• Chronic kidney disease
• Heat stress
• Occupational health

While the Ebola and Zika viruses have made national and international headlines in recent months, another epidemic of larger magnitude is quietly devastating agricultural communities in developing countries worldwide. In Central America, the death toll from a mysterious type of chronic kidney disease (CKD) is estimated to be 20 000 in just 10 years.1 Unlike the CKD seen in developed countries, which is typically linked to hypertension and diabetes, this disease appears to be multifactorial and disproportionately afflicts young men of working age. In El Salvador, CKD is the second leading cause of mortality among men of working age.2 Similar excesses have been reported in other parts of Central America,3 as well as in Sri Lanka,4 India5 and Egypt.6 Occupation is believed to be the driving factor. According to the leading hypothesis, heat stress and dehydration from strenuous work such as manual cutting of sugar cane, perhaps in a synergistic association with exposure to environmental toxins, result …