A pilot case-control study using a one health approach to evaluate behavioral, environmental, and occupational risk factors for chronic kidney disease of unknown etiology in Sri Lanka

Abstract Background Chronic kidney disease of unknown etiology (CKDu) was first recognized in Sri Lanka in the early 1990s, and since then it has reached epidemic levels in the North Central Province of the country. The prevalence of CKDu is reportedly highest among communities that engage in chena and paddy farming, which is most often practiced in the dry zone including the North Central and East Central Provinces of Sri Lanka. Previous studies have suggested varied hypotheses for the etiology of CKDu; however, there is not yet a consensus on the primary risk factors, possibly due to disparate study designs, sample populations, and methodologies. Methods The goal of this pilot case-control study was to evaluate the relationships between key demographic, cultural, and occupational variables as risk factors for CKDu, with a primary interest in pesticide exposure both occupationally and through its potential use as an ingredient in brewed kasippu alcohol. An extensive one health focused survey was developed with in cooperation with the Centre for Research, Education, and Training on Kidney Diseases of Sri Lanka. Results A total of 56 CKDu cases and 54 control individuals were surveyed using a proctored, self-reported questionnaire. Occupational pesticide exposure and alcohol consumption were not found to be significant risk factors for CKDu. However, a statistically significant association with CKDu was observed with chewing betel (adjusted odds ratio [aOR]: 6.11, 95% confidence interval [CI]: 1.93, 19.35), age (aOR: 1.07, 95% CI: 1.02, 1.13), owning a pet dog (aOR: 3.74, 95% CI: 1.38, 10.11), water treatment (aOR: 3.68, 95% CI: 1.09, 12.43) and pests in the house (aOR: 5.81, 95% CI: 1.56, 21.60). Conclusions The findings of this study suggest future research should focus on practices associated with chewing betel, potential animal interactions including pests in the home and pets, and risk factors associated with water.

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A Pilot Case-Control Study Using a One Health Approach to Evaluate Behavioral, Environmental, and Occupational Risk Factors for Chronic Kidney Disease of Unknown Etiology in Sri Lanka

10.21203/rs.3.rs-35799/v1 ◽

2020 ◽

Author(s):

Jake Pry ◽

Wendi Jackson ◽

Ruwini Rupasinghe ◽

Guneratne Lishanthe ◽

Zied Badurdeen ◽

...

Keyword(s):

Risk Factors ◽

Sri Lanka ◽

One Health ◽

Case Control Study ◽

Pesticide Exposure ◽

Case Control ◽

Unknown Etiology ◽

North Central ◽

The North ◽

Control Study

Abstract Background: Chronic kidney disease of unknown etiology (CKDu) was first recognized in Sri Lanka in the early 1990s, and since then it has reached epidemic levels in the North Central Province of the country. The prevalence of CKDu is reportedly highest among communities that engage in chena and paddy farming, which is most often practiced in the dry zone including the North Central and East Central Provinces of Sri Lanka. Previous studies have suggested varied hypotheses for the etiology of CKDu; however, there is not yet a consensus on the primary risk factors, possibly due to disparate study designs, sample populations, and methodologies.Methods: The goal of this pilot case-control study was to evaluate the relationships between key demographic, cultural, and occupational variables as risk factors for CKDu, with a primary interest in pesticide exposure both occupationally and through its potential use as an ingredient in brewed kasippu alcohol. An extensive one health focused survey was developed with in cooperation with the Centre for Research, Education, and Training on Kidney Diseases of Sri Lanka. Results: A total of 56 CKDu cases and 54 control individuals were surveyed using a proctored, self-reported questionnaire. Occupational pesticide exposure and alcohol consumption were not found to be significant risk factors for CKDu. However, a statistically significant association with CKDu was observed with chewing betel (adjusted odds ratio [aOR]: 6.11, 95% confidence interval [CI]: 1.93, 19.35), age (aOR: 1.07, 95% CI: 1.02, 1.13), owning a pet dog (aOR: 3.74, 95% CI: 1.38, 10.11), water treatment (aOR: 3.68, 95% CI: 1.09, 12.43) and pests in the house (aOR: 5.81, 95% CI: 1.56, 21.60).Conclusions: The findings of this study suggest future research should focus on practices associated with chewing betel, potential animal interactions including pests in the home and pets, and risk factors associated with water.

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A pilot study of behavioral, environmental, and occupational risk factors for chronic kidney disease of unknown etiology in Sri Lanka

10.1101/837393 ◽

2019 ◽

Author(s):

Jake M. Pry ◽

Wendi Jackson ◽

Ruwini Rupasinghe ◽

Guneratne Lishanthe ◽

Zied Badurdeen ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Sri Lanka ◽

Kidney Disease ◽

Case Control Study ◽

Pesticide Exposure ◽

Unknown Etiology ◽

North Central ◽

The North ◽

Control Study

ABSTRACTChronic kidney disease of unknown etiology (CKDu) was first recognized in Sri Lanka in the early 1990s, and since then it has reached epidemic levels in the North Central Province of the country. The prevalence of CKDu is reportedly highest among communities that engage in chena and paddy farming, which is most often practiced in the dry zone including the North Central and East Central Provinces of Sri Lanka. Previous studies have suggested varied hypotheses for the etiology of CKDu; however, there is not yet a consensus on the primary risk factors, possibly due to disparate study designs, sample populations, and methodologies. The goal of this pilot case-control study was to evaluate the relationships between key demographic, cultural, and occupational variables as risk factors for CKDu, with a primary interest in pesticide exposure both occupationally and through its potential use as an ingredient in brewed kasippu alcohol. A total of 56 CKDu cases and 54 control individuals were surveyed using a proctored, self-reported questionnaire. Occupational pesticide exposure and alcohol consumption were not found to be significant risk factors for CKDu. However, a statistically significant association with CKDu was observed with chewing betel (OR: 6.11, 95% CI: 1.93, 19.35), age (OR: 1.07, 95% CI: 1.02, 1.13), owning a pet dog (OR: 3.74, 95% CI: 1.38, 10.11), water treatment (OR: 3.68, 95% CI: 1.09, 12.43) and pests in the house (OR: 5.81, 95% CI: 1.56, 21.60). The findings of this study suggest future research should focus on practices associated with chewing betel, potential animal interactions including pests in the home and pets, and risk factors associated with water.AUTHOR SUMMARYSince a new variant of chronic kidney disease was acknowledged in the early 1990s among those in the agricultural community of Sri Lanka, especially rice farmers, the research community has searched for causes of what has become known as chronic kidney disease of unknown etiology or CKDu. Previous studies have focused on heavy metals in the environment as they are known to be toxic to the kidneys however, a proverbial “smoking gun” has yet to be identified. Understanding that the causes is potential multifactorial we implemented a pilot case-control study using a One Health methodology administering a comprehensive interview to assess environmental, animal, and, human exposures that may be contributing to the diagnosis of CKDu. We found statistically significant odds ratio among those that reported having a pet dog, chewing betel (a traditional preparation or various ingredients wrapped in a betel leaf inserted between the teeth and cheek), pests in the home, treating drinking water, and older age. These results serve to guide further hypothesis generation regarding mechanisms behind associated exposures from infectious diseases such as hantavirus and leptospirosis to food preparation through boiling drinking water in aluminum vessels and oral pesticide exposure linked to betel preparation.

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A pilot case-control study using a one health approach to evaluate behavioral, environmental, and occupational risk factors for chronic kidney disease of unknown etiology in Sri Lanka

10.21203/rs.3.rs-35799/v2 ◽

2020 ◽

Author(s):

Jake Pry ◽

Wendi Jackson ◽

Ruwini Rupasinghe ◽

Guneratne Lishanthe ◽

Zied Badurdeen ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Sri Lanka ◽

Kidney Disease ◽

One Health ◽

Pesticide Exposure ◽

Case Control ◽

Unknown Etiology ◽

North Central ◽

The North

Abstract Background: Chronic kidney disease of unknown etiology (CKDu) was first recognized in Sri Lanka in the early 1990s, and since then it has reached epidemic levels in the North Central Province of the country. The prevalence of CKDu is reportedly highest among communities that engage in chena and paddy farming, which is most often practiced in the dry zone including the North Central and East Central Provinces of Sri Lanka. Previous studies have suggested varied hypotheses for the etiology of CKDu; however, there is not yet a consensus on the primary risk factors, possibly due to disparate study designs, sample populations, and methodologies.Methods: The goal of this pilot case-control study was to evaluate the relationships between key demographic, cultural, and occupational variables as risk factors for CKDu, with a primary interest in pesticide exposure both occupationally and through its potential use as an ingredient in brewed kasippu alcohol. An extensive one health focused survey was developed with in cooperation with the Centre for Research, Education, and Training on Kidney Diseases of Sri Lanka. Results: A total of 56 CKDu cases and 54 control individuals were surveyed using a proctored, self-reported questionnaire. Occupational pesticide exposure and alcohol consumption were not found to be significant risk factors for CKDu. However, a statistically significant association with CKDu was observed with chewing betel (adjusted odds ratio [aOR]: 6.11, 95% confidence interval [CI]: 1.93, 19.35), age (aOR: 1.07, 95% CI: 1.02, 1.13), owning a pet dog (aOR: 3.74, 95% CI: 1.38, 10.11), water treatment (aOR: 3.68, 95% CI: 1.09, 12.43) and pests in the house (aOR: 5.81, 95% CI: 1.56, 21.60).Conclusions: The findings of this study suggest future research should focus on practices associated with chewing betel, potential animal interactions including pests in the home and pets, and risk factors associated with water.

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Association between chronic kidney disease of unknown etiology (CKDU) and anthropometric measures and indices: A case-control study in Sri Lanka

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2020.09.206 ◽

2020 ◽

Vol 40 ◽

pp. 474

Author(s):

H.M. Abeywickrama ◽

Y. Koyama ◽

S. Wimalasiri ◽

M. Uchiyama ◽

U. Shimizu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Sri Lanka ◽

Kidney Disease ◽

Case Control Study ◽

Case Control ◽

Unknown Etiology ◽

Anthropometric Measures ◽

Control Study

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Risk Factors for Herpes Zoster Infection in Patients With Chronic Kidney Disease: A Case-control Study

10.21203/rs.3.rs-252260/v1 ◽

2021 ◽

Author(s):

Qiao Wang ◽

Jiahui Ma ◽

Zhenxing Li ◽

Zhi Li ◽

Dong Huang ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Herpes Zoster ◽

Kidney Disease ◽

Odds Ratio ◽

Case Control Study ◽

Immunosuppressive Agents ◽

Tertiary Hospital ◽

Case Control ◽

Control Study

Abstract Background: Chronic kidney disease (CKD) increases the susceptibility to the infection of herpes zoster (HZ). Less is known about the risk factors of HZ in CKD patients.Methods and Participants: This is a case-control study. CKD patients diagnosed with HZ infection between January 2015 and October 2020 in a tertiary hospital were identified. One age- and gender- matched control was paired for each case, matched to the date of initial HZ diagnose. The uni- and multivariate analysis were used to evaluate the risk factors for development of HZ in CKD patients.Results: Forty-six HZ patients and controls were identified. In general, about 80% (72 out of 92) patients were classified at end-stage renal disease (ESRD, CKD Ⅳ to Ⅴ). Multivariate analyses revealed that immunosuppressive agents (odds ratio: 12.50, 95% CI: 1.53-102.26, P=0.021) and dialysis (odds ratio: 3.33, 95% CI: 1.13-9.78, P=0.029) were independent risk factors of HZ in patient with CKD. Conclusion: Immunosuppressive medication and dialysis were associated with HZ infection in CKD. Further guideline may highlight the necessity of zoster vaccine for patients with CKD, who undertake immunosuppressive or dialysis treatment.

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Risk factors for viral hepatitis A infection in Gampaha District, Sri Lanka: an unmatched case control study

BMC Public Health ◽

10.1186/s12889-020-08490-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Nalin Ariyarathna ◽

Chrishantha Abeysena

Keyword(s):

Risk Factors ◽

Sri Lanka ◽

Viral Hepatitis ◽

Hepatitis A ◽

Case Control Study ◽

Case Control ◽

Viral Hepatitis A ◽

Control Study

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Risk factors for long-term complications in patients with type 2 diabetes attending government institutions in the Western Province of Sri Lanka: A case control study

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2006.07.006 ◽

2007 ◽

Vol 75 (3) ◽

pp. 377-378 ◽

Cited By ~ 5

Author(s):

D.A.C.L. Amarasinghe ◽

P. Fonseka ◽

K.C.S. Dalpatadu ◽

N.C. Unwin ◽

D.J.S. Fernando

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Sri Lanka ◽

Case Control Study ◽

Case Control ◽

Government Institutions ◽

Western Province ◽

Control Study

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Baked Food Consumption Is A Risk Factor for Chronic Kidney Disease: A 1:1 Paired Case-control Study

10.21203/rs.3.rs-30191/v1 ◽

2020 ◽

Author(s):

Xiaoying Lai ◽

Shiyu Zhou ◽

Zewei Lin ◽

Chuanjie Yan ◽

Hong Zhu ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Case Control Study ◽

Case Control ◽

Sleep Efficiency ◽

Lifestyle Behaviors ◽

Aquatic Product ◽

Confounding Variables ◽

Control Study

Abstract Background Chronic Kidney Disease (CKD) has become a global public health problem. Identifying the risk factors of CKD can provide strategies for the prevention of CKD. Studies showed that lifestyles play an important role in CKD, but the relationship between them remained unclear. Thus we aimed to explore the association of lifestyle behaviors (the dietary habits especially) with CKD. Methods A 1:1 matched case-control study including 1414 participates from the HUIQIAO health database system from Jan. 2015 to Dec. 2018 was conducted. Our main outcome measure was the diagnose of CKD, and exposures were lifestyle behaviors measured by a questionnaire. The anthropometric characteristics were included as confounding variables. Results We used conditional logistics regression to assess the odds ratios (ORs) and adjusted ORs for the risk factors. With the assumption of missing at random (MAR) pattern, the missing values of confounding variables and exposures were handled by multiple imputation. We found that lifestyle behaviors regarding skipping breakfast ≥ 3 times per week (1.672, 95% CI, 1.086–2.574), sleep efficiency ≤ 75% (1.633, 95% CI, 1.195–2.232), consuming baked food frequently (1.683, 95% CI, 1.163–2.434), proper intake of oil (0.789, 95% CI, 0.624–0.996), proper intake of aquatic product (0.732, 95% CI, 0.567–0.944), proper intake of soybean and nuts (0.625, 95% CI, 0.447–0.873) were associated with CKD. Conclusion These results suggest that moderate intake of soybean, nuts, and aquatic product, control oil intake, having breakfast at least 4 times per week, maintaining good sleep efficiency, and consuming less baked foods may contribute to prevent the development of CKD. Trial registration: This study is registered at http://www.chictr.org.cn (ChiCTR2000031864).

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