Arterial stiffness & Sri Lankan chronic kidney disease of unknown origin

Abstract

Chronic kidney disease (CKD) is common and independently associated with cardiovascular disease (CVD). Arterial stiffness contributes to CVD risk in CKD. In many developing countries a considerable proportion of CKD remains unexplained, termed CKDu. We assessed arterial stiffness in subjects with Sri Lankan CKDu, in matched controls without CKD and in those with defined CKD. Aortic blood pressure (BP), pulse wave velocity (PWV) and augmentation index (AIx) were assessed in 130 subjects (50 with CKDu, 45 with CKD and 35 without CKD) using the validated TensioMed™ Arteriograph monitor. Brachial and aortic BP was lower in controls than in CKDu and CKD subjects but no different between CKDu and CKD. Controls had a lower PWV compared to subjects with CKDu and CKD. Despite equivalent BP and renal dysfunction, CKDu subjects had a lower PWV than those with CKD (8.7 ± 1.5 vs. 9.9 ± 2.2 m/s, p < 0.01). Excluding diabetes accentuated the differences in PWV seen between groups (controls vs. CKDu vs. CKD: 6.7 ± 0.9 vs. 8.7 ± 1.5 vs. 10.4 ± 1.5 m/s, p < 0.001 for all). Sri Lankan CKDu is associated with less arterial stiffening than defined causes of CKD. Whether this translates to lower cardiovascular morbidity and mortality long term is unclear and should be the focus of future studies.

Quality of Life and Symptom Burden among Chronic Kidney Disease of Uncertain Etiology (CKDu) Patients in Girandurukotte, Sri Lanka

“…The mean BMI value of the CKDu subjects was closer to the lower limit of normal BMI levels for Asians, which is consistent with previous findings [57]. Another study found a mean BMI of 22 kg/m 2 among CKDu patients [58]. A recent study revealed that severity of CKDu is inversely associated with BMI and suggested that low BMI might increase susceptibility to the disease [59].…”

Chronic Kidney Disease Among Workers: A Review of the Literature

“…Chronic kidney disease of unknown etiology (CKDu) presents as chronic kidney disease (CKD) without traditional risk factors such as diabetes, hypertension, cardiovascular disease, or older age at onset (Crowe et al, 2013). During the past 40 years, a global epidemic of CKDu has emerged among young male agricultural workers in regions of Mesoamerica (central Mexico, Belize, Guatemala, El Salvador, Honduras, Nicaragua, and northern Costa Rica), South Asia, and Eastern Europe (F. Gifford et al, 2016;Wesseling et al, 2015). With more than 20,000 documented deaths, the Pan American Health Organization (PAHO) called attention to this growing epidemic in 2013 (Pan American Health Organization, 2013).…”

Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review

“…Glomerular collapse, interstitial infiltration, and vascular pathological features such as fibrous intimal thickening and arteriolar hyalinosis are also common (Nanayakkara et al 2012a(Nanayakkara et al , 2012bSelvarajah et al 2016). CKDu is associated with less arterial stiffening than CKD (Gifford et al 2016). When a study correlated the aforementioned prominent histopathological changes with clinical stages of CKDu put forward by the National Kidney Foundation, based on the individual eGFR values, the following were reported (Table 2) (Wijetunge et al 2015).…”