Wesseling et al. Respond.

We appreciate Ventres' observations and share his goal to reduce CKD incidence "by occupational, environmental, and health-related reforms that make this work [agricultural labor] more humane." In our summary of the workshop on the Mesoamerican nephropathy (MeN) in San José, Costa Rica, November 2012, we also noted the need for a broad understanding of the epidemic and we call readers' attention to the full report(1) that details the comprehensive discussion of the epidemic including the issues raised by Ventres. In the workshop, we took account of the several points raised in his letter, but in our editorial we wished to call special attention to the growing evidence of heat stress and dehydration as an essential cofactor in a likely multifactorial disease etiology. (Am J Public Health. Published online ahead of print January 16, 2014: e1. doi:10.2105/AJPH.2013.301803).