Emergence of new CKDu hotspots in rural areas of India: a comprehensive overview of environmental, socio-legal and health implications

Chronic Kidney Disease of Unknown Etiology (CKDu) emerges as a public health concern, particularly in low- and middle-income countries. Recent studies indicate a considerable rise in CKDu cases and the emergence of new hotspots in rural India, where minimal healthcare access and poor working conditions exacerbate vulnerability. Higher prevalence of Chronic Kidney Disease without attributing a cause, mostly prevalent in Southern India. Cases are predominantly reported from Telengana, Andra Pradesh, Tamil Nadu, Goa, Odisha, Punjab and Chattisgarh. In India, the disparity in healthcare infrastructure, particularly for dialysis and transplantation, along with social stigma, hampers effective management and early detection. Addressing CKDu demands an integrated approach from environmental, legal, public health and policy framework for ensuring enhanced water quality assessments. Early diagnostic measures, engaging multidisciplinary research and drawing lessons from global experiences to formulate evidence-based interventions is pivotal.