Abstract
BackgroundChronic 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.MethodsThe 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.ResultsA 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).ConclusionsThe 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.
Highlights
There has been a notable increase in the recognized incidence of chronic kidney disease (CKD) around the world [1]
The study population was comprised of individuals who resided in the North Central Province (NCP) or Uva Province (UP), participants in community Chronic kidney disease of unknown etiology (CKDu) testing outreach, and/or sought medical care at Girandurukotte district hospital (UP) or Medawachchiya clinic (NCP)
All participants resided in the CKDu endemic regions in Girandurukotte and Medawachchiya districts in Sri Lanka at the time of diagnosis
Summary
There has been a notable increase in the recognized incidence of chronic kidney disease (CKD) around the world [1]. Diabetes mellitus and hypertension remain the leading causes of CKD, in recent years a different form of CKD has reached epidemic levels, creating serious public health complications in rural communities in the dry zone of Sri Lanka [6, 7]. Existing studies describe the majority of these CKD patients as not having hypertension or diabetes mellitus, two of the major risk factors for CKD. It has been defined as a distinct condition: CKD of unknown or uncertain etiology (CKDu). Chronic kidney disease of unknown etiology (CKDu) was first recognized in Sri Lanka in the early 1990s, and since it has reached epidemic levels in the North Central Province of the country. Previous studies have suggested varied hypotheses for the etiology of CKDu; there is not yet a consensus on the primary risk factors, possibly due to disparate study designs, sample populations, and methodologies
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