For the past two decades, researchers have reported an increased mortality due to chronic kidney disease (CKD) among sugarcane workers in northwestern Nicaragua. The rate of CKD is ten times higher in Nicaragua than it is in America and kills more Nicaraguan men than HIV/AIDS, diabetes, and leukemia combined. Patients in later stages of the disease require renal replacement therapy, such as transplant or dialysis, to survive; however, these expensive treatment methods are not readily accessible in lowincome regions. The World Bank, in conjunction with Boston University School of Public Health, has funded studies to investigate the high prevalence of CKD among sugarcane workers, but the etiology of this disease remains unknown. The causes of the CKD epidemic are multi-faceted and must be examined at the micro and macro-levels through interdisciplinary perspectives. I argue that 1) there are short-term and long-term public health and occupational interventions that should be promptly implemented to mitigate the CKD epidemic, and 2) further research is required to answer remaining questions.