EMERGENCE OF A CKDu ENDEMIC FOCUS IN AGRARIAN CENTRAL INDIA: FIELD EVIDENCE FOR A HEAT–WATER–TOXIN PATHOGENIC TRIAD

 

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https://storage.unitedwebnetwork.com/files/1099/26430cbe6f8efda83b9d4fe549299cdc.pdf
EMERGENCE OF A CKDu ENDEMIC FOCUS IN AGRARIAN CENTRAL INDIA: FIELD EVIDENCE FOR A HEAT–WATER–TOXIN PATHOGENIC TRIAD

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Shubham
Dubey
Shubham Dubey shubham_dubey@rediffmail.com Jawaharlal Nehru Medical College Department of Nephrology Wardha India *
Pranjal Kashiv pranjalkashiv88@gmail.com Jawaharlal Nehru Medical College Department of Nephrology Wardha India -
Vijay Jeyachandran vijayjeyachandran2010@gmail.com Jawaharlal Nehru Medical College Department of Nephrology Wardha India -
Twinkle Pawar pawartwinkle@gmail.com Jawaharlal Nehru Medical College Department of Nephrology Wardha India -
Sunny Malde sunnymalde94@gmail.com Jawaharlal Nehru Medical College Department of Nephrology Wardha India -
Sushrut Gupta sushrutgupta95@gmail.com Jawaharlal Nehru Medical College Department of Nephrology Wardha India -
Mohit Kurundwadkar dr.kurundwadkar@gmail.com Jawaharlal Nehru Medical College Department of Nephrology Wardha India -
Charulata Bawankule cp52kule68@gmail.com Saraswati Kidney Care Center Department of Nephrology Nagpur India -
Amit Pasari dramit28@yahoo.co.in Jawaharlal Nehru Medical College Department of Nephrology Wardha India - Saraswati Kidney Care Center Department of Nephrology Nagpur India
Manish Balwani balwani.manish@yahoo.com Jawaharlal Nehru Medical College Department of Nephrology Wardha India - Saraswati Kidney Care Center Department of Nephrology Nagpur India
 
 
 
 
 

Chronic kidney disease of unknown etiology (CKDu) is increasingly recognized in tropical agrarian regions, where environmental and occupational exposures contribute to renal injury. A rising number of non-diabetic, non-hypertensive CKD cases in agrarian communities around Wardha, central India prompted investigation into potential regional clustering. This study characterized clinical patterns and environmental risk factors, emphasizing the proposed heat–water–toxin triad as a pathogenic framework.

A cross-sectional observational study (2022–2024) was conducted at a rural tertiary nephrology unit. Adults with sustained eGFR < 60 mL/min/1.73 m² for ≥ 3 months, without diabetes, hypertension, or glomerulonephritis, were enrolled. A total of 100 participants were included, as per sample-size estimation using Cochran’s formula (n ≈ 94). Data on occupation (> 8 h/day outdoor work), hydration habits, agrochemical exposure, and groundwater dependence were collected. Laboratory variables (serum creatinine, electrolytes, uric acid, urine ACR) and imaging findings were analyzed. Multivariate logistic regression identified predictors of advanced CKD (stage ≥ 4).

Mean age = 57.3 ± 13.2 years; 74 % were male. Outdoor occupations predominated—farmers (73%) and laborers (16%), with smaller proportions of shopkeepers (6%), homemakers (4%), and clerks (1%).
Groundwater was the primary drinking source for 65 %.
Mean serum creatinine = 3.96 ± 3.63 mg/dL, eGFR = 23.93 ± 12.80 mL/min/1.73 m², and blood urea = 74.14 ± 52.12 mg/dL.
Proteinuria < 300 mg/day occurred in 69 %, suggesting a tubulointerstitial phenotype.
CKD stages 4–5 were seen in 67 %, reflecting delayed presentation.
Predictors of lower eGFR were > 8 h/day outdoor work (OR 2.36, 95 % CI 1.09–5.12; p = 0.03) and groundwater use (OR 2.91, 95 % CI 1.14–7.02; p = 0.02).
Hyperuricemia (43 %), mild hyponatremia, and anemia (Hb 8.95 ± 2.61 g/dL) were common.

CKDu in central India’s agrarian population represents an emerging endemic focus, characterized by non-proteinuric, tubulointerstitial-predominant injury among heat-exposed individuals without traditional risk factors. The heat–water–toxin triad—thermal stress, recurrent dehydration, and groundwater contamination—appears central to its pathogenesis. Strengthening occupational heat-safety, groundwater quality surveillance, and community awareness programs is critical to address this climate-linked kidney disease burden.

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