The Center for Public Integrity

A woman holds a photograph of her husband and men who worked with him in the sugar cane fields near Chichigalpa, Nicaragua. The man died from chronic kidney disease; four of his sons currently have the disease.

A man holds his young sleeping children in La Isla, a community near Chichigalpa, Nicaragua, which has been hit hard by a mysterious epidemic of chronic kidney disease.

Children, whose father died from chronic kidney disease, collect leaves to wrap food to sell in their community near Chichigalpa, Nicaragua.

Children play in a stream near their home in La Isla, Nicaragua. Workers at the nearby sugar cane plantation have alleged for nearly a decade that pesticides and working conditions are responsible for the epidemic of chronic kidney disease in their area, while researchers have found evidence that chronic dehydration may play a key role.

The epidemic in Central America spans six countries along a nearly 700-mile stretch of the Pacific coast. Kidney disease has killed more people in El Salvador and Nicaragua than diabetes, HIV/AIDS and leukemia combined in the last five years.

Luis Asavedo, 37, hours before he died from chronic kidney disease in Nicaragua. His wife and 9-month-old sat with him in the final hours.

Children and women are reflected in a well in Uddanam, India, an area heavily affected by CKD. In India, the epidemic affects a very particular geographic area along the coast of northern Andhra Pradesh, leading researchers to hypothesize that it may be due to a toxic exposure in the water or soil.

The mysterious form of chronic kidney disease in India mostly affects farmers in the region, where cashews, rice and coconut are the main crops. However, unlike similar epidemics in Central America and Sri Lanka, researchers from Harvard and Stony Brook Universities have found that men and women are almost equally affected.

Laxmi Narayna undergoes dialysis treatment at Seven Hills Hospital in Visakhapatnam, India. The 46-year-old coconut farmer travels hours to and from the city each week for treatment, but according to his doctor, "on dialysis people don't do well. Holding on for a year would be just about it."

Laxmi Narayna begins the long journey home from Seven Hills Hospital in Visakhapatnam, where he receives dialysis treatment twice a week, to his village of Gonaputtuga in northern Andhra Pradesh. A state government insurance program pays for his treatment and covers some of the travel costs. The little he currently pays is already a burden for the coconut farmer and his family.

A farmer tills his rice paddy in Padaviya, Sri Lanka. A recent government report found that cadmium and arsenic are partly responsible for the CKDu epidemic in North Central Sri Lanka, stating that "prevention of indiscriminate use of fertilizers and certain pesticides which have nephrotoxic properties can help to protect the kidney."

Wimal Rajarathna receives dialysis treatment at Anuradhapura General Hospital.