Chronic renal failure in North Central Province of Sri Lanka: an environmentally induced disease

Wanigasuriya, Kamani; Peiris‐John, Roshini; Wickremasinghe, Rajitha; Hittarage, Ariyasena

doi:10.1016/j.trstmh.2007.05.006

Cited by 126 publications

(119 citation statements)

References 6 publications

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“…Irrespective of the causative factor(s) of CKD-mfo, the renal tubular damage occurs in patients at an early stage of the disease [17]; with time; it causes irreversible renal fibrosis leading to renal failure and premature death [6,17,24]. Once kidneys are fibrosed, the damage is irreversible, so prevention is the only way forward.…”

Section: Postulated Causes For Ckd-mfomentioning

confidence: 99%

Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: causes, solutions, and recommendations

Wimalawansa

2014

Environ Health Prev Med

125

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During the last two decades, Sri Lanka, located close to the equator, has experienced an escalating incidence of chronic kidney disease (CKD) of unknown aetiology (CKDue) in dry zonal areas. Similar incidences of unusual CKDs have been reported in the dry zonal, agricultural areas of several other equatorial countries. In Sri Lanka, the incidence of CKDue is highest in the North Central Province (NCP), where approximately 45 % of the country's paddy fields are located. However, in recent years, the disease has spread into areas adjacent to as well as distant from the NCP. The cause of CKD in Sri Lanka is unknown, and may likely due to interactions of different potential agents; thus, CKD is of multi-factorial origin (CKD-mfo). These factors include, the negative effects from overuse of agrochemicals. Nevertheless, the potential interactions and synergism between probable agents have not been studied. This systematic review discusses the proposed hypotheses and causes of CKD-mfo in Sri Lanka, and ways to decrease the incidence of this disease and to eradicate it, and provide some recommendations. During the past decade, a number of groups have investigated this disorder using different methodologies and reported various correlations, but failed to find a cause. Research has focussed on the contamination of water with heavy metals, agrochemicals, hard water, algae, ionicity, climate change, and so forth. Nevertheless, the levels of any of the pollutants or conditions reported in water in NPC are inconsistent not correlated with the prevalence of the disease, and are too low to be the sole cause of CKD-mfo. Meanwhile, several nephrotoxins prevalent in the region, including medications, leptospirosis, toxic herbs, illicit alcohol, locally grown tobacco, and petrochemicals, as well as the effects of changed habits occured over the past four decades have not been studied to date. Taken together, the geographical distribution and overall findings indicate that combinations of factors and/or their interactions are likely to precipitate CKD-mfo, which kills more than 5,000 people annually in Sri Lanka; most victims are middleaged male farmers. Much anecdotal evidence from this region suggests that consumption of contaminated water is the most likely source of this deadly disease. Although the aetiology is unknown, prevention of this ''environmentally acquired'' disease seems relatively straightforward. Solutions include (a) preventing environmental pollution, (b) stopping the irresponsible use and decreasing the usage of agrochemicals, and encouraging the use of environmentally friendly agricultural methods, (c) taking proper precautions when using agrochemicals and safe disposal of their containers, (d) changing the risky behaviour of farmers and educating them to preserve the environment, and (e) providing clean potable water to all affected regions. Implementing a well-coordinated, in-depth, region-wide, broad-based research study together with a long-term effective surveillance programme across the country i...

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Section: Postulated Causes For Ckd-mfomentioning

confidence: 99%

Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: causes, solutions, and recommendations

Wimalawansa

2014

Environ Health Prev Med

125

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“…Based on CKDu's clinical profile and risk factors, it was postulated that environmental toxins which affect vulnerable groups in a specific geographical area contribute to the onset and progression of the disease [7]. Several investigators have explored the aetiological contribution of exposure to various environmental toxins such as pesticides, microbial toxins and heavy metals [6,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…CKDu mainly affects farming communities with poor socioeconomic background [5]. The estimated prevalence of CKDu in a community based study was reported as 16.9% in women and 12.9% in men, but the severe stages were seen more frequently in men, leading to a higher mortality and morbidity in men [5,6].Based on CKDu's clinical profile and risk factors, it was postulated that environmental toxins which affect vulnerable groups in a specific geographical area contribute to the onset and progression of the disease [7]. Several investigators have explored the aetiological contribution of exposure to various environmental toxins such as pesticides, microbial toxins and heavy metals [6,[8][9][10].…”

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confidence: 99%

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

et al. 2017

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Introduction Chronic kidney disease of unknown etiology (CKDu) has emerged as a significant public health problem in Sri Lanka. The role of environmental exposure to cadmium and arsenic in the aetiology of CKDu is still unclear. Identification of a panel of novel urinary biomarkers would be invaluable in the study of toxin mediated damage postulated to be the aetiology of CKDu.Objectives The aims of this study were to evaluate the profile of novel urinary biomarkers in CKDu patients and identify any association with environmental exposure to heavy metals.Methods Thirty seven randomly selected CKDu patients attending a renal clinic in the North Central Province and two control groups namely a farmer group (n=39) and a non-farmer group (n=40) from a non-endemic area were included in this comparative cross sectional study. Urine samples were analyzed for heavy metals and five urinary biomarkers.Results CKDu patients had significantly elevated urinary levels of fibrinogen (198.2 ng/mg creatinine p<0.001), clusterin (3479 ng/mg creatinine p<0.001), cystatin-C (5124.8 ng/mg creatinine p<0.001) and β2-microglobulin (9913.4 ng/mg creatinine p<0.001) compared to the control groups. Fibrinogen and β2-microglobulin were the best to discriminate CKDu patients from normal individuals with the receiver operator areas under the curve being 0.867 and 0.853, respectively. Urinary fibrinogen and KIM-1 levels correlated positively with urinary arsenic levels. KIM-1 levels correlated positively with urinary mercury and lead levels but no correlation was seen with urinary cadmium levels.Conclusions Fibrinogen and β2-microglobulin have the potential of being a screening tool for detection of CKDu and may aid the early diagnosis of toxin mediated tubular injury in CKDu. Their usefulness need to be further validated in a larger epidemiological study of patients with early stages of CKDu. IntroductionChronic kidney disease of unknown aetiology (CKDu), which emerged at the beginning of this century, has reached epidemic proportions in the North Central Dry Zone of Sri Lanka [1,2]. The disease burden is most prominent in the North Central Province and has extended to two adjacent provinces, namely, Uva and North Western provinces. The disease is not due to conventional risk factors such as diabetes, hypertension, chronic glomerulonephritis. The diagnosis of CKDu is based on exclusion of known aetiological factors of chronic kidney disease and presence of tubulo-interstitial pathology on renal biopsy [3,4].The population in the North Central Province is around 2.5 million according to the last census conducted in 2012 and farming is the main livelihood of the majority. CKDu mainly affects farming communities with poor socioeconomic background [5]. The estimated prevalence of CKDu in a community based study was reported as 16.9% in women and 12.9% in men, but the severe stages were seen more frequently in men, leading to a higher mortality and morbidity in men [5,6].Based on CKDu's clinical profile and risk factors, it was postulate...

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“…Thus, it has been named CKD of uncertain etiology (CKDu). The majority of CKDu patients in the NCP are from the low socioeconomic farming community [8]. As a result of the insidious onset and progression of the disease, these patients present in the late stages, which requires renal replacement therapy such as dialysis and transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…In this CKDu endemic region, an epidemiological survey to evaluate the possible risk factors has revealed that a family history of CKDu, taking ayurvedic treatment, and a history of snake bite are significant predictors for CKDu occurrence [8]. As a result of the clinically observed heterogeneity in disease progression, we hypothesized that the rate of disease progression and death could be modified by different demographic, clinical, and lifestyle-related factors.…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka

Senevirathna

Abeysekera

Nanayakkara

et al. 2011

Environ Health Prev Med

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Background The alarming rise in the prevalence of chronic kidney disease of uncertain etiology (CKDu) among the low socioeconomic farming community in the North Central Province of Sri Lanka has been recognized as an emerging public health issue in the country.Methods This study sought to determine the possible factors associated with the progression and mortality of CKDu. The study utilized a single-center cohort registered in 2003 and followed up until 2009 in a regional clinic in the endemic region, and used a Cox proportional hazards model. Results We repeatedly found an association between disease progression and hypertension. Men were at higher risk of CKDu than women. A significant proportion of the patients in this cohort were underweight, which emphasized the need for future studies on the nutritional status of these patients. Conclusions Compared with findings in western countries and other regions of Asia, we identified hypertension as a major risk factor for progression of CKDu in this cohort.

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Chronic renal failure in North Central Province of Sri Lanka: an environmentally induced disease

Cited by 126 publications

References 6 publications

Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: causes, solutions, and recommendations

Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: causes, solutions, and recommendations

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka

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