There is wide geographic variability in the prevalence of chronic kidney disease, and much of this variability is unexplained by known clinical risk determinants such as diabetes and hypertension. Additional factors contributing to this geographic variability include social determinants of kidney health, as well as genetic factors (ancestry) and non-genetic factors (the environment). Environmental nephrotoxins can accelerate the progression of kidney disease in some patients at risk. Examples of environmental nephrotoxins that have previously been associated with changes in glomerular filtration rate include chlorotriazine herbicides (e.g., atrazine) and trace metals (e.g., arsenic, cadmium, lead, and mercury). Land management practices influence the concentration of these nephrotoxins in our soil and water. In this review, we explore sustainable approaches to agriculture and the preservation of natural landscapes as land management practices that can optimize kidney health in a variety of communities.
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