A small crowd of villagers waits at a low-slung concrete school building in Pedda Srirampuram, a village in the southern Indian state of Andhra Pradesh. The early morning air is crisp and the men and women are dressed in light shawls and sweaters. Each holds two plastic bags—one with their medical records, the other with a clear plastic container of their urine. They line up to be seen by one of four young men at two large wooden tables.
A researcher named Srinivas Rao sits at the first table. “What’s your name?” he asks a short, wiry man who is next in line. “D. Kesava Rao,” the man replies, handing over his medical records. Rao, the researcher, flips through the pages, noting down details. “His kidneys are not functioning at all,” Rao remarks. “Both his kidneys.”
This is an illness that has substantial mortality. People who would [otherwise] be working, raising families, are dying. It’s quite extraordinary.
Kesava Rao, 45, has chronic kidney disease of unknown etiology (CKDu) and depends on dialysis to survive. “Every week I undergo dialysis, 4 weeks a month,” Rao says. A soft-spoken man with a ready smile, Rao has worked all his life on construction sites or coconut farms. He lived a healthy life and hardly ever saw a doctor, he says, until a fever led to an exam and his diagnosis. Rao didn’t have diabetes or, until his kidneys failed, hypertension, the two main causes of chronic kidney disease worldwide. Nor do most of the other villagers who have gathered here, all chronic kidney disease patients, waiting to get a free blood test for creatinine, a metabolite and a proxy for kidney function, and give samples of urine and blood for research.
This region in coastal Andhra Pradesh is at the heart of what local doctors and media are calling a CKDu epidemic. There is little rigorous prevalence data, but unpublished studies by Gangadhar Taduri, a nephrologist at the Nizam’s Institute of Medical Sciences in Hyderabad, in the neighboring state of Telangana, suggest the disease affects 15% to 18% of the population in this agricultural region, known for rice, cashews, and coconuts. Unlike the more common kind of CKD, seen mostly in the elderly in urban areas, CKDu appears to be a rural disease, affecting farm workers, the majority of them men between their 30s and 50s. “It is a problem of disadvantaged populations,” says Taduri, who is leading the team of researchers in the village.
Read the the rest of the article here on sciencemag.org