WCN26-8678 OPERATIONAL COMPLEXITY AS A DETERMINANT OF EQUITABLE ACCESS TO HEALTH TECHNOLOGIES: EVIDENCE FROM THE KIDNEY TRANSPLANT AND ORPHAN DRUG PARADOX IN COLOMBIA

Introduction: Chronic kidney disease of unknown etiology (CKDu) is increasingly recognized in tropical agrarian regions, where environmental and occupational exposures contribute to renal injury.A rising number of non-diabetic, non-hypertensive CKD cases in agrarian communities around Wardha, central India prompted investigation into potential regional clustering.This study characterized clinical patterns and environmental risk factors, emphasizing the proposed heat-water-toxin triad as a pathogenic framework.Methods: A cross-sectional observational study (2022-2024) was conducted at a rural tertiary nephrology unit.Adults with sustained eGFR < 60 mL/min/1.73m 2 for $ 3 months, without diabetes, hypertension, or glomerulonephritis, were enrolled.A total of 100 participants were included, as per sample-size estimation using Cochran's formula (n 94).Data on occupation (> 8 h/day outdoor work), hydration habits, agrochemical exposure, and groundwater dependence were collected.Laboratory variables (serum creatinine, electrolytes, uric acid, urine ACR) and imaging findings were analyzed.Multivariate logistic regression identified predictors of advanced CKD (stage $ 4).Results: Mean age = 57.3 13.2 years; 74 % were male.Outdoor occupations predominated-farmers (73%) and laborers (16%), with smaller proportions of shopkeepers (6%), homemakers (4%), and clerks (1%).Groundwater was the primary drinking source for 65 %.Mean serum creatinine = 3.96 3.63 mg/dL, eGFR = 23.93 12.80 mL/min/1.73m 2 , and blood urea = 74.14 52.12 mg/dL.Proteinuria < 300 mg/day occurred in 69 %, suggesting a tubulointerstitial phenotype.CKD stages 4-5 were seen in 67 %, reflecting delayed presentation.Predictors of lower eGFR were > 8 h/day outdoor work (OR 2.36, 95 % CI 1.09-5.12;p = 0.03) and groundwater use (OR 2.91, 95 % CI 1.14-7.02;p = 0.02).Hyperuricemia (43 %), mild hyponatremia, and anemia (Hb 8.95 2.61 g/dL) were common.Conclusion: CKDu in central India's agrarian population represents an emerging endemic focus, characterized by non-proteinuric, tubulointerstitial-predominant injury among heat-exposed individuals without traditional risk factors.The heat-water-toxin triad-thermal stress, recurrent dehydration, and groundwater contamination-appears central to its pathogenesis.Strengthening occupational heatsafety, groundwater quality surveillance, and community awareness programs is critical to address this climate-linked kidney disease burden.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.