Evaluation of the Etiology of Chronic Kidney Disease of Unknown Etiology Beyond Heat Stress: A Pakistani Perspective

Abstract

Objective: Chronic kidney disease of unknown origin (CKDu) is emerging as an important public health problem in Pakistan, where conventional risk factors like diabetes and hypertension do not fully explain its rising prevalence. This review aims to analyze the multifactorial etiology of CKDu in the Pakistani context, stressing upon environmental and occupational exposures beyond the widely discussed heat stress hypothesis. Methodology: The PRISMA 2020 guidelines were followed. Studies were selected according to the PECO model to assess the relation of environmental pollution with CKD. Search was done through PubMed, Google Scholar, Pakmedinet, and Euromed. We included only English literature articles emphasizing the volume of these pollutants in Pakistan. Results: This review shows that there is a significant impact of changing environmental dynamics on Pakistan, which is causing profound adverse effects on the quality of water, air, and food. This change is affecting the epidemiology and demography of various diseases, along with CKDu. About 120 articles were selected, out of which 48 were included in the review due to relevance to the topic. Conclusion: The recent recognition of microplastic, nanoplastic dust particles, heavy metals, premature birth, or low birth weight might be a cause of CKD in patients who do not live in agricultural areas. There is a need to look at the etiology at the community level, as it seems that early intervention can prevent this important cause of CKD.