Using GIS Mapping to Track Hot Spots of Kidney Disease in California
Shuchi Anand, Allison Staniec, Maria E. Montez‐Rath, Penny Vlahos
Abstract
To the Editor: Chronic kidney disease of unknown origin is a leading cause of death in adults living in dry, lowland farming regions of Sri Lanka, Nicaragua, El Salvador, and India. The Central Valley of California has a high annual incidence of end-stage renal disease (ESRD) of 545 cases per million population, as compared with 382 cases per million population in the United States. 1 The climate, topography, and agricultural activity in this region overlap substantially with international regions where chronic kidney disease of unknown origin is endemic, but it remains unclear whether agricultural activity is linked to the incidence of ESRD in California. We mapped the nitrate level in groundwater -a proxy for agricultural activity, fertilizer use, and pesticide application 2 -and superimposed hot spots of unexplained ESRD in California.