Evaluation of biochemical profile of Chronic Kidney Disease of uncertain etiology in Sri Lanka

Abstract

Chronic Kidney Disease of uncertain etiology (CKDu) is an endemic, disease that mostly affects young agricultural workers in the rural dry zone of Sri Lanka. This study was designed to identify specific biochemical manifestations of CKDu cases. All (119) nondialysis definite CKDu patients in Girandurukotte and Wilgamuwa were selected. Blood and urine samples were collected and measured biochemical parameters. All analyses were performed in IBM SPSS statistics version 23 (IBM Corp, USA). The median blood pressure was normal though nearly half of the patients (45.4%) who were in the advanced stages (Stage 3b, 4 and 5) of CKDu. Patients without a history of hypertension before the diagnosis of CKDu (100%) and minimal proteinuria (26%) are similar to the previous findings. Patients without a history of diabetes before the CKDu diagnosis had high percentages of diabetes (15.7%) and pre-diabetes (59.8%) and hence indicated the possibility of uremia induced impaired glucose intolerance in the rural areas of the country. There were 62.2% patients who had low vitamin D and only a minority had evidence of bone mineral diseases. Out of liver disease markers serum glutamic pyruvic transaminases (SGPT), serum glutamic oxaloacetic transaminases (SGOT), gamma-glutamyl transferase (GGT), and Lactic acid degydrogenase (LDH) had an inverse correlation with the advancement of the disease indicating subclinical liver disease. Osmolality in serum and urine showed a discrepancy despite > 50% of CKDu patients had increased their serum osmolality. The current study supports most of the previously described manifestations of CKDu. Moreover, some specific patterns have been identified which need to be validated in a larger group.

Evaluation of liver function biomarkers, blood pressure, and anthropometric parameters among chronic kidney disease patients: Laboratory-based cross-sectional study in Northwest Ethiopia

“…The strong positive correlations between the serum levels of AST and ALT with eGFR in the current study indicate that as the severity of CKD increases, the mean values of aminotransferases significantly decreased. These results are in agreement with a number previous studies [ 12 , 13 , 28 ]. Thus, hepatic aminotransferases follow a specific pattern at different stages of CKD and are used as indicators of the progression of CKD.…”

“…On the contrary, the present study showed that there was no significant difference in the serum levels of both total and direct bilirubin across the clinical stages of CKD, which agrees with previous studies [ 13 , 28 ]. In contrast to our findings, a study conducted in Iraq showed that the mean serum level of total bilirubin was significantly decreased in CKD patients under dialysis when compared with their mean levels in CKD patients not undergoing dialysis.…”

The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review

“…In most community studies, declined renal function in the absence of diabetes mellitus, hypertension, and glomerular diseases is treated as CKDu or CKD of nontraditional causes. These clinical manifestations associated with CKDu were confirmed in a recent study with CKDu patients in Sri Lanka [ 25 ]. Nonetheless, several community studies conducted in 2019 in CKDu affected regions indicate the gravity of this epidemic.…”

Body Composition, Anemia, and Kidney Function among Guatemalan Sugarcane Workers

“…By way of comparison, among a population of 377 Mexican American and Other Hispanic American males aged 18-40 reported by the U.S. National Health and Nutrition Examination Survey (NHANES) from 2017 March 2020, the mean value of HbA1c was 5.42% (SD: 0.80) and the prevalence of elevated HbA1c was 13.5% (compared to 21% in our cohort), while the average BMI was 29.37 kg/m 2 (SD: 6.46) compared to 21.7 kg/m 2 in our cohort [46]. One other study in the CKDu literature that has reported levels of HbA1c was recently published from Sri Lanka, which found nearly 60% of participants with elevated HbA1c, and another 16% in the diabetic range [47]. Raines and colleagues reported 3.7% of participants in the diabetic range among cases in a study in Nicaragua, however that paper did not report results for the prediabetic range, limiting our ability to draw comparisons [48].…”