Update on Uncertain Etiology of Chronic Kidney Disease in Sri Lanka’s North-Central Dry Zone

AbstractCentella asiatica is a commonly consumed green leafy vegetable in many developing countries due its high nutritious value and availability at low cost. The present study was conducted to assess the Cd, Cr and Pb uptake associated health risks of Centella asiatica harvested from organic and non-organic cultivations in a chronic kidney disease of uncertain etiology (CKDue) prevalent area in Sri Lanka. The health risk assessment was conducted in terms of the bioconcentration factor (BCF), soil-to-root and root-to-leaf translocation factors ($${\text{TF}}\,({\text{soil-root}})$$ TF ( soil-root ) and $${\text{TF}}\,({\text{root-leaf}})$$ TF ( root-leaf ) ), Target hazard quotient for each heavy metal (THQ) and hazard index (HI). In addition, the spatial variation of physical and chemical parameters of the root zone soil were assessed using MINITAB 17 statistical software. Results indicated significant spatial variations in conductivity, organic matter content and Cr concentrations among organic and non-organic study sites. The Cr, Cd and Pb concentrations recorded from roots and leaves of Centella asiatica were higher than the safe limits for consumption established by the European Union. The health risk analysis indicated that there is a potential of hyper-accumulating Cd in the roots of Centella asiatica. Further, the THQ and HI of the heavy metals indicated possible adverse non-cancer health risks associated with long-term consumption of leaves of Centella asiatica. Therefore, necessary precautionary actions to prevent the excessive buildup of Cr, Cd and Pb in the edible portions of Centella asiatica are essential in order to ensure consumer safety.

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Fluoride releasing kinetics in a weathered bearing biotite gneiss

10.31705/eru.2021.13 ◽

2021 ◽

Author(s):

M.H.Ashan Madusanka ◽

◽

Sandun Sadanayake ◽

lkMeththika Vithanage ◽

◽

...

Keyword(s):

Sri Lanka ◽

Kidney Disease ◽

Dental Fluorosis ◽

Geographic Area ◽

Climatic Conditions ◽

Who Guidelines ◽

Biotite Gneiss ◽

Basement Rocks ◽

Dry Zone ◽

Uncertain Etiology

In several regions of the dry zone of Sri Lanka, excessive quantities of fluoride (F-) in groundwater have affected the water quality significantly. Apart from the well-known prevalence of dental fluorosis, Chronic Kidney Disease of uncertain etiology (CKDu) is widespread in different pockets in the dry zone of Sri Lanka [1]. Fluoride is one of the substances suspected of being causative of CKDu in the area. Since the kidneys retain more F- than in any other soft tissue and excess F- exposure can cause kidney disease. Within the same zone, the prevalence of CKDu varies by geographic area in a ground water and spatial distribution of selected trace elements in groundwater. The optimum F- level in drinking water, according to WHO guidelines, is 1.5 (mg/L); however, due to the unfavorable climatic conditions that exist in tropical countries, people ingest more water than normal intake, resulting in a high F- intake. The source of F- is geogenic. It has been found that the F- content of basement rocks ranges from 9.5×10-5 to 1.44×10-3 kg/L in the region [3]. Farmers consume about 2-3 liters of water a day to quench their thirst, resulting in a daily F- intake of 3×10-3-1×10-2 kg/L [4].

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17114041 ◽

2020 ◽

Vol 17 (11) ◽

pp. 4041 ◽

Cited By ~ 1

Author(s):

Hansani Madushika Abeywickrama ◽

Swarna Wimalasiri ◽

Yu Koyama ◽

Mieko Uchiyama ◽

Utako Shimizu ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Kidney Disease ◽

Sri Lanka ◽

Kidney Disease ◽

Short Form ◽

Symptom Burden ◽

Symptom Index ◽

The Mean ◽

Uncertain Etiology

Symptom burden and health-related quality of life (HRQOL) are important predictors of how a disease affects patients’ lives, especially for endemic health problems such as chronic kidney disease of uncertain etiology (CKDu). Our study describes symptom burden, HRQOL, and associated demographic and clinical variables in CKDu patients in the Girandurukotte area, Sri Lanka. A cross-sectional study included 120 CKDu patients attending the renal clinic in the endemic area. The instruments applied were the Kidney Disease Quality of Life—Short Form (KDQOL-SFTM) version 1.3 and CKD Symptom Index—Sri Lanka. Socio-demographic, disease-related, and anthropometric variables were also investigated. The mean age of patients was 61.87 (SD 11.31), while 69.2% were male. The mean glomerular filtration rate was 28.17 (SD 14.03) mL/min/1.73 min2, and 70.8% were anemic. Bone/joint pain was the most experienced symptom while the median number of symptoms reported by patients was 5 (IQR 3–7). The mean symptom burden, physical component summary, mental component summary, and kidney-disease-specific component scores were 12.71 (SD 10.45), 68.63 (SD 19.58), 78.53 (SD 18.78), and 81.57 (SD 5.86), respectively. Age was found to be a significant predictor of HRQOL, while hemoglobin level and being a farmer were significant predictors of symptom burden. Our data indicate that CKDu patients in all stages experience at least one symptom affecting all aspects of HRQOL.

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Rainwater as an alternative drinking water source for the Chronic Kidney Disease Of Uncertain etiology (CKDu) prone areas: a case study for Girandurukotte, Sri Lanka

Journal of Water Sanitation and Hygiene for Development ◽

10.2166/washdev.2020.085 ◽

2020 ◽

Vol 10 (3) ◽

pp. 539-548

Author(s):

V. M. Jayasooriya ◽

V. M. M. Perera ◽

S. Muthukumaran

Keyword(s):

Water Quality ◽

Chronic Kidney Disease ◽

Drinking Water ◽

Surface Water ◽

Sri Lanka ◽

Kidney Disease ◽

Water Source ◽

Drinking Water Source ◽

Significant Difference ◽

Uncertain Etiology

Abstract Chronic Kidney Disease of uncertain etiology (CKDu) is a fatal disease that causes death from kidney failure due to unknown risk factors and has already affected more than 400,000 people in the rural agricultural landscape (dry zone) of Sri Lanka. The major drinking source in Sri Lanka is groundwater and it is suspected that the pollution of groundwater sources due to agricultural means has a major impact on CKDu. The primary objective of this study is to determine whether rainwater can be used as an alternative safe drinking water source in Girandurukotte area, Sri Lanka, which is known to be an area endemic for CKDu. The physical, chemical, and biological analyses were performed to compare the water quality parameters of three water sources (groundwater, surface water, and rainwater) for Girandurukotte area. The most common storage tanks in polyethylene (PE) and ferrocement (FC) were compared to assess the influence of the material of rainwater tank on water quality. The results showed that there is a significant difference in rainwater in terms of water quality compared to groundwater and surface water. Rainwater in FC and PE tanks showed significant differences (p < 0.05) for some parameters however, they were still within accepted potable drinking water standards.

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Biomarkers of kidney injury among children in a high-risk region for chronic kidney disease of uncertain etiology

Pediatric Nephrology ◽

10.1007/s00467-020-04595-3 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jessica H. Leibler ◽

Oriana Ramirez-Rubio ◽

Juan José Amador Velázquez ◽

Damaris López Pilarte ◽

Wassim Obeid ◽

...

Keyword(s):

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Kidney Injury ◽

Uncertain Etiology

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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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Association of Hantavirus Infections and Leptospirosis With the Occurrence of Chronic Kidney Disease of Uncertain Etiology in the North Central Province of Sri Lanka: A Prospective Study With Patients and Healthy Persons

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2020.556737 ◽

2020 ◽

Vol 10 ◽

Author(s):

N. P. Sunil-Chandra ◽

J. A. A. S. Jayaweera ◽

W. Kumbukgolla ◽

M. V. M. L. Jayasundara

Keyword(s):

Chronic Kidney Disease ◽

Sri Lanka ◽

Kidney Disease ◽

Significant Risk ◽

Study Groups ◽

Hantavirus Infection ◽

Strain Specificity ◽

Climate Conditions ◽

Significant Difference ◽

Uncertain Etiology

Chronic Kidney disease of uncertain etiology (CKDu) has become a significant disease burden, affecting farming community of Sri Lanka and the exact etiology, which could be multifactorial, is not hitherto established. This study is aimed to determine the association of past hantavirus infection and leptospirosis with the occurrence of CKDu. A cohort (n = 179) of known CKDu patients living in high-CKDu prevalent areas of Anuradhapura district of Sri Lanka was compared with a group of 49 healthy, sex-matched younger blood relatives of CKDu patients (control-1) and another 48 healthy, age, and sex-matched individuals living in low-CKDu prevalent area (control-2) of the same district where same life style and climate conditions prevail. Fifty out of 179 (27.9%) CKDu patients, 16/49 (32.7%) of control-1 and 7/48 (14.6%) of control-2 were found positive for IgG antibodies to Puumala, Hantaan or both strains of hantaviruses. Hantaan strain specificity was found to be predominant in all study groups. Hantavirus IgG sero-prevalence of healthy individuals living in low-CKDu prevalent area was significantly lower compared to CKDu patients and healthy younger blood relatives living in high-CKDu prevalent areas (p = 0.03). Past hantavirus infection possesses a significant risk for the occurrence of CKDu (OR = 4.5; 95% CI-3.1-5.4, p = 0.02). In contrast, IgG seroprevalence to hantaviruses was not significantly different in CKDu patients and healthy younger blood relatives living in high-CKDu prevalent areas indicating past hantavirus infection has no association with the occurrence of CKDu or possibly, younger relatives may develop CKDu in subsequent years. Seroprevalence to leptospirosis showed no significant difference between CKDu patients and healthy controls.

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