is in some cases not known; it is referred to as chronic kidney disease of unknown aetiology (ckdu). as of 2020 a rapidly progressive chronic kidney disease, unexplained by diabetes and hypertension, had increased dramatically in prevalence over a few decades in several regions in central america and mexico, a ckdu referred to as the mesoamerican nephropathy (men). it was estimated in 2013 that at least 20,000 men had died prematurely, some in their 20s and 30s; a figure of 40,000 per year was estimated in 2020. in some affected areas ckd mortality was five times the national rate. men primarily affects men working as sugarcane labourers. the cause is unknown, but in 2020 the science found a clearer connection between heavy labour in high temperatures and incidence of ckdu; improvements such as regular access to water, rest and shade, can significantly decrease the potential ckdu incidence. ckdu also affects people in sri lanka where it is the eighth largest cause of in-hospital mortality. although ckdu was first documented among sugar cane workers in costa rica in the 1970s, it may well have affected plantation labourers since the introduction of sugar cane farming to the caribbean in the 1600s. in colonial times the death records of slaves on sugar plantations was much higher than for slaves forced into other labour. race african, hispanics, and south asians, particularly those from pakistan, sri lanka, bangladesh, and india, are at high risk of developing ckd. africans are at greater risk due to the number of people affected with hypertension among them. as an example, 37% of eskd cases in african americans can be attributed to high blood pressure, compared with 19% among caucasians. treatment efficacy also differs between racial groups. administration of antihypertensive drugs generally halts disease progression in white populations but has little effect in slowing kidney disease among black people, and additional treatment such as bicarbonate therapy is often required. while lower socioeconomic status contributes to the number of people affected with ckd, differences in the number of people affected by ckd are still evident between africans and whites when controlling for environmental factors. society and culture the international society of nephrology is an international body representing specialists in kidney diseases. united states the national kidney foundation is a national organization representing people with chronic kidney diseases and professionals who treat kidney diseases. the american kidney fund is a national nonprofit organization providing treatment-related financial assistance to one of every five people undergoing dialysis each year. the renal support network is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by ckd. the american association of kidney patients is a nonprofit, patient-centric group focused on improving the health and well-being of ckd and people undergoing dialysis . the renal physicians association is an association representing nephrology professionals. united kingdom it was said to be costing the national health service about £1.5 billion a year in 2020. kidney care uk and the uk national kidney federation represent people with chronic kidney disease. the renal association represents kidney physicians and works closely with the national service framework for kidney disease. australia kidney health australia serves that country. other animals the incidence rate of ckd in dogs was 15.8 cases per 10,000 dog years at risk. the mortality rate of ckd was 9.7 deaths per 10,000 dog years at risk. (rates developed from a population of 600,000 insured swedish dogs; one dog year at risk is one dog at risk for one year)the breeds with the highest rates were the bernese mountain dog, miniature schnauzer and boxer. the swedish elkhound, siberian husky and finnish spitz were the breeds with the lowest rates. research currently, several compounds are in development for the treatment of ckd. these include the angiotensin receptor blocker (arb) olmesartan medoxomil; and sulodexide, a mixture of low molecular weight heparin and dermatan sulfate. unbiased research with complete reporting is required to determine the safety and effectiveness of acupuncture to treat depression, pain, sleep problems, and uraemic pruritus in people who are undergoing dialysis treatments on a regular basis.