Patients residing in agricultural communities have a high risk of developing chronic kidney disease. In the Great Plains, geo-environmental risk factors (variable climate, temperature, air quality, water quality and drought) combine with agro-environmental risk factors (exposure to fertilizers, soil conditioners, herbicides, fungicides and pesticides) to increase risk for toxic nephropathy. However, research defining the specific influence of agricultural chemicals on the progression of kidney disease in rural communities has been somewhat limited.