Parashar_2026_Indian.J.Public.Health__

BACKGROUND: Chronic kidney disease (CKD) continues to rise globally. Understanding its multifactorial causes - including environmental toxins like pesticides - will be crucial for developing effective prevention strategies. OBJECTIVES: This study examines whether there is an association between CKD of unknown etiology (CKDu) and agrochemicals in people involved in farming in Himachal Pradesh. MATERIALS AND METHODS: A case-control study of patients with CKDu and age and sex-matched healthy controls was conducted at a tertiary care hospital in Himachal Pradesh, a state in North India. RESULTS: The study included 100 CKDu cases and 101 controls. Both groups had a similar mean age, with the majority of participants aged between 46 and 65 years and residing in rural areas. A higher proportion of cases were housewives, whereas more controls were employed. Farming was the predominant occupation in both groups, particularly in field crop cultivation, with similar levels of exposure to fertilizers and pesticides. Approximately 75% of participants in both groups relied on surface water as their primary source of drinking water. Mean weight and body mass index (BMI) were significantly lower in cases than in controls. Red blood cell cholinesterase levels showed varying trends with pesticide use in both groups, but were not statistically significant. Lower educational attainment, unemployment, and abnormal BMI were significantly associated with CKDu. Other factors, such as farming, pesticide use, and water source, showed elevated odds but lacked statistical significance, suggesting a multifactorial etiology of the disease. CONCLUSION: The findings suggest a multifactorial etiology of CKDu, highlighting the need for further research into occupational, environmental, and socioeconomic determinants.