Chronic Kidney Disease of Unknown Origin: interdisciplinary approaches to understanding a complex medical phenomenon

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Over the past twenty years, across Low and Middle Income Countries (LMICs), there has been an unexplained increase and change in the causes of Chronic Kidney Disease (CKD). This new type of CKD is known as Chronic Kidney Disease of Unknown Origin (CKDu), today described as a new epidemic for countries in the global south, adding substantially to the burden of CKD globally. In Mexico, the focus of this application, the problem is critical given the high prevalence of CKD and inequalities in access to appropriate healthcare. CKDu is particularly problematic because it cannot be understood in conventional causal terms, meaning it is not an outcome of diabetes or hypertension, but is, instead, linked to social, cultural and environmental concerns. CKDu predominantly affects the young, is linked to informal work (e.g. the agri-industries and mining), as well as long term environmental harm and degradation. Despite increasing concern, it is difficult to establish the percentage of CKD deaths that can actually be classified as CKDu due to the complex conditions it emerges from. In the absence of single causes or established risk factors, explanations have been driven by community, labour and environmental activists in addition to small groups of epidemiologists, public health researchers and toxicologists engaged in exploratory research. Our partnership team has, in addition, two current independent pilot projects, conducted by University of Guadalajara (CI Lozano) and the University of Liverpool (PI Kierans). These projects are documenting a multidimensional picture of CKDu emergence, focusing on the links between the structural conditions of poverty, political economy, environment and the everyday lives of poor communities in the state of Jalisco, focusing on the community of Poncitlán on the shores of lake Chapala. Lozano is identifying the multiple risk factors and social determinants of renal damage, while Kierans takes an anthropological approach mapping the cultural production of clinical and scientific knowledge on CKDu and documenting the cultural and social practices associated with its emergence.CKDu is, therefore, a complex problem, an outcome of geographical, geological, historical, political, economic, social and biological processes. Establishing a collaborative, genuinely interdisciplinary partnership is critical for developing ways of understanding this condition and the responses needed for those living in poor and degraded environments. Existing research largely stems from clinical and scientific perspectives and priorities. Substantive contributions from the Arts and Humanities and Social Sciences are lacking, particularly those offering historically situated and culturally contextualised insights into the changing interrelationships between poverty work, health and environment. Taking a unique interdisciplinary approach, this partnership will make valuable contributions. It will integrate and expand our existing projects to include two further pilots: (1) a local community history pilot to document the changing experiences, explanations and challenges associated with CKD over time; (2) an environmental history project, to document land use and environmental relations over-time. By working in partnership, we will create dialogue, foster innovative methodological approaches and comprehensive understandings of CKDu. We will produce a research protocol for the study of CKDu to be applied within and beyond Mexico. We will work with a wide range of beneficiaries at community, state, federal and international to advance knowledge sharing, the co-production of health, welfare and environmental policies as well as strategies for intervention for the health and wellbeing needs of affected communities.