Objective: To discuss the role of climate change and excessive exposure to heat in potentiating the effect of agricultural toxicants associated with the CKD epidemic in El Salvador. In El Salvador, (population 6.3 million) more than 16,000 patients were admitted to hospital with a diagnosis of CKD from 2005–2010. The disease was dubbed, CKDnt (non-traditional) - because it was not caused by traditional precursors, diabetes or hypertension. In Bajo Lempa, Usulután, 18% of the population had CKD in 2009. Although CKDnt etiology is unclear, the two primary suspects are, heat stress and exposure to toxic agrochemicals, especially in sugarcane cultivation. During the period 2005-10, El Salvador imported 16 million kg of pesticides. This works out to 2.5 kg of pesticides per person over the 6-year period, within a small land area (21,040 km2). The indiscriminate use of pesticides could release significant amounts of toxicants to the environment. Heat stress and dehydration from strenuous manual labor and lengthy exposure to increasing ambient temperatures could lead to kidney damage. Drinking less than the recommended minimum amount or consuming water that contains environmental toxicants can exacerbate this renal damage. Our research indicated that women and children living in these agricultural communities are also affected but to a lesser degree. It can be hypothesized that men, women and children are exposed to a basal level of agrochemicals in the environment. However, the men are subjected to additionally higher doses of toxicants due to their direct involvement in agriculture, and exposure to heat stress.