Epidemiology of chronic kidney disease, with special emphasis on chronic kidney disease of uncertain etiology, in the north central region of Sri Lanka.

Kithsiri Bandara Jayasekara,Gardiye Waligamage Gamini Priyantha Kumara,Ranawaka Hewage Karunarathna,Ramiah Sivakanesan,Dhammika Menike Dissanayake,Asanga Ranasinghe

doi:10.2188/jea.je20140074

Abstract

BackgroundThe aim of the study was to identify the epidemiology of chronic kidney disease of uncertain etiology in Sri Lanka.MethodsA cross-sectional study was carried out by analyzing health statistics, and three cohort studies were conducted (n = 15 630, 3996, and 2809) to analyze the demographic information, age-specific prevalence, etiology, and stage of presentation. We screened 7604 individuals for chronic kidney disease of uncertain etiology.ResultsThe results showed that the male:female ratio was 2.4:1, the mean age of patients was 54.7 ± 8 years, 92% of the patients were farmers, and 93% consumed water from shallow dug wells. Familial occurrence was common (36%). The prevalence of chronic kidney disease in different age groups was 3% in those aged 30–40 years; 7% in those aged 41–50 years, 20% in those aged 51–60 years, and 29% in those older than 60 years. Chronic kidney disease of uncertain etiology was diagnosed in 70.2% of patients, while 15.7% and 9.6% were due to hypertension and diabetic mellitus, respectively. The majority of patients were stage 4 (40%) at first presentation, while 31.8% were stage 3 and 24.5% were stage 5. Stage 1 and 2 presentation accounted for only 3.4%.ConclusionsLow prevalence of CKDU was noticed (1.5%) among those who consumed water from natural springs. Prevalence was highest among males, rice farming communities, and those presenting at later disease stages.

Highlights

Chronic kidney disease (CKD) is increasingly recognized as a global public health problem
The study reported that 28% of the CKD patients who were greater than 65 years of age were neither diabetic nor hypertensive, suggesting that cardiovascular disease is an important cause
According to the guidelines provided by the Ministry of Health, the diagnostic criteria used for Chronic kidney disease of uncertain etiology (CKDU) include absence of diabetes mellitus, J Epidemiol 2015;25(4):[275-280]

Summary

Introduction

Chronic kidney disease (CKD) is increasingly recognized as a global public health problem. The study reported that 28% of the CKD patients who were greater than 65 years of age were neither diabetic nor hypertensive, suggesting that cardiovascular disease is an important cause. Diabetes and hypertension account for 30% and 21% of ESRD patients, respectively; glomerulonephritis and CKD due to uncertain etiology account for a larger portion among younger patients in Epidemiology of Chronic Kidney Disease of Uncertain Etiology in Sri Lanka developing countries.[5,6] A study involving International Society of Nephrology-sponsored screening programs in China, Mongolia, and Nepal revealed that 43% of people with CKD did not have diabetes or hypertension.[7] The estimated prevalence of moderate CKD in developed countries is unclear but is generally thought to be between 5% and 7% of the total adult population.[8,9,10]. Chronic kidney disease of uncertain etiology was diagnosed in 70.2% of patients, while 15.7% and 9.6% were due to hypertension and diabetic mellitus, respectively. Prevalence was highest among males, rice farming communities, and those presenting at later disease stages

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