Chronic Kidney Disease of unknown cause (CKDu) in disadvantaged communities in low-and-middle income countries (LMICs)

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There is an epidemic of primarily tubular-interstitial chronic kidney disease (CKD) clustering in agricultural communities in low-and-middle income countries (LMICs). This was featured recently in Science which reported previous work of some of the current applicants. Although it is currently unclear whether there is a unified underlying aetiology, these conditions have been collectively termed CKD of unknown cause (CKDu). CKDu is estimated to have led to the premature deaths of tens to hundreds of thousands of young men and women in LMICs over the last two decades. Thus, there is an urgent need to understand the aetiology and pathophysiology of these condition(s) and to develop preventive interventions.Currently it is known that CKDu exists in Central America and mainly affects male rural agricultural workers. It may also be occurring in other tropical/subtropical parts of the world, but standardized data are not available for comparison, and also it is not known which population subgroups it affects. Obtaining this information is an essential step towards discovering the cause(s) of CKDu.We have recently established a partnership involving a practical protocol to estimate distributions of renal function in disadvantaged communities: the Disadvantaged populations estimated glomerular filtration rate (eGFR) epidemiology study (DEGREE). This will provide key information to inform hypotheses and to guide further research into the causes of CKDu. The Foundation Award will enable this partnership to make a step-change by implementing the prevalence survey protocol (and a related validation study) in four centres (India, Malawi, Peru, Mexico) in three tropical/subtropical regions (Asia, Africa, and Latin America) where the disease is likely to be endemic. This will provide the basis for developing further studies to discover the cause(s) of CKDu, and developing interventions to prevent it.