Chronic kidney disease has killed tens of thousands of young men and is becoming more deadly. But nobody knows exactly what it is, or what to do about it
It goes by many names, but around here they call it "the malady of the sugar cane". It's a quiet epidemic that has been preying on Central America for at least 20 years, killing impoverished landworkers in their tens of thousands across Nicaragua, Costa Rica, El Salvador and Guatemala. And it is becoming ever more deadly. Between 2005 and 2009, incidents in El Salvador rose by 26%. By 2011 the chronic kidney disease (CKD) that is killing Edilberto had become the country's second-biggest killer of men.
That year the health minister, María Isabel Rodríguez, made a dramatic appeal to the international community for help, telling them: "It is wasting away our populations." But nobody knows what to do about it, because nobody knows what exactly it is. In the wealthier west, CKD is largely caused by hypertension or diabetes, but most of the victims here have neither. And it attacks the kidneys in an unusual way.
Rather than damaging the filtering system, as in ordinary CKD, this disease seems to have an impact on the tubules – the part of the kidney where the composition of the urine is determined. At the moment, the only scientific consensus is that it's real, and unexplained. I have travelled to El Salvador to investigate the mystery of the malady.