Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka – lessons learned from the WHO CKDu population prevalence study

Redmon, Jennifer Hoponick; Elledge, Myles; Womack, Donna; Wickremashinghe, Rajitha; Wanigasuriya, Kamani; Peiris‐John, Roshini; Lunyera, Joseph; Smith, Kristin K.; Raymer, James; Levine, Keith

doi:10.1186/1471-2369-15-125

Cited by 66 publications

(58 citation statements)

References 34 publications

(44 reference statements)

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“…Environmental factors, such as heavy metal exposures (21), high seasonal temperatures (22), agrochemical use, mycotoxins (23), contaminated water supplies, and snake bite (24), have all been studied as potential causes of CKDu. However, the underlying etiologies have not been clearly identified in most regions (18), and highlighting common risk factors across these global settings and populations could be important for understanding and preventing CKDu. Therefore, we performed a systematic review of the existing literature to identify common exposures and potential risk factors for CKDu across different global populations.…”

Section: Introductionmentioning

confidence: 99%

“…In El Salvador, ESRD that is largely attributable to CKDu has become the leading cause of hospital deaths (8), and in Sri Lanka, nearly 4% of the national health care budget is now spent on treating CKDu (14,15). As such, it has become a public health priority and the focus of many World Health Organization-sponsored epidemiologic studies (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

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CKD of Uncertain Etiology

Lunyera¹,

Mohottige²,

Isenburg

et al. 2016

Clinical Journal of the American Society of Nephrology

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166

148

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Background and objectives Epidemics of CKD of uncertain etiology (CKDu) are emerging around the world. Highlighting common risk factors for CKD of uncertain etiology across various regions and populations may be important for health policy and public health responses.Design, setting, participants, & measurements We searched PubMed, Embase, Scopus and Web of Science databases to identify published studies on CKDu. The search was generated in January of 2015; no language or date limits were used. We used a vote-counting method to evaluate exposures across all studies.Results We identified 1607 articles, of which 26 met inclusion criteria. Eighteen (69%) were conducted in known CKDu-endemic countries: Sri Lanka (38%), Nicaragua (19%), and El Salvador (12%). The other studies were from India, Japan, Australia, Mexico, Sweden, Tunisia, Tanzania, and the United States. Heavy metals, heat stress, and dietary exposures were reported across all geographic regions. In south Asia, family history, agrochemical use, and heavy metal exposures were reported most frequently, whereas altitude and temperature were reported only in studies from Central America. Across all regions, CKDu was most frequently associated with a family history of CKDu, agricultural occupation, men, middle age, snake bite, and heavy metal exposure.Conclusions Studies examining etiologies of CKDu have reported many exposures that are heterogeneous and vary by region. To identify etiologies of CKDu, designing consistent and comparative multisite studies across highrisk populations may help elucidate the importance of region-specific versus global risk factors.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CKD of Uncertain Etiology

Lunyera¹,

Mohottige²,

Isenburg

et al. 2016

Clinical Journal of the American Society of Nephrology

Self Cite

166

148

View full text Add to dashboard Cite

show abstract

“…Chronic kidney disease (CKD) has affected young agricultural workers without evidence of a recognized cause, in hot regions in Central America [8,9] and Asia [10,11] and has been recently named and categorized by the International Society of Nephrology as chronic kidney disease of unknown (CKDu) etiology [12].…”

Section: Introductionmentioning

confidence: 99%

Hydration Status and Kidney Health of Factory Workers Exposed to Heat Stress: A Pilot Feasibility Study

et al. 2019

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Dehydration associated with heat stress increases the risk of workplace injury or illness, decreases productivity, and may contribute to the chronic kidney disease epidemic identified in outdoor workers from hot climates. There is limited research on the effects of chronic occupational heat stress among indoor workers. We aimed to test the feasibility of measuring markers of hydration and kidney function in foundry factory workers in Southern Brazil, exposed and not exposed to heat stress. Factory workers exposed to heat stress (wet bulb globe temperature ≥28.9) and not exposed to heat were identified by management and invited to participate. Clinical and biochemical markers of hydration and kidney function were evaluated before and after a single 8.5 h work shift (lunch time not included). Feasibility outcomes included rates of enrolment, % completion of study protocols, and time to complete data collection. This study was deemed feasible with 80% enrolment and 90% completion of the protocol. Among the preselected workers, the enrolment rate was 91%. All subjects completed the physiological measures and blood collection and 95% completed the urine studies. Mean time to complete data collection pre-shift was 19.1 ± 4.2 min and post-shift: 14.3 ± 4.0 min. Workers exposed to heat stress had a greater decline in estimated glomerular filtration rate compared to controls over the work shift (–13 ± 11 vs. –5 ± 7 mL/min; p < 0.01). We demonstrated the feasibility and challenges of conducting future hydration and kidney function research among indoor factory workers. Further study is needed to determine if exposure to indoor heat contributes to a decline in kidney function.

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“…In 1990 the disease was ranked at 27 th in the total number of reported deaths which climbed eight places to 19 th in 2010 only second to the rise of HIV within this time period (Mills et al, 2015). (Wanigasuriya, 2014).…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

Serum Creatinine Level and Its Relation to Backache in Chronic Kidney Disease with Unknown Aetiology (CKDu) Patients in North Central Province, Sri Lanka

Aslam¹,

Kumarasinghe²

2018

Preprint

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Background -Chronic kidney disease with unknown aetiology (CKDu) is a progressing disease which is affecting many Sri Lankans' yearly, this disease is slow progressive, irreversible and asymptomatic disease. Patients suffering from CKDu over the past two decades have been evaluated using the estimated glomerular filtration rate (e-GFR). This is the standard test performed under WHO guidelines to investigate and grade the CKDu, and this creatinine clearance is measured in this in order to grade the patient. Backache has been a common symptom presented in most of the chronic kidney disease patients (CKD), patients with CKDu are liable to get backache due to the renal failure that takes place (Jayathilake et al., 2013;Redmon et al., 2016). Objective -To detect a correlation between serum creatinine values and level of backachepresented in the patient.Method -Using an interview based questionnaire to assess patients' body condition and the degree of backache is assessed, 59 patients were part of the study for a period of five months and had an average age of 60.3 years. The questionnaire answers are scaled into four main types of backache from the least to the most painful based on the pain scale adapted from Kapkia. Serum creatinine is measured using an automated analyzer which is measured using Jaffe's reaction. Using Pearson R correlation, the relationship was determined between serum creatinine and backache (Kafkia et al., 2011). Results -The results were obtained for 58 patients (n=58), where the mean backache score was 2.30 and mean serum creatinine value 2.77. The Pearson R value obtained was 0.01 which is indicating almost no relationship between backache and serum creatinine. Patients with stage 3 kidney disease (n=14) had an average E-GFR of 38.0, stage 4 (n=38) with 22.3 and stage 5 (n=6) with 14.0.Conclusion -Backache can be used an indicator of CKDu since it is presented in most patients' suffering from the disease but unable to be used to determine the stage of CKDu suffered by the patient due to the external causes that leads to backache. Several predisposing factors such as temperature, water source and agricultural activity can influence the backache.

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Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka – lessons learned from the WHO CKDu population prevalence study

Cited by 66 publications

References 34 publications

CKD of Uncertain Etiology

CKD of Uncertain Etiology

Hydration Status and Kidney Health of Factory Workers Exposed to Heat Stress: A Pilot Feasibility Study

Serum Creatinine Level and Its Relation to Backache in Chronic Kidney Disease with Unknown Aetiology (CKDu) Patients in North Central Province, Sri Lanka

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