Mysterious kidney disease plagues Central America

By Elizabeth Landau, CNN

Updated 1138 GMT (1938 HKT) June 11, 2014

The casket is lowered at a funeral for a 49-year-old sugar cane worker in Chichigalpa, Nicaragua. Mortality rates from chronic kidney disease in La Isla community are so high that it is now called La Isla de Viudas, or "The Island of Widows."
Photos: 'The Island of Widows'
The casket is lowered at a funeral for a 49-year-old sugar cane worker in Chichigalpa, Nicaragua. Mortality rates from chronic kidney disease in La Isla community are so high that it is now called La Isla de Viudas, or "The Island of Widows."
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A man who worked in the sugar cane fields for decades receives dialysis at home with his daughter. He and his 24-year-old son, who worked in the fields for just five years, are both suffering from kidney disease. The names of the victims and their families are being withheld due to the ongoing tension about the prevalence of the disease.
Photos: 'The Island of Widows'
A man who worked in the sugar cane fields for decades receives dialysis at home with his daughter. He and his 24-year-old son, who worked in the fields for just five years, are both suffering from kidney disease. The names of the victims and their families are being withheld due to the ongoing tension about the prevalence of the disease.
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A 29-year-old sugar cane worker who suffers from kidney disease stands in the fields in Chichigalpa.
Photos: 'The Island of Widows'
A 29-year-old sugar cane worker who suffers from kidney disease stands in the fields in Chichigalpa.
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Security guards confront local workers and a member of La Isla Foundation for trespassing in the fields. La Isla is a nongovernmental organization addressing the increased incidence of kidney disease in the area.
Photos: 'The Island of Widows'
Security guards confront local workers and a member of La Isla Foundation for trespassing in the fields. La Isla is a nongovernmental organization addressing the increased incidence of kidney disease in the area.
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Loved ones grieve the death of a 36-year-old man who worked in the fields for 12 years.
Photos: 'The Island of Widows'
Loved ones grieve the death of a 36-year-old man who worked in the fields for 12 years.
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People gather for the funerals of two former sugarcane workers. From 2002 to 2012, 75% of deaths for men ages 35 to 55 in Chichigalpa have been attributed to chronic kidney disease, according to La Isla Foundation.
Photos: 'The Island of Widows'
People gather for the funerals of two former sugarcane workers. From 2002 to 2012, 75% of deaths for men ages 35 to 55 in Chichigalpa have been attributed to chronic kidney disease, according to La Isla Foundation.
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A widow stands in the doorway of her home. She lost her husband and two brothers to kidney disease.
Photos: 'The Island of Widows'
A widow stands in the doorway of her home. She lost her husband and two brothers to kidney disease.
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A father and son who are both sick with kidney disease wade in the water at the beach in Puerto Corinto, a coastal town near Chichigalpa.
Photos: 'The Island of Widows'
A father and son who are both sick with kidney disease wade in the water at the beach in Puerto Corinto, a coastal town near Chichigalpa.
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Story highlights

  • CKDu is a complex health problem with unknown origins
  • The disease is especially prevalent among sugarcane workers
  • Kidney dialysis and transplants are often too expensive for employees
  • Some research on the disease is funded by the sugarcane industry, causing controversy
Juan Salgado was 16 when he started cutting sugarcane, in a town near the Pacific coast of Nicaragua in 1966.
His symptoms began about 35 years later: Fever. Headaches. Poor appetite. Feelings of faintness. For no obvious reason, his kidneys were severely damaged, to the point that doctors said he couldn't do agricultural work anymore. Many of his friends had it worse.
"I know, many, many workers who were colleagues of mine, who have already died, and I know also many who are not capable of working anymore because of the disease," said Salgado, now 65, who worked near the town of Chichigalpa, Nicaragua.
The disease is known by scientists as "chronic kidney disease of unknown origin," or CKDu. In rural communities in Nicaragua, it's "creatinina," the Spanish word for creatinine, a biomarker of kidney strength.
At least 20,000 people have died prematurely from this mysterious disease in Central America in the last two decades, according to one estimate, but the real scope of the problem is unknown. The illness is not related to diabetes or hypertension -- drivers of kidney disease in the United States -- and affects primarily young men.
The disease is concentrated on the Pacific Coast in male agricultural workers, especially those cutting sugarcane. El Salvador, Nicaragua and Costa Rica seem to be hotbeds of the illness.
Scientists believe that a multitude of factors could be contributing to the disease, but that there's likely at least one factor that is job-related. Making matters tricky, the sugarcane industry has been a provider of funding for major studies on the illness, raising concerns that companies could be influencing the results.
In Salgado's opinion, the Nicaraguan sugarcane industry players "know well the cause of this disease."