Over the last decade, a new form of kidney disease of unknown etiology has emerged in the dry zone of Sri Lanka. The occurrence is mainly amongst males of age group 30–60 years engaged in agriculture. Almost 80% of these patients eventually die from kidney failure within the first two years after diagnosis. High prevalence of Chronic Kidney Disease(CKD) has become an environmental health issue of national concern in Sri Lanka. Hypertension and Diabetes is known to be the main causes for renal failure, but in areas with high prevalence of CKD, the majority of patients do not show any identifiable cause, thus, it has been named CKD of unknown etiology (CKDue). Endemic occurrence of the kidney disease was recognized in the 1990s in the North Central Province, situated in the dry zone of Sri Lanka, and this has been increasing over a period of 10–15 years. High prevalence of CKDue is observed in two main districts of the North Central Province —Anuradhapura and Polonnaruwa. The prevalence is now spreading to the adjoining districts of North Western province, Uva province, Eastern province, Central province and the Northern province . Recently this epidemic has been found in the Southern province near Hambanthota as well. The affected area covers approximately 17,000 square km and with a population about 2.5 million in which more than 95% live in rural areas  The presence of high levels of fluoride widespread use of agrochemicals, presence of heavy metals like cadmium, lead and arsenic and uranium in soil and water are postulated as contributory factors. Up to now, there is no unequivocal evidence to recognize the possible environmental causative factors. The prevalence of the disease is mostly among paddy farmers and agriculture laborers. Many of these farmers die simply because they cannot afford the cost of treatment. Apart from the cost, it’s the lack of availability of dialysis facilities in nearby hospitals that makes it extremely difficult for the poor to avail treatment. Most cases, people found they are sick at a very late stage, so that it's not possible to reverse the situation.