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.2.18458/v1 ◽

2019 ◽

Author(s):

Jesse Pry ◽

Wendi Jackson ◽

Ruwini Rupasinghe ◽

Guneratne Lishanthe ◽

Zied Badurdeen ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Sri Lanka ◽

Case Control Study ◽

Pesticide Exposure ◽

Case Control ◽

Unknown Etiology ◽

North Central ◽

The North ◽

Control Study

Abstract 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. 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.

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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

One Health Outlook ◽

10.1186/s42522-020-00034-3 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Jake M 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 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

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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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Utilizing a One Health approach for identifying risk factors associated with an epidemic of chronic kidney disease of unknown etiology (CKDu) in the North Central region of Sri Lanka

Annals of Global Health ◽

10.1016/j.aogh.2016.04.651 ◽

2016 ◽

Vol 82 (3) ◽

pp. 575

Author(s):

W.A. Jackson ◽

J.M. Pry ◽

S. Wickramasinghe ◽

R. Rupasinghe ◽

S. Jayawickrama ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Central Region ◽

One Health ◽

Unknown Etiology ◽

North Central Region ◽

North Central ◽

Factors Associated ◽

The North

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The incidence, prevalence and trends of Chronic Kidney Disease and Chronic Kidney Disease of uncertain aetiology (CKDu) in the North Central Province of Sri Lanka: an analysis of 30,566 patients

BMC Nephrology ◽

10.1186/s12882-019-1501-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 7

Author(s):

Asanga Venura Ranasinghe ◽

Gardiye Weligamage Gamini Priyantha Kumara ◽

Ranamuka Henayage Karunarathna ◽

Ambepitiyawaduge Pubudu De Silva ◽

Korale Gedara Dilini Sachintani ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Sri Lanka ◽

Kidney Disease ◽

Central Province ◽

North Central ◽

The North ◽

North Central Province ◽

Incidence Prevalence

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Biochemical and histopathological changes in Wistar rats after consumption of boiled and un-boiled water from high and low disease prevalent areas for chronic kidney disease of unknown etiology (CKDu) in north Central Province (NCP) and its comparison with low disease prevalent Colombo, Sri Lanka

BMC Nephrology ◽

10.1186/s12882-020-1693-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

M. G. Thammitiyagodage ◽

N. R. de Silva ◽

C. Rathnayake ◽

R. Karunakaran ◽

Kumara WGSS ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Sri Lanka ◽

Kidney Disease ◽

Wistar Rats ◽

Unknown Etiology ◽

Central Province ◽

Histopathological Changes ◽

North Central ◽

North Central Province ◽

Boiled Water

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Kidney Disease, Health, and Commodification of Drinking Water: An Anthropological Inquiry into the Introduction of Reverse Osmosis Water in the North Central Province of Sri Lanka

Human Organization ◽

10.17730/1938-3525-80.2.140 ◽

2021 ◽

Vol 80 (2) ◽

pp. 140-151

Author(s):

M.W. Amarasiri de Silva ◽

Steven M. Albert

Keyword(s):

Drinking Water ◽

Sri Lanka ◽

Kidney Disease ◽

Reverse Osmosis ◽

Alternative Form ◽

Unknown Etiology ◽

Central Province ◽

North Central ◽

The North ◽

North Central Province

In response to evidence suggesting that polluted drinking water is a risk factor for Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka, the government introduced reverse osmosis (RO) water as an alternative form of drinking water in the North Central Province (NCP) between 2010 and 2016. We examine whether CKDu prevalence and disease progression have been reduced as a result of the introduction of RO water and behavioral changes and how villagers perceive the changes.

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Glyphosate’s Synergistic Toxicity in Combination with Other Factors as a Cause of Chronic Kidney Disease of Unknown Origin

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16152734 ◽

2019 ◽

Vol 16 (15) ◽

pp. 2734 ◽

Cited By ~ 9

Author(s):

Sarath Gunatilake ◽

Stephanie Seneff ◽

Laura Orlando

Keyword(s):

Chronic Kidney Disease ◽

Sri Lanka ◽

Kidney Disease ◽

Health Workers ◽

Heat Stroke ◽

Unknown Origin ◽

Unknown Etiology ◽

Deficient Diet ◽

Tropical Regions ◽

The North

Chronic kidney disease of unknown etiology (CKDu) is a global epidemic. Sri Lanka has experienced a doubling of the disease every 4 or 5 years since it was first identified in the North Central province in the mid-1990s. The disease primarily affects people in agricultural regions who are missing the commonly known risk factors for CKD. Sri Lanka is not alone: health workers have reported prevalence of CKDu in Mexico, Nicaragua, El Salvador, and the state of Andhra Pradesh in India. A global search for the cause of CKDu has not identified a single factor, but rather many factors that may contribute to the etiology of the disease. Some of these factors include heat stroke leading to dehydration, toxic metals such as cadmium and arsenic, fluoride, low selenium, toxigenic cyanobacteria, nutritionally deficient diet and mycotoxins from mold exposure. Furthermore, exposure to agrichemicals, particularly glyphosate and paraquat, are likely compounding factors, and may be the primary factors. Here, we argue that glyphosate in particular is working synergistically with most of the other factors to increase toxic effects. We propose, further, that glyphosate causes insidious harm through its action as an amino acid analogue of glycine, and that this interferes with natural protective mechanisms against other exposures. Glyphosate’s synergistic health effects in combination with exposure to other pollutants, in particular paraquat, and physical labor in the ubiquitous high temperatures of lowland tropical regions, could result in renal damage consistent with CKDu in Sri Lanka.

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