Tracking a Mysterious Kidney Disease

March 1, 2025

Each morning before sunrise, a young farmworker in California’s Salinas Valley endures four hours of dialysis to filter the toxins and fluids his failing kidneys can no longer process. Despite his exhaustion, he heads straight to the fields to harvest lettuce under the blistering sun.

Stories like his inspire Stanford nephrologist Shuchi Anand, MD, to uncover the causes of a mysterious kidney disease disproportionately impacting agricultural workers in hot climates around the globe. This devastating condition, known as chronic kidney disease of unknown origin (CKDu), has emerged as a pressing public health issue in regions such as Sri Lanka and Central California.

A Global Challenge with Local Implications

CKDu is a progressive and often irreversible disease, primarily affecting young and middle-aged men engaged in strenuous agricultural labor in hot, low-lying regions. Unlike traditional kidney disease linked to diabetes or hypertension, CKDu develops in individuals without these common risk factors. By the time symptoms appear, the disease is typically in its final stage, requiring costly and grueling dialysis or kidney transplantation for survival.

In Sri Lanka, CKDu has ravaged farming communities, where contaminated groundwater, extreme heat, and crop-burning byproducts are suspected contributors. Since 2018, Dr. Anand and her team have been studying the disease there, building local research capacity and testing interventions, such as filtering drinking water.

Now, Anand and Stanford nephrology fellow Marimar Contreras Nieves, MD, are applying their expertise to study a similar crisis closer to home. Central California’s agricultural heartland shows alarmingly high rates of end-stage kidney disease among farmworkers—many of whom are unaware of their illness until it’s too late.

Unraveling the Puzzle in Central California

Unlike Sri Lanka, the migrant farmworker population in Central California presents unique research challenges. Farmworkers often move frequently, face barriers to healthcare access, and may not trust medical institutions. To overcome these obstacles, Anand and Contreras are collaborating with local nephrologists, community groups, and bilingual research assistants to document patient stories and map potential environmental exposures.

By starting with dialysis patients in the final stage of the disease, the team is working backward to trace connections between agricultural work, environmental factors, and CKDu. Interviews conducted in clinics across Salinas and Fresno aim to capture the experiences of these workers, whose lives have been upended by kidney failure.

A Shared Mission Across Continents

Dr. Anand’s research is rooted in a commitment to preventing this disease globally. In Sri Lanka, her team monitors healthy individuals over time to identify risk factors. In Central California, they are focused on empowering communities to advocate for better working conditions, especially as rising temperatures exacerbate heat-related health risks.

The work also highlights the importance of partnerships across disciplines and institutions. Dr. Anand’s collaborators include experts from Stanford and local universities, as well as farmworker rights organizations, to explore solutions that can mitigate the impact of CKDu.

Hope for Prevention

National Kidney Month is an opportunity to raise awareness about kidney disease, including underrecognized threats like CKDu. As Dr. Anand and her team continue their work, they remain focused on not just understanding the disease but also preventing its devastating effects.

“Progressive kidney disease in a working-age person impoverishes families and robs them of a loved one,” Anand says. By shedding light on this condition and advocating for at-risk populations, researchers hope to create meaningful change for communities in need.