Chronic Kidney Disease of Unknown Etiology in Sri Lanka

Abstract

Background: Chronic Kidney Disease of Unknown Etiology (CKDu) presents a significant health burden in Sri Lanka, particularly in the North Central Province. Despite extensive studies, the etiology remains elusive, making it crucial to investigate the disease's prevalence, risk factors, and impact on the affected populations to formulate effective management and preventive strategies.

Methods and Materials: This cross-sectional survey was conducted in Anuradhapura and Polonnaruwa districts, employing both retrospective data collection from hospital records (2003-2010) and prospective epidemiological and laboratory investigations. The study utilized quantitative and qualitative methodologies, encompassing analysis of medical records, patient surveys, interviews, and laboratory testing for potential etiological factors, including heavy metals and agrochemicals in biological samples.

Results: The study observed a rising incidence of CKDu until 2016, followed by a slight decrease in 2017, possibly attributed to improved drinking water quality. Predominantly affecting males aged 40-60 years, particularly farmers, the five-year survival rate was notably higher in Anuradhapura compared to Polonnaruwa. Geographic clustering of CKDu cases suggested environmental factors, with higher cadmium and fluoride levels in endemic areas pointing towards a complex etiology involving agricultural practices. Despite numerous investigations, no definitive cause has been identified, although the role of environmental and occupational exposures remains a strong hypothesis.

Conclusion: CKDu in Sri Lanka is a multifaceted disease likely influenced by environmental, occupational, and possibly genetic factors. Efforts to improve water quality have shown potential benefits in reducing incidence rates. Future research should focus on comprehensive environmental assessments and targeted interventions to mitigate CKDu risk factors. Establishing national guidelines for management and promoting community awareness are imperative for addressing this public health issue.