At least 20,000 people are estimated to have died of chronic kidney disease (CKD) in Central America in the past two decades – most of them sugar cane workers along the Pacific coast....[C]ane cutters have not qualified for benefits. They say ISA does not give sick workers a copy of their medical records. An ISA [part of Pellas Group] spokesman said: “The company cannot compensate for something that it has not caused.” ...ISA does not accept there is a connection between CKD and working conditions on its plantations. “To date, scientific studies have not been able to determine the causes of CKD or establish a causal link between sugar cane work and the disease,” said a spokesman.