1 A majority of patients are middle-age male rice paddy farm workers living in rural areas with little to no specialist care. More than 20,000 deaths in Sri Lanka have been ascribed to patients with this disease over the past decade. Although investigations into its etiology are underway, patients afflicted with the disease urgently need care.
The problem of chronic kidney disease of unknown etiology (CKDu) affecting farm workers in Sri Lanka (and potentially in other regions of the world including Mesoamerica) has brought intense and acute attention to this disparity. Thus the disparity in care for end-stage renal disease is even larger for those living in rural areas in low- and middle-income countries. Hemodialysis is the default predominant therapy even in these low-resource settings its availability is chiefly limited to major metropolitans where the necessary specialists and water treatment facilities are available. Recent analyses have shown that in low- and middle-income countries, fewer than a quarter of patients reaching end-stage renal disease initiate dialysis.
