A mysterious epidemic of chronic kidney disease among agricultural workers and manual laborers may be caused by a combination of increasingly hot temperatures, toxins and infections, according to researchers at the University of Colorado Anschutz Medical Campus.

The study was published today in the New England Journal of Medicine.

In recent years, chronic kidney disease has emerged as a major illness among workers in hot climates. It was first identified in the 1990s by clinicians treating sugar cane workers in Central America. In 2012, it claimed roughly 20,000 lives and has now been identified in California, Florida and in Colorado’s San Luis Valley.

But the exact cause has been hard to determine.

“We looked at all the available literature on the subject and asked, `What do we know today? Where are the gaps?” said the study’s lead author Lee Newman, MD, MA, director of the Center for Health, Work & Environment and professor in the Dept. of Environmental & Occupational Health at the Colorado School of Public Health. “We were hoping to synthesize everything we know so far for a framework for moving forward.”

Read more at University of Colorado Anschutz Medical Campus