substantial variety in progression of disease, with some individuals having slow or no further decline in kidney function following diagnosis, while others rapidly progress to end stage kidney disease (eskd). history high incidence of kidney disease in young agricultural workers, mostly in sugarcane, was first reported in communities in nicaragua, el salvador and costa rica in the 1990s, with the first published report appearing in 2002. early studies suggested that men was most prevalent in communities with a large proportion of individuals working in sugarcane and other high-intensity agriculture, as well as in non-agricultural occupations involving heavy manual labor in hot environments at sea level, and was less prevalent among subsistence farmers and in communities located at higher altitudes. a landmark international research meeting devoted to men, organized primarily by the program on work, environment and health in central america (saltra), occurred in 2012. this workshop also led to the creation of the consortium on the epidemic of nephropathy in central america and mexico (cencam), an international group of researchers and clinicians whose mission is to increase international collaboration for the exploration and research of men; contribute to a reduction in the overall prevalence and impact of men; and raise awareness and action about men in central america and mexico. two additional international workshops were held in 2015 and 2019, and summaries of all three workshops are available. in april 2013, a high-level meeting with regional health ministries, nongovernmental organizations, aid agencies, clinical specialists and researchers was held in san salvador city, el salvador, leading the panamerican health organization (paho) to finally declare ckdu "a pressing and extremely serious health problem in the region". the declaration described ckd as having "catastrophic effects associated with toxic-environmental and occupational factors, dehydration and behaviors harmful to renal health". in it, the ministers of health of the central american integration system declared their commitment to address ckdu comprehensively and to "strengthening scientific research in the framework of the prevention and control of chronic non-communicable diseases". this declaration was subsequently endorsed by paho through the resolution cd52.r1, adopted during the 52nd directing council, 65th session of the regional committee of who for the americas, in october 2013.