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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Quality drinking water is a critical environmental determinant of health. In Costa Rica, certain water sources contained arsenic concentrations exceeding 10 µg/L, raising public health concerns. Chronic kidney Disease of Unknown Etiology (CKDu) has emerged as a significant health issue in several regions worldwide, including Costa Rica. The availability of CKDu registries now enables systematic assessment of potential associations with environmental contaminants. This study aims to explore the relationship between CKDu morbidity during 2020 to 2023 and drinking water quality—specifically, historical exposure arsenic and hardness levels-, and to compare findings with similar research conducted in Sri Lanka.
An ecological design was used, comprising three main components: (1) spatial analysis, (2) classification of water sources based on arsenic level, total and calcium hardness, and (3) general description as well as multivariate statistical analysis. Age-standardized morbidity rates (SMR) were calculated using the indirect standardization method, alongside crude rates per 10,000 population.
A distinct spatial pattern of CKDu morbidity was observed. Elevated SMRs were concentrated along the Pacific coast and in counties such as Limón, Puntarenas, and Heredia. Fourteen counties reported SMRs exceeding the national average (see Figure 1). A statistically significant trend was found between increased SMR and higher levels of water hardness and arsenic. Multivariate analysis confirmed that areas with higher total water hardness and historical arsenic exposure over 10 µg/L had a significantly increased risk of CKDu.
Figure 1. Standardized Morbidity Rate by age for CKDu ICD U-50 from 2020 to 2023 in Costa Rica
Figure 2. CKDu 2020-23 and historical arsenic exposure though drinking water
Figure 3. CKDu 2020-23 and calcium hardness
Figure 4. CKD 2020-23 and total hardness level
General description
Table 1 shows that there are statistically significant differences in the distribution of SMR between each category of the three parameters of quality drinking water explored. It also shows a significant upward trend in the categories for each parameter.
Note: p value for Kruscall Wallis
Table 1. General description
Multivariable analysis
Table 2. Multivariable analysis
Results of the exploratory multivariable analysis show that areas with an average of hard and very hard drinking water have higher of risk of CKDu compared to areas that have soft water. On the other hand, areas with historical exposure of arsenic in drinking water have higher risk of CKDu compared to counties not exposed.
The findings suggest a potential association between drinking water quality and CKDu morbidity in Costa Rica.
Counties with elevated levels of water hardness and historical arsenic in their drinking water exhibited higher SMRs and an increased risk of CKDu.
These results are consistent with findings from Sri Lanka and highlight the need for targeted public health interventions and water quality monitoring in high-risk areas.
