Dehydration and malaria augment the risk of developing chronic kidney disease in Sri Lanka

Abstract

Chronic kidney disease (CKD) of unknown etiology (CKDu) is a serious health issue in Sri Lanka. One-to-one age and sex-matched two sample comparative study was carried out in the Medawachchiya divisional secretariat area of the North Central Province (NCP) of Sri Lanka, by randomly selecting 100 CKDu patients and 100 age and sex-matched subjects from non-CKDu affected families from the same area. An interviewer-administered questionnaire was used for the collection of data pertaining to occupation, medical history and lifestyle. Data were analyzed using a conditional linear logistic model. Working for >6 h in the field per day, exposure to sun, drinking water only from well, consumption of <3 L of water per day, and having a history of malaria were found to be having significant (P < 0.05) likelihood toward the development of CKDu. Treatment of water prior to consumption had a significant protective effect against CKDu. Dehydration, history of malaria and drinking untreated well water from are likely contribute to the development of CKD of unknown etiology among the inhabitants of NCP, Sri Lanka.

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy

“…associated with the presence of dysuria at the end of the work day that cannot be ascribed to urinary tract infection (76). Similar to the situation in Central America, many subjects with CKD also have hyperuricemia (mean levels of 7.2 mg/dl versus 5.2 mg/dl in controls) and hypokalemia (Channa Jayasumana, personal communication).…”

“…The association of the disease with drinking well water (76) has led to concerns of toxin exposure, such as from heavy metals (cadmium and arsenic) or agrochemicals (71). While an early study linked cadmium exposure with the CKD (72), more recent studies have found minimal evidence for cadmium or other heavy metal exposure, with levels in both deep and surface wells within acceptable limits (77,78).…”

Metabolic and Kidney Diseases in the Setting of Climate Change, Water Shortage, and Survival Factors

“…80 Recently, epidemics of CKD have been reported in India, Sri Lanka, Mexico, and Central America. [81][82][83][84][85][86] The CKD observed in these areas is not because of the classic causes of CKD, such as diabetes or hypertension, but rather, seems to be a type of chronic tubulointerstitial disease. 87,88 Although the roles of toxins and infections have not been completely ruled out, common risk factors for each of the epidemics are hot temperatures and recurrent dehydration that can be linked with climate change.…”

Upregulation of Oxidative Stress Related Genes in a Chronic Kidney Disease Attributed to Specific Geographical Locations of Sri Lanka

“…The climate between the two areas is also different; Girandurukotte is of the dry zone and has temperatures averaging 28.1°C and 22 mm rainfall in the warmest and driest periods of May and June, respectively [37], whereas Kandy being of the wet zone and having temperatures averaging 25.9°C and 100 mm rainfall in the warmest and driest periods of April and February, respectively [38]. The people of Girandurukotte, especially those involved in farming, are exposed to the high temperatures and have a threat of dehydration [39]. Consumption of contaminated water in a dehydrated state further concentrates the effect of the possible toxins.…”