcare and should be linked to continuous research.