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Tungsanga S, Fung W, Okpechi IG, Ye F, Ghimire A, Li PKT, Shlipak MG, Tummalapalli SL, Arruebo S, Caskey FJ, Damster S, Donner JA, Jha V, Levin A, Saad S, Tonelli M, Bello AK, Johnson DW. Organization and Structures for Detection and Monitoring of CKD Across World Countries and Regions: Observational Data From a Global Survey. Am J Kidney Dis 2024; 84:457-468.e1. [PMID: 38788792 DOI: 10.1053/j.ajkd.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 05/26/2024]
Abstract
RATIONALE & OBJECTIVE Established therapeutic interventions effectively mitigate the risk and progression of chronic kidney disease (CKD). Countries and regions have a compelling need for organizational structures that enable early identification of people with CKD who can benefit from these proven interventions. We report the current global status of CKD detection programs. STUDY DESIGN A multinational cross-sectional survey. SETTING & PARTICIPANTS Stakeholders, including nephrologist leaders, policymakers, and patient advocates from 167 countries, participating in the International Society of Nephrology (ISN) survey from June to September 2022. OUTCOME Structures for the detection and monitoring of CKD, including CKD surveillance systems in the form of registries, community-based detection programs, case-finding practices, and availability of measurement tools for risk identification. ANALYTICAL APPROACH Descriptive statistics. RESULTS Of all participating countries, 19% (n=31) reported CKD registries, and 25% (n=40) reported implementing CKD detection programs as part of their national policies. There were variations in CKD detection program, with 50% (n=20) using a reactive approach (managing cases as identified) and 50% (n=20) actively pursuing case-finding in at-risk populations. Routine case-finding for CKD in high-risk populations was widespread, particularly for diabetes (n=152; 91%) and hypertension (n=148; 89%). Access to diagnostic tools, estimated glomerular filtration rate (eGFR), and urine albumin-creatinine ratio (UACR) was limited, especially in low-income (LICs) and lower-middle-income (LMICs) countries, at primary (eGFR: LICs 22%, LMICs 39%, UACR: LICs 28%, LMICs 39%) and secondary/tertiary health care levels (eGFR: LICs 39%, LMICs 73%, UACR: LICs 44%, LMICs 70%), potentially hindering CKD detection. LIMITATIONS A lack of detailed data prevented an in-depth analysis. CONCLUSIONS This comprehensive survey highlights a global heterogeneity in the organization and structures (surveillance systems and detection programs and tools) for early identification of CKD. Ongoing efforts should be geared toward bridging such disparities to optimally prevent the onset and progression of CKD and its complications. PLAIN-LANGUAGE SUMMARY Early detection and management of chronic kidney disease (CKD) is crucial to prevent progression to kidney failure. A multinational survey across 167 countries revealed disparities in CKD detection programs. Only 19% reported CKD registries, and 25% implemented detection programs as part of their national policy. Half used a reactive approach while others actively pursued case-finding in at-risk populations. Routine case-finding was common for individuals with diabetes and hypertension. However, limited access to gold standard tools such as estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR), especially in low-income and lower-middle income countries, may hinder CKD detection. A global effort to bridge these disparities is needed to optimally prevent the onset and progression of CKD and its complications.
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Affiliation(s)
- Somkanya Tungsanga
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of General Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Winston Fung
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Nephrology and Hypertension and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anukul Ghimire
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California at San Francisco, San Francisco, California; General Internal Medicine Division, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science and Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | | | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- School of Public Health, Imperial College, London, United Kingdom; George Institute for Global Health, University of New South Wales, New Delhi, India; Manipal Academy of Higher Education, Manipal, India
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Syed Saad
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Canada and Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada; Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aminu K Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David W Johnson
- Department of Kidney and Transplant Services and Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Translational Research Institute, Brisbane, Australia; Australasian Kidney Trials Network at the University of Queensland, Brisbane, Australia
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Maity I, Sati H, Singh G, Bhowmik D, Agarwal SK, Bagchi S. Burden of Chronic Kidney Disease of Undetermined Aetiology (CKDu) in a Tertiary Care Public Hospital in North India. Nephron Clin Pract 2024:1-8. [PMID: 38964302 DOI: 10.1159/000539317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/05/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Chronic kidney disease of undetermined aetiology (CKDu) is an important public health problem. Indian data are mostly based on studies from rural regions in south and east India. We examined the burden and profile of CKDu in patients attending a tertiary care hospital in north India. METHODS We assessed records of consecutive new CKD patients registered in a nephrology clinic from January 2015 to June 2022. Patients were classified as having CKDu based on predefined inclusion and exclusion criteria. Clinical and laboratory parameters at presentation and kidney biopsy when done were noted. RESULTS Records of 32,369 patients with CKD were screened, and 29,663 were included (2,706 excluded due to inadequate data). A total of 370 (1.2%) patients were categorized as CKDu. Mean age was 41 ± 14.7 years, 58.1% being male. Of them, 158 (42.7%) patients were in CKD stage 3, 89 (24.1%) in stage 4, 84 (22.7%) in stage 5, and 39 (10.5%) were dialysis dependent at presentation; 232 (62.7%) patients had proteinuria <0.5 gm/day and 138 (37.3%) between 0.5 and 1 gm/day. Renal histology was available for 65 CKDu patients: 62 had chronic tubulointerstitial nephritis (CTIN) and 3 had non-specific changes. CONCLUSION When defined using strict criteria with intensive diagnostic workup, burden of CKDu is low in our hospital-based cohort of CKD patients. CTIN is the predominant histopathological finding in kidney biopsy.
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Affiliation(s)
- Indradip Maity
- Department of Nephrology, All India of Medical Sciences, New Delhi, India
| | - Hemchand Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Geetika Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipankar Bhowmik
- Department of Nephrology, All India of Medical Sciences, New Delhi, India
| | | | - Soumita Bagchi
- Department of Nephrology, All India of Medical Sciences, New Delhi, India
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Claudel SE, Waikar SS. Systematic Review of Kidney Injury Biomarkers for the Evaluation of CKD of Uncertain Etiology. Kidney Int Rep 2024; 9:1614-1632. [PMID: 38899184 PMCID: PMC11184258 DOI: 10.1016/j.ekir.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Chronic kidney disease of uncertain etiology (CKDu) is an incompletely defined phenotype of chronic kidney disease (CKD) affecting young individuals mostly in agricultural communities in Central America and South Asia. CKDu is a diagnosis of exclusion made in individuals from endemic regions. Methods We conducted a systematic review of the primary literature on urinary and plasma kidney injury biomarkers measured in the setting of CKDu (through February 2023). The literature was identified via a Web of Science search and hand search of the references of previously identified literature. Search terms included "CKDu," "Mesoamerican Nephropathy," "CKD of unknown etiology," "Chronic Interstitial Nephritis in Agricultural Communities," "biomarker," "urin∗," and/or "plasma." Results A total of 25 papers were included. The 2 most frequently measured biomarkers were urinary kidney injury molecule-1 (KIM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL). There was substantial variability in study design, laboratory assay methods, and statistical methodology, which prohibited meta-analysis. Conclusion Biomarkers that identify tubulointerstitial disease early and accurately may substantially accelerate progress in the study of CKDu and facilitate public health approaches that eventually lead to its prevention and elimination. To date, the literature is limited by relatively small sample sizes and methodological limitations which should be addressed in future studies.
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Affiliation(s)
- Sophie E. Claudel
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sushrut S. Waikar
- Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Lockwood TE, Banati RB, Nikagolla C, Violi JP, Bishop DP. Concentration and Distribution of Toxic and Essential Elements in Traditional Rice Varieties of Sri Lanka Grown on an Anuradhapura District Farm. Biol Trace Elem Res 2024; 202:2891-2899. [PMID: 37725314 PMCID: PMC11052878 DOI: 10.1007/s12011-023-03847-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
Toxic heavy metals have been the focus of many investigations into chronic kidney disease of unknown aetiology (CKDu) within Sri Lanka. It has been hypothesised that exposure to nephrotoxic arsenic, cadmium and lead could play a role in the development of CKDu, and these metals have previously been found in unsafe concentrations in Sri Lankan rice. Traditional varieties of Sri Lankan rice remain popular due to their perceived health benefits, but their uptake of trace and toxic heavy metals remained unexplored. Here, we report a one-time, cross-sectional dataset on the concentrations of essential and toxic elements present in eleven samples of polished and unpolished traditional rice varieties, all regularly grown and sold in the Anuradhapura district, a CKDu hotspot. All rice was sourced from the same farm, with the exception of one store bought sample grown on another, unidentified farm. Cadmium concentrations varied significantly between varieties, and potentially unsafe concentrations of cadmium were detected in the store-bought sample (Suwadel, 113±13 μg kg-1). Elemental imaging of the grains revealed lead to be stored mainly in the rice bran, which is removed during polishing, while cadmium was distributed in the edible portion of the grain. Essential elements were generally higher in the traditional rice varieties than those reported for non-traditional varieties and are a potential source of trace elements for nutrient-deficient communities. The concentration of selenium, an element that plays a protective role in the kidneys, was too low to provide the minimum recommended intake. The methods developed in this study could be applied to a more comprehensive study of elemental uptake of rice under controlled growing conditions.
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Affiliation(s)
- Thomas E Lockwood
- Hyphenated Mass Spectrometry Laboratory (HyMaS), Faculty of Science, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Richard B Banati
- Australian Nuclear Science and Technology Organisation (ANSTO), Lucas Heights, NSW, 2234, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Chandima Nikagolla
- Faculty of Engineering, School of Civil and Environmental Engineering, Queensland University of Technology, QLD, Brisbane, 4000, Australia
| | - Jake P Violi
- School of Chemistry, University of New South Wales, Kensington, NSW, 2052, Australia
| | - David P Bishop
- Hyphenated Mass Spectrometry Laboratory (HyMaS), Faculty of Science, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
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Nayak-Rao S. Profile of chronic kidney disease from a nephrology underserviced region in North Eastern India: a preliminary report from a single center in Assam. Int Urol Nephrol 2024; 56:1103-1108. [PMID: 37642796 DOI: 10.1007/s11255-023-03736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
Chronic kidney disease (CKD) is a worldwide health problem affecting at least 10% of the world's population. CKD represents especially a large burden in low- to middle-income countries that are ill equipped to deal with its consequences. The burden of CKD is increasing in India as well. Although diabetes and hypertension account for much of this burden of CKD, there are regions where a surprisingly high rate of CKD of undetermined etiology (CKD-U) has been described in certain areas of the country. In our observational cross-sectional study, we attempted to look at burden and etiology of CKD in a predominantly rural referral center. Out of 334 patients with diagnosed CKD, of whom 70% were male, included from Oct 2021 to July 2022, CKD-U was the single largest cause of CKD in 154 (46.1%) followed by diabetic nephropathy in 148 (44.3%). 80% of CKD patients presented initially with advanced CKD (stages 4 and 5). Approximately, 2/3rd of CKD patients reported a family income of less than 10,000 Rs/month (< 130USD). Hypertension was seen in 89% of patients in total (73% in CKD-U vs. 100% in other cause CKD). Our initial study brings to focus another new and as yet unrecognized hotspot for CKD-U in the Indian subcontinent. Given the vast diversity in the population in this region and variable delivery health care resources, we believe that concerted efforts should be made by governmental and other agencies to better understand the nature of this undiagnosed CKD epidemic so that adequate preventative strategies can be envisaged.
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Chang CJ, Yang HY. Chronic Kidney Disease Among Agricultural Workers in Taiwan: A Nationwide Population-Based Study. Kidney Int Rep 2023; 8:2677-2689. [PMID: 38106601 PMCID: PMC10719565 DOI: 10.1016/j.ekir.2023.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Chronic kidney disease (CKD) in agricultural communities is a significant public health issue. We aimed to investigate the epidemiology of CKD among Taiwanese farmers and its association with outdoor heat exposure. Methods A nested case-control study was conducted on participants in the National Adult Health Examination (NAHE) from 2012 to 2018. The farming occupation was identified through National Health Insurance data. The primary outcomes of interest were the development of CKD, defined as a decreased estimated glomerular filtration rate (eGFR) with diagnosis by physicians, and CKD of undetermined etiology (CKDu), defined as CKD excluding common traditional etiologies. We calculated the county-wide average ambient temperature from a climate reanalysis dataset (ERA5-Land). All CKD cases were matched 1:2 to non-CKD participants by age and biological sex. We estimated the odds ratios (ORs) of CKD and CKDu for farmers and changes in mean ambient temperature (°C) before the examination. Results We identified 844,412 farmers and 3,750,273 nonfarmers. Among 24.9% of farmers and 7.4% of nonfarmers with reduced kidney function, only 1 in 7 received a diagnosis of CKD. The farming occupation was independently predictive of CKDu (OR = 1.09, 95% confidence interval [CI] = 1.001-1.18) but not CKD. Increased ambient temperature (°C) was associated with a higher risk of CKD (OR = 1.023, 95% CI = 1.017-1.029), with particularly strong associations observed among middle-aged participants and diabetics. Conclusions Taiwanese farmers might have a higher risk of developing CKDu. Outdoor heat exposure is associated with the development of CKD, and middle-aged participants and those with diabetes are more vulnerable than the general population.
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Affiliation(s)
- Che-Jui Chang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hsiao-Yu Yang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Population Health and Welfare Research Center, National Taiwan University College of Public Health, Taipei, Taiwan
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Ekanayake EMDV, De Silva PMCS, Gunasekara TDKSC, Thakshila WAKG, Gunarathna SD, Pinipa RAI, Jayasinghe S, Chandana EPS, Wijewickrama ES, Jayasundara N. Prevalence of Chronic Kidney Disease of Uncertain Etiology Within Selected Farming Communities in Rural Sri Lanka. Can J Kidney Health Dis 2023; 10:20543581231199013. [PMID: 37771543 PMCID: PMC10524071 DOI: 10.1177/20543581231199013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/14/2023] [Indexed: 09/30/2023] Open
Abstract
Background Chronic kidney disease of uncertain etiology (CKDu) is an emergent health concern, particularly in tropical farming communities in several global hotspots, including Sri Lanka. This particular nephropathy is characterized by a progressive decline in kidney function in the absence of conventional chronic kidney disease (CKD) risk factors such as diabetes mellitus, hypertension, and other identifiable kidney disorders. As it is almost asymptomatic at early stages, CKDu is mostly diagnosed at late stages with significant kidney damage. Hence, the identification of disease susceptibility and vulnerable communities at the earliest possible instances is highly important for the management of the disease. Objective We aimed to compare kidney health across three different farming communities in Sri Lanka to identify CKDu susceptibilities. Methods A cross-sectional study was performed with three selected farming communities: paddy farmers (PF; N = 581), sugarcane farmers (SF; N = 550), and vegetable farmers (VF; N = 244) in comparison with an age-matched control group of nonfarming (NF; N = 225) individuals. A medical examination was performed to investigate health status and medical history, whereas a urinalysis was performed to determine creatinine and albumin contents. Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR) were used for assessment of kidney function. CKDu susceptibility was determined based on eGFR, and urinary ACR adhering to the clinical practice guidelines in Sri Lanka. Results The median (interquartile range [IQR]) eGFR levels of PF (85 mL/min/1.73 m2 [72-97]) and SF (93 mL/min/1.73 m2 [73-112]) were significantly lower than that of the NF group (103 mL/min/1.73 m2 [87-125]) (P < .0001), whereas eGFR of VF (100 mL/min/1.73 m2 [80-111]) was not significantly different compared with NF. The median (IQR) urinary ACR levels of the study groups, PF, SF, VF, and NF, were 0.59 (0.26-1.45), 0.46 (0.28-0.88), 0.45 (0.34-0.90), and 0.44 (0.34-1.02) mg/mmol, respectively. However, urinary ACR did not differ significantly across the study groups (P > .05). The prevalence of CKDu within PF (13.60%), SF (12.54%), and VF (6.67%) communities was significantly higher (P < .05) compared with the NF (2.67%). Of the total CKD cases, CKDu susceptible cases represented 73%, 69%, 50%, and 25% in PF, SF, VF, and NF, respectively, indicating a high risk of CKDu susceptibility among farming communities. Moreover, a noteworthy association of CKDu was observed with agrochemical exposure (odds ratio [OR] = 3.11, 95% confidence interval [CI] = 1.36-7.09). Concerning the farming practices, sugarcane farming showed the highest association with CKDu prevalence (OR = 3.40, 95% CI = 1.49-7.78). Conclusions Compared with the nonfarming group, a significant risk of CKDu was observed in the three farming communities, particularly among paddy and sugarcane farmers. Longitudinal epidemiological studies to identify vulnerable farming communities and associated risk factors are critically needed to develop effective management strategies against CKDu within farming communities.
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Affiliation(s)
- E. M. D. V. Ekanayake
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, Sri Lanka
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, USA
| | | | | | | | - S. D. Gunarathna
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, Sri Lanka
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, USA
| | - R. A. I. Pinipa
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, Sri Lanka
| | - Sudheera Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - E. P. S. Chandana
- Department of Biosystems Technology, Faculty of Technology, University of Ruhuna, Matara, Sri Lanka
| | - E. S. Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
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Sharma S, Sharma N, Anandh U, Gowrishankar S. Chronic Tubulointerstitial Nephropathy of Agricultural Communities. KIDNEY AND DIALYSIS 2023; 3:229-243. [DOI: 10.3390/kidneydial3020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Chronic interstitial nephritis in agricultural communities is an emerging public health concern affecting numerous agricultural communities in tropical countries, including regions in India, with a significant impact on the health and well-being of affected individuals. The affected individuals suffer from various psychosocial, nutritional, and metabolic challenges due to organ failure, which affects their quality of life. The etiology remains poorly understood, and various risk factors, which include various environmental and occupational hazards, have been implicated in its development. The recent discovery of lysosomal proximal tubulopathy has reignited interest in its pathogenesis. Along with the representative feature of chronic interstitial nephritis, changes suggestive of tubular injury have also been reported. It is suggested to use the term “chronic tubulointerstitial nephropathy of agricultural community” instead of chronic interstitial nephritis of the agricultural communities. Chronic tubulointerstitial nephropathy in agricultural communities is a slowly progressive disease that initially does not cause any symptoms in patients and most patients have a delayed onset of symptoms. Several diagnostic criteria have been introduced over the past years and one introduced by the Ministry of Health of Sri Lanka is widely used. The management of this chronic illness is no different from other causes of chronic interstitial nephritis and our focus should be on implementing various preventive strategies to reduce its incidence in agricultural communities and protect the health and well-being of agricultural workers. By disseminating knowledge about chronic tubulointerstitial nephropathy in agricultural communities, we can contribute to the development of evidence-based interventions to reduce the burden of the disease on affected communities. Moreover, we would like to sensitize physicians to this entity to increase awareness and identify potential endemic areas in various agricultural communities.
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Affiliation(s)
- Sourabh Sharma
- Department of Nephrology, Vardhman Mahavir Medical College, Safdarjung Hospital, Delhi 110029, India
| | - Neha Sharma
- Department of Pathology, Vardhman Mahavir Medical College, Safdarjung Hospital, Delhi 110029, India
| | - Urmila Anandh
- Department of Nephrology, Amrita Hospitals, Faridabad 121002, India
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Sinha S, Basu R, Chakravarty K. An analytical observational study on chronic kidney disease of unknown etiology at a rural tertiary care hospital in West Bengal. Indian J Public Health 2023; 67:208-214. [PMID: 37459014 DOI: 10.4103/ijph.ijph_768_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background Chronic kidney disease of unknown etiology (CKDu) has been a growing concern in the Indian population causing significant morbidity and mortality in these recent years. Thus, it is vital to understand the probable risk factors associated with its manifestation. This study aims to assess the distribution of various etiologies among CKD patients, investigate all the probable risk factors associated with CKDu, and estimate the health-related quality of life (QoL) among all CKDu patients in the study area. Materials and Methods It was an analytical, observational, cross-sectional study where one objective had a case-control study design. It was conducted at Bankura Sammilani Medical College in Bankura district, West Bengal, during July 2022-August 2022. A total of 198 patients have been studied through detailed interviews using a predesigned, pretested, semi-structured schedule. Potential risk factors and their strength of association were analyzed with the help of multivariate logistic regression. Results It was found that the prevalence of CKDu was almost 71% in the study population, mostly affecting agricultural workers (67.17%), daily laborers (46.46%), and construction workers. Perceived heat stress, excessive daily dietary intake of salt, and drinking contaminated water are the factors that had shown the strongest association with the occurrence of CKDu in this population. The deterioration in QoL in CKDu pretty much mirrors that of CKD. Conclusion CKDu is definitely an occupational disease, mostly affecting the wage workers and farmers spending long hours in unhealthy work environments. Environmental exposure to heavy metals must be checked and dietary modification must be done through counseling to regulate salt intake. CKDu, as a rising public health concern certainly needs special attention and immediate planning as it has a different etiopathology than CKD and the affected population, disease progression, and risk factors are markedly distinctive as well.
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Affiliation(s)
- Sagnik Sinha
- Student, 3rd Professional MBBS (Part II), Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
| | - Rivu Basu
- Assistant Professor, Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| | - Kapiljit Chakravarty
- Consultant Nephrologist, Department of Medicine, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India
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Lasanthika C, Wanigasuriya K, Hettiaratchi U, Amarasekara TD, Evangeline Goonewardena CS. Psychometric Properties of an Instrument to Determine the Factors Affecting Treatment Adherence Among Patients Receiving Hemodialysis in Sri Lanka. J Patient Exp 2023; 10:23743735231151558. [PMID: 36741823 PMCID: PMC9893358 DOI: 10.1177/23743735231151558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Nonadherence is a widespread problem among patients receiving hemodialysis, while contributing factors are underexplored due to lack of a validated instrument. The study aimed to develop and validate a new disease-specific instrument determining the factors affecting treatment adherence behaviors among patients receiving hemodialysis in a Sri Lankan hospital. The content validation process using a modified Delphi technique suggested 42-item instrument with an average Item-level Content Validity Index (I-CVI) of 0.94. Subsequent principal component analysis (PCA) revealed 5 components with 17 items (patient-centered psychological and physical factors, factors associated with health care, hemodialysis therapy-related factors, socioeconomic factors, and factors associated with the continuity of the treatment), explaining 67.24% total variance. The reliability estimate based on Mislevy and Bock for each component greater than 0.8 and overall standardized Cronbach's alpha of 0.605, indicated acceptable internal consistency reliability. Root mean square residual (RMSR) and weighted root mean square residual (WRMR) indices of 0.084 and 0.059, respectively, indicated acceptable model fit. The final 17-item instrument provides a valid measure for the factors affecting treatment adherence behaviors of the patients receiving hemodialysis in a Sri Lankan hospital.
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Affiliation(s)
- Chalani Lasanthika
- Faculty of Graduate Studies, University of Sri
Jayewardenepura, Nugegoda, Sri Lanka,Department of Nursing and Midwifery, Faculty of Allied Health
Sciences, University of Sri
Jayewardenepura, Nugegoda, Sri Lanka,Chalani Lasanthika, Department of Nursing
and Midwifery, Faculty of Allied Health Sciences, University of Sri
Jayewardenepura, Nugegoda 10250, Sri Lanka.
| | - Kamani Wanigasuriya
- Center for Kidney Research, Faculty of Medical Sciences, University of Sri
Jayewardenepura, Nugegoda, Sri Lanka
| | - Usha Hettiaratchi
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri
Jayewardenepura, Nugegoda, Sri Lanka
| | - Thamara Dilhani Amarasekara
- Department of Nursing and Midwifery, Faculty of Allied Health
Sciences, University of Sri
Jayewardenepura, Nugegoda, Sri Lanka
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11
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Waiddyanatha S, Silva A, Weerakoon K, Siribaddana S, Isbister GK. Does snake envenoming cause chronic kidney disease? A cohort study in rural Sri Lanka. Clin Toxicol (Phila) 2023; 61:47-55. [PMID: 36440905 DOI: 10.1080/15563650.2022.2147843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is limited information on the risk of chronic kidney disease (CKD) following snakebite and its relationship with chronic interstitial nephritis in agricultural communities (CINAC). We aimed to investigate CKD in patients with a confirmed snakebite in rural Sri Lanka. METHODS Patients prospectively recruited to the Anuradhapura snakebite cohort with authenticated bites were followed up. Two groups of patients were followed up: 199 patients in group I with a snakebite (August 2013-October 2014), reviewed after 4 years, and 168 patients in group II with a snakebite (May 2017-August 2018), reviewed after one year, with serum creatinine (estimated glomerular filtration rate [eGFR]) and urinary albumin to creatinine ratio (ACR). RESULTS There were 12/199 (6%) in group I and 9/168 (5%) in group II with AKI following snakebite; 3/12 in group I and 2/9 in group II had haemodialysis. On review after 1 and 4 years, no patient had CKD and all had an eGFR ≥60 mL/min/1.73m2. Of 234 patients with a creatinine measured on discharge, 17/140 in group I and 11/94 in group II had a low eGFR (<60mL/min/1.73m2). In group I, 14/17 had a normal eGFR after four years, including 11/12 who had AKI following snakebite, and the 3/17 with a low eGFR on review had CKD or co-morbidities for CKD. In group II, 10/11 had a normal eGFR after one year, including all nine patients with AKI following snakebite, and the one patient with a low eGFR on review had CKD. Fifty patients (25%) in group I and 43 (26%) in group II had a high urinary ACR on review, all but two in each group had microalbuminuria. Multivariate logistic regression showed in group I that only comorbidities for CKD were associated with high urinary ACR, and in group II comorbidities for CKD, snakebite associated AKI and snake type were associated with high urinary ACR. All nine patients from both groups with a low eGFR (CKD stages 3-5) had CKD prior to the snakebite or treatment for hypertension or diabetes. CONCLUSION There was no significant association between snakebite-associated AKI and CKD in patients followed up from a snakebite cohort post-bite. Microalbuminuria was common in these patients but likely associated with hypertension, diabetes mellitus and CINAC in this rural farming population.
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Affiliation(s)
- Subodha Waiddyanatha
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Anjana Silva
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.,South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Department of Pharmacology, Faculty of Medicine, Nursing and Health Sciences, Monash Venom Group, Monash University, Melbourne, VIC, Australia
| | - Kosala Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Geoffrey K Isbister
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.,Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
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12
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Urinary biomarkers indicate pediatric renal injury among rural farming communities in Sri Lanka. Sci Rep 2022; 12:8040. [PMID: 35577796 PMCID: PMC9110366 DOI: 10.1038/s41598-022-10874-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/13/2022] [Indexed: 01/11/2023] Open
Abstract
Pediatric renal injury is an emerging health concern in communities affected by chronic kidney disease of uncertain etiology (CKDu). Early detection of susceptibilities through highly sensitive and specific biomarkers can lead to effective therapeutic and preventive interventions against renal diseases. Here, we aimed to investigate the utility of kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in early detection of renal abnormalities in selected pediatric communities in Sri Lanka. The study areas were stratified as CKDu endemic, emerging, and non-endemic based on the prevalence of CKDu, and a total of 804 school students (10–18 years of age) participated in the study. The median (IQR) urinary KIM-1 levels of the participants were 0.193 (0.026–0.338), 0.082 (0.001–0.220) and 0.040 (0.003–0.242) ng/mgCr for CKDu endemic, emerging and non-endemic regions respectively. Participants from CKDu endemic regions reported elevated (p < 0.0001) urinary KIM-1 expression compared to those from the other regions. The median (IQR) NGAL levels in participants from CKDu endemic (2.969; 1.833–5.641), emerging (3.374; 1.766–6.103), and non-endemic (3.345; 1.742–5.128 ng/mgCr) regions showed no significant difference. Also, urinary albumin-creatinine ratio (UACR) showed no significant differences across gender or residency. The prevalence of albuminuria was 1–2% in the locations irrespective of CKDu burden. Albuminuric participants reported higher (p < 0.05) urinary KIM-1 levels in comparison to normoalbuminuric participants. Significantly elevated urinary KIM-1 expression in a pediatric population from CKDu affected regions, especially in the presence of albuminuria, may indicate low-grade early renal damage supporting the utility of KIM-1 as a quantifiable biomarker.
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13
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Arambegedara D, Jayasinghe S, Udagama P. Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:4893-4910. [PMID: 34799798 PMCID: PMC8604553 DOI: 10.1007/s11356-021-17316-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/27/2021] [Indexed: 05/08/2023]
Abstract
Increasing prevalence of endemic chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is a major health problem since the 1990s. Despite numerous studies on CKDu, research groups have been unable to develop a comprehensive approach to mitigate the disorder, and thereby to identify research gaps. We conducted a systematic literature review of 119 publications on CKDu in Sri Lanka from Pubmed, Google Scholar, and Scopus, published until end September 2020. A higher CKDu prevalence in the working population of the North Central Province was reported with recent studies indicating patients from non-endemic regions as well. A majority were etiological studies that recorded conflicting and inconclusive evidence on CKDu etiology. Studies on clinico-pathological, diagnostic, biochemical, and molecular biological aspects of CKDu, studies analyzing CKDu symptom burden, anthropological, and behavioral impacts of CKDu, were reviewed as well. A dearth of research exists on nutritional, demographical, immunological, and microbial aspects of CKDu. The overview of the reviewed literature indicated the absence of a comprehensive plan of action to mitigate this situation. Hence, we propose the "One Health" approach with a systems dynamics model as a potential way forward to alleviate the CKDu epidemic in Sri Lanka. This enables the representation of multiple causative agents (and interactions thereof) among environmental, animal, and human systems, in concert with the "exposome" that provides the totality of exposure the individual has undergone since birth.
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Affiliation(s)
- Dinushi Arambegedara
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka
| | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 8, Sri Lanka
| | - Preethi Udagama
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka.
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14
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John O, Gummudi B, Jha A, Gopalakrishnan N, Kalra OP, Kaur P, Kher V, Kumar V, Machiraju RS, Osborne N, Palo SK, Parameswaran S, Pati S, Prasad N, Rathore V, Rajapurkar MM, Sahay M, Tatapudi RR, Thakur JS, Venugopal V, Jha V. Chronic Kidney Disease of Unknown Etiology in India: What Do We Know and Where We Need to Go. Kidney Int Rep 2021; 6:2743-2751. [PMID: 34805627 PMCID: PMC8589686 DOI: 10.1016/j.ekir.2021.07.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chronic kidney disease (CKD) not associated with known risk factors has been reported from parts of India and is presumed to be similar to CKD of unknown etiology (CKDu) that has been described from Central America. The reports from India have been fragmented without clear description of the disease phenotype or its determinants. This paper summarizes the current state of knowledge around CKDu in India based on a review of literature, multi-stakeholder consultation, and a survey of Indian nephrologists. We also contacted individual research groups to solicit data. Our findings suggest that that CKDu is reported from most regions in India; however, it is interpreted differently from the phenotype described from Central America and Sri Lanka. The differences include lack of a clear demographic or occupation group, older age of affected participants, and presence of mild hypertension and low-grade proteinuria. Well-designed prospective field studies with appropriate diagnostic workup are needed to establish the disease burden and identify etiologies, along with socioeconomic and health consequences, the intersection with the environment, and the public health response. Community-based research should phenotype the entire CKD population rather than be restricted to cases with presumed CKDu based on predefined criteria. Guidelines are needed for clinical evaluation, referral, management, and harmonization of clinical documentation and health records. More data are needed to support the existence of a unique CKDu phenotype in India.
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Affiliation(s)
- Oommen John
- George Institute for Global Health India, UNSW, New Delhi, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Balaji Gummudi
- George Institute for Global Health India, UNSW, New Delhi, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Anubhuti Jha
- George Institute for Global Health India, UNSW, New Delhi, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Om P Kalra
- Pt BD Sharma University of Health Sciences, Rohtak, India
| | | | - Vijay Kher
- Medanta Kidney & Urology Institute, Medanta the Medicity, Gurugram, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Nicolas Osborne
- School of Public Health University of Queensland Herston Australia.,School of Population Health University of New South Wales Australia
| | | | - Sreejith Parameswaran
- Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vinay Rathore
- All India Institute of Medical Sciences, Raipur, India
| | | | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, India
| | | | - Jarnail S Thakur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidhya Venugopal
- Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Vivekanand Jha
- George Institute for Global Health India, UNSW, New Delhi, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.,School of Public Health, Imperial College, London, UK
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15
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Pett J, Mohamed F, Knight J, Linhart C, Osborne NJ, Taylor R. Two decades of chronic kidney disease of unknown aetiology (CKDu) research: Existing evidence and persistent gaps from epidemiological studies in Sri Lanka. Nephrology (Carlton) 2021; 27:238-247. [PMID: 34704321 PMCID: PMC9298898 DOI: 10.1111/nep.13989] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/29/2021] [Accepted: 10/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic Kidney Disease of unknown origin (CKDu) excludes known primary renal conditions or systemic disease (such as diabetes mellitus or hypertension). Prominence of CKDu has been noted for some decades in Sri Lanka, especially among men in particular rural areas, prompting many studies directed towards environmental causation. This article critically reviews relevant primary studies. METHODS Articles for this literature review (n = 86) were found by searching Medline, Embase, Global Health and ProQuest databases over 2000-2020 utilizing a standard algorithm. Articles were critiqued according to criteria for diagnosis of CKDu, aetiological agents investigated, analytic methods employed and findings. RESULTS Criteria for diagnosis of CKDu varied significantly, including pre-selection by proteinuria, eGFR and biopsy proven interstitial nephritis. Prevalence studies have been largely conducted in the North Central Province, with recent studies demonstrating the presence of CKDu in other regions. Aetiological factors investigated in primary studies included water source, use of agrochemicals, agricultural work, heavy metals, snake bites, ayurvedic medication, heat stress, infectious diseases and usage of tobacco and betel leaf. There is no conclusive evidence for any one aetiological agent despite consistent evidence of distal factors such as male sex, rural residence and farming. CONCLUSIONS The current body of evidence for any aetiological agent as the cause of CKDu in Sri Lanka is limited. Further research with stronger study designs is necessary to increase knowledge of aetiology of CKDu in Sri Lanka to identify and eliminate exposure to possible causative agent(s) prior to concluding that the disease is multifactorial.
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Affiliation(s)
- Jennifer Pett
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine University of Peradeniya, Kandy, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health, University of Peradeniya, Peradeniya, Sri Lanka.,Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Biomedical Informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, The University of Sydney, Sydney, NSW, Australia
| | - John Knight
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Christine Linhart
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas J Osborne
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Richard Taylor
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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16
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Paidi G, Iroshani Jayarathna AI, Salibindla DBAMR, Amirthalingam J, Karpinska-Leydier K, Alshowaikh K, Ergin HE. Chronic Kidney Disease of Unknown Origin: A Mysterious Epidemic. Cureus 2021; 13:e17132. [PMID: 34548965 PMCID: PMC8437007 DOI: 10.7759/cureus.17132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/12/2021] [Indexed: 12/19/2022] Open
Abstract
Amongst the many threats to health in our world, the most challenging ones are the ones with unknown causes. There is a mysterious epidemic of kidney disease called chronic kidney disease of unknown etiology (CKDu) that is occurring in many parts of the world. Unrelated to known risk factors such as diabetes and hypertension, CKDu mostly affects the young and middle-aged, with slight preponderance in males. It mostly occurs in people living in rural areas, especially working in agricultural jobs. Worldwide, the number of people with chronic kidney disease, and those who need dialysis and renal replacement, is increasing every year as compared to other chronic conditions like diabetes and AIDS. It's not just alarming but a great challenge to healthcare systems across the world, especially in resource-poor countries. CKDu has become a silent killer for most patients. The occurrence of end-stage renal disease (ESRD) in CKDu can be catastrophic for individuals, especially in countries with limited medical facilities, causing a significant socio-economic burden. Even within these economically developing nations, people affected by CKDu usually are from the most vulnerable and underserved populations. As a definitive etiology has not been postulated for CKDu to date, this comprehensive review was undertaken to throw light on the poorly understood epidemiologic risk factors and the course of the disease.
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Affiliation(s)
- Gokul Paidi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | | | - Jashvini Amirthalingam
- General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Khadija Alshowaikh
- Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Huseyin Ekin Ergin
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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17
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Fang Y, Shi H, Xiang T, Liu J, Liu J, Tang X, Fang X, Chen J, Zhai Y, Shen Q, Li G, Sun L, Bi Y, Wang X, Qian Y, Wu B, Wang H, Zhou W, Ma D, Mao J, Jiang X, Sun S, Shen Y, Liu X, Zhang A, Wang X, Huang W, Li Q, Wang M, Gao X, Wu Y, Deng F, Zhang R, Liu C, Yu L, Zhuang J, Sun Q, Dang X, Bai H, Zhu Y, Lu S, Zhang B, Shao X, Liu X, Han M, Zhao L, Liu Y, Gao J, Bao Y, Zhang D, Ma Q, Zhao L, Xia Z, Lu B, Wang Y, Zhao M, Zhang J, Jian S, He G, Zhang H, Zhao B, LI X, Wang F, Li Y, Zhu H, Luo X, Li J, Rao J, Xu H. Genetic Architecture of Childhood Kidney and Urological Diseases in China. PHENOMICS (CHAM, SWITZERLAND) 2021; 1:91-104. [PMID: 36939782 PMCID: PMC9590557 DOI: 10.1007/s43657-021-00014-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
Kidney disease is manifested in a wide variety of phenotypes, many of which have an important hereditary component. To delineate the genotypic and phenotypic spectrum of pediatric nephropathy, a multicenter registration system is being implemented based on the Chinese Children Genetic Kidney Disease Database (CCGKDD). In this study, all the patients with kidney and urological diseases were recruited from 2014 to 2020. Genetic analysis was conducted using exome sequencing for families with multiple affected individuals with nephropathy or clinical suspicion of a genetic kidney disease owing to early-onset or extrarenal features. The genetic diagnosis was confirmed in 883 of 2256 (39.1%) patients from 23 provinces in China. Phenotypic profiles showed that the primary diagnosis included steroid-resistant nephrotic syndrome (SRNS, 23.5%), glomerulonephritis (GN, 32.2%), congenital anomalies of the kidney and urinary tract (CAKUT, 21.2%), cystic renal disease (3.9%), renal calcinosis/stone (3.6%), tubulopathy (9.7%), and chronic kidney disease of unknown etiology (CKDu, 5.8%). The pathogenic variants of 105 monogenetic disorders were identified. Ten distinct genomic disorders were identified as pathogenic copy number variants (CNVs) in 11 patients. The diagnostic yield differed by subgroups, and was highest in those with cystic renal disease (66.3%), followed by tubulopathy (58.4%), GN (57.7%), CKDu (43.5%), SRNS (29.2%), renal calcinosis /stone (29.3%) and CAKUT (8.6%). Reverse phenotyping permitted correct identification in 40 cases with clinical reassessment and unexpected genetic conditions. We present the results of the largest cohort of children with kidney disease in China where diagnostic exome sequencing was performed. Our data demonstrate the utility of family-based exome sequencing, and indicate that the combined analysis of genotype and phenotype based on the national patient registry is pivotal to the genetic diagnosis of kidney disease. Supplementary Information The online version contains supplementary material available at 10.1007/s43657-021-00014-1.
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Affiliation(s)
- Ye Fang
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Hua Shi
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Tianchao Xiang
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Jiaojiao Liu
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Jialu Liu
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Xiaoshan Tang
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Xiaoyan Fang
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Jing Chen
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Yihui Zhai
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Qian Shen
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Guomin Li
- grid.411333.70000 0004 0407 2968Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Li Sun
- grid.411333.70000 0004 0407 2968Department of Rheumatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Yunli Bi
- grid.411333.70000 0004 0407 2968Department of Urology, Children’s Hospital of Fudan University, Shanghai, China
| | - Xiang Wang
- grid.411333.70000 0004 0407 2968Department of Urology, Children’s Hospital of Fudan University, Shanghai, China
| | - Yanyan Qian
- grid.411333.70000 0004 0407 2968Clinical Genetic Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Bingbing Wu
- grid.411333.70000 0004 0407 2968Clinical Genetic Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Huijun Wang
- grid.411333.70000 0004 0407 2968Clinical Genetic Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Wenhao Zhou
- grid.411333.70000 0004 0407 2968Clinical Genetic Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Duan Ma
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
- grid.8547.e0000 0001 0125 2443Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, Institutes of Biomedical Sciences, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Jianhua Mao
- grid.13402.340000 0004 1759 700XThe Children Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyun Jiang
- grid.412615.5The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shuzhen Sun
- grid.460018.b0000 0004 1769 9639Shandong Provincial Hospital, Jinan, China
| | - Ying Shen
- grid.24696.3f0000 0004 0369 153XBejing Children’s Hospital Affiliated to Capital University of Medical Science, Beijing, China
| | - Xiaorong Liu
- grid.24696.3f0000 0004 0369 153XBejing Children’s Hospital Affiliated to Capital University of Medical Science, Beijing, China
| | - Aihua Zhang
- grid.452511.6Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaowen Wang
- grid.33199.310000 0004 0368 7223Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenyan Huang
- grid.16821.3c0000 0004 0368 8293Shanghai Children’s Medical Centre, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qiu Li
- grid.488412.3Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Mo Wang
- grid.488412.3Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojie Gao
- grid.452787.b0000 0004 1806 5224Shenzhen Children’s Hospital, Shenzheng, China
| | - Yubin Wu
- grid.412467.20000 0004 1806 3501Shengjing Hospital of China Medical University, Shenyang, Liaoning China
| | - Fang Deng
- grid.489986.2Anhui Provincial Children’s Hospital, Hefei, China
| | - Ruifeng Zhang
- grid.460138.8Xuzhou Children’s Hospital, Xuzhou, China
| | - Cuihua Liu
- Henan Children’s Hospital, Zhengzhou, China
| | - Li Yu
- grid.413432.30000 0004 1798 5993Guangzhou First People’s Hospital, Guangzhou, China
| | - Jieqiu Zhuang
- grid.417384.d0000 0004 1764 2632The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing Sun
- grid.508137.80000 0004 4914 6107Qingdao Women and Children’s Hospital, Qingdao, China
| | - Xiqiang Dang
- grid.452223.00000 0004 1757 7615Xiangya Hospital Central South University, Changsha, Hunan China
| | - Haitao Bai
- grid.412625.6The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ying Zhu
- grid.412679.f0000 0004 1771 3402First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Siguang Lu
- Children’s Hospital of Lianyungang, Lianyungang, China
| | - Bili Zhang
- Tianjin Children Hospital, Tianjing, China
| | - Xiaoshan Shao
- The Children’s Hospital of Guiyang City, Guiyang, China
| | - Xuemei Liu
- grid.27255.370000 0004 1761 1174Qilu Children’s Hospital of Shandong University, Jinan, China
| | - Mei Han
- Dalian Children’s Hospital, Dalian, China
| | - Lijun Zhao
- grid.440213.00000 0004 1757 9418Shanxi Children’s Hospital, Taiyuan, China
| | - Yuling Liu
- grid.460171.5Boai Hospital of Zhongshan, Zhongshan, China
| | - Jian Gao
- Weifang Maternal and Child Health Hospital, Weifang, China
| | - Ying Bao
- grid.452902.8Xi’an Children’s Hospital, Xian, China
| | - Dongfeng Zhang
- grid.470210.0Children’s Hospital of Hebei Province, Shijiazhuang, China
| | - Qingshan Ma
- grid.430605.4First Affiliated Hospital of Jilin University, Changchun, China
| | - Liping Zhao
- Wuxi Municipal Children’s Hospital, Wuxi, China
| | - Zhengkun Xia
- grid.89957.3a0000 0000 9255 8984Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Biao Lu
- grid.413385.8General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yulong Wang
- grid.452704.0The Second Hospital of Shandong University, Jinan, China
| | - Mengzhun Zhao
- grid.194645.b0000000121742757Shenzhen Hospital of University of Hong Kong, Shenzhen, China
| | - Jianjiang Zhang
- grid.412633.1First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shan Jian
- grid.413106.10000 0000 9889 6335Peking Union Medical College Hospital, Beijing, China
| | - Guohua He
- Child Health Hospital of Foshan, Foshan, Guangdong China
| | - Huifeng Zhang
- grid.452702.60000 0004 1804 3009The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bo Zhao
- grid.415549.8Kunming Children’s Hospital, Kunming, China
| | - Xiaohua LI
- grid.413375.70000 0004 1757 7666Affiliated Hospital of Inner Mongolia Medical University, Hohehot, China
| | - Feiyan Wang
- Urumqi City Children’s Hospital, Urumqi, China
| | - Yufeng Li
- grid.16821.3c0000 0004 0368 8293Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Hongtao Zhu
- grid.13394.3c0000 0004 1799 3993Academy of Pediatrics, Xinjiang Medical University, Urumqi, China
| | - Xinhui Luo
- Xinjiang Uygur Autonomous Region People’s Hospital, Urumqi, China
| | - Jinghai Li
- grid.470082.9Changchun Children’s Hospital, Changchun, China
| | - Jia Rao
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
| | - Hong Xu
- grid.411333.70000 0004 0407 2968Department of Nephrology, Children’s Hospital of Fudan University, National Pediatric Medical Center of CHINA, 399 Wanyuan Road, Shanghai, China
- Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Shanghai, China
- grid.411333.70000 0004 0407 2968Shanghai Key Lab of Birth Defect, Children’s Hospital of Fudan University, Shanghai, 201102 China
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18
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Gunawardena S, Dayaratne M, Wijesinghe H, Wijewickrama E. A Systematic Review of Renal Pathology in Chronic Kidney Disease of Uncertain Etiology. Kidney Int Rep 2021; 6:1711-1728. [PMID: 34169213 PMCID: PMC8207327 DOI: 10.1016/j.ekir.2021.03.898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/06/2021] [Accepted: 03/29/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Despite much research on chronic kidney disease of uncertain etiology (CKDu) in Sri Lanka and the Mesoamerican nephropathy, the etiology and pathogenesis of this disease remains elusive. The pathology has broadly been described as chronic tubulointerstitial nephritis and no specific signature lesions have been identified. METHODS A scoping review was conducted through MEDLINE and Google Scholar databases for peer-reviewed publications on biopsy studies related to CKDu - Sri Lanka and Mesoamerican nephropathy to develop a comparative and critical analysis of the renal pathology found in these patients. RESULTS Thirteen studies met the selection criteria. Interstitial fibrosis was the predominant lesion in all the studies. Tubulointerstitial and glomerular abnormalities showed a more variable distribution. No characteristic histopathological feature was reported other than a proximal tubular lysosomal inclusion body which was claimed to indicate a toxic etiology. Three main pathogenetic mechanisms were postulated: repeated acute insults leading to scarring, low-grade chronic insults leading to non-inflammatory fibrosis, and tubulointerstitial damage in combination with glomerular injury. The main limitations in the interpretation and comparative analysis of these studies were the heterogeneity in case selection and biopsy reporting. CONCLUSIONS Although no characteristic histopathological feature could be found in CKDu-Sri Lanka or Mesoamerican nephropathy, there are noticeable differences between these two groups in the frequency and severity of the glomerular and tubulointerstitial changes which warrant more explorative studies preferably on kidneys in early stages of the disease. Future strategies should ensure that more uniform selection criteria and reporting methods are used.
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Affiliation(s)
- Sameera Gunawardena
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Maleesha Dayaratne
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Harshima Wijesinghe
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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19
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Hettiarachchi TW, Fernando BNTW, Sudeshika T, Badurdeen Z, Anand S, Kularatne A, Wijetunge S, Abeysundara HTK, Nanayakkara N. Prevalence, risk factors and predicted risk of cardiac events in chronic kidney disease of uncertain aetiology in Sri Lanka: A tubular interstitial nephropathy. PLoS One 2021; 16:e0249539. [PMID: 33852602 PMCID: PMC8046203 DOI: 10.1371/journal.pone.0249539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/21/2021] [Indexed: 11/19/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with 'traditional' chronic kidney disease (CKD). However, chronic kidney disease of uncertain aetiology (CKDu), a tubular interstitial nephropathy is typically minimally proteinuric without high rates of associated hypertension or vascular disease and it is unknown if the rates of CVD are similar. This study aimed to identify the prevalence and the risk of CVD in patients with CKDu. This cross-sectional study included patients with confirmed CKDu who were attending two renal clinics in CKDu endemic-area. A detailed medical history, blood pressure, electrocardiogram (resting and six minutes vigorous walking), echocardiograms, appropriate laboratory parameters and medical record reviews were used to collect data at baseline. The WHO/Pan American Health Organization, cardiovascular risk calculator was employed to determine the future risk of CVD. The clinics had recorded 132 number of patients with CKDu, of these 119 consented to participation in the study. The mean age was 52 (± 9.5) years and mean eGFR was 51.1 (± 27.61); a majority (81.5% (n = 97)) were males. Thirty-four patients (28.6%) had evidence of ischaemic heart disease (IHD). Troponin-I (p = 0.02), Age >50 years (p = 0.01) and hyperuricemia (p = 0.01) were significantly associated with IHD in CKDu. Left ventricular hypertrophy was reported in 20.2% (n = 24). According to the risk calculator, 97% of the enrolled patients were at low risk (<10%) for experiencing a cardiovascular event within the next 10 years. Patients with CKDu have low prevalence and risk for CVD, implying that a majority are likely to survive to reach end-stage kidney disease. Our findings highlight the need for developing strategies to minimize the progression of CKDu to end-stage renal disease.
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Affiliation(s)
- Thilini W. Hettiarachchi
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka
| | - Buddhi N. T. W. Fernando
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Thilini Sudeshika
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Galaha, Sri Lanka
| | - Zeid Badurdeen
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, United States of America
| | | | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka
| | - Hemalika T. K. Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Galaha, Sri Lanka
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20
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Chou LF, Chen TW, Yang HY, Tian YC, Chang MY, Hung CC, Hsu SH, Tsai CY, Ko YC, Yang CW. Transcriptomic signatures of exacerbated progression in leptospirosis subclinical chronic kidney disease with secondary nephrotoxic injury. Am J Physiol Renal Physiol 2021; 320:F1001-F1018. [PMID: 33779314 DOI: 10.1152/ajprenal.00640.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
High-incidence regions of leptospirosis caused by Leptospira spp. coincide with chronic kidney disease. This study investigated whether asymptomatic leptospirosis is an emerging culprit that predisposes to progressive chronic kidney disease when superimposed on secondary nephrotoxic injury. Kidney histology/function and whole transcriptomic profiles were evaluated for Leptospira-infected C57/BL6 mice with adenine-induced kidney injury. The extent of tubulointerstitial kidney lesions and expression of inflammation/fibrosis genes in infected mice with low-dose (0.1%) adenine, particularly in high-dose (0.2%) adenine-fed superimposed on Leptospira-infected mice, were significantly increased compared with mice following infection or adenine diet alone, and the findings are consistent with renal transcriptome analysis. Pathway enrichment findings showed that integrin-β- and fibronectin-encoding genes had distinct expression within the integrin-linked kinase-signaling pathway, which were upregulated in 0.2% adenine-fed Leptospira-infected mice but not in 0.2% adenine-fed mice, indicating that background subclinical Leptospiral infection indeed enhanced subsequent secondary nephrotoxic kidney injury and potential pathogenic molecules associated with secondary nephrotoxic leptospirosis. Comparative analysis of gene expression patterns with unilateral ureteric obstruction-induced mouse renal fibrosis and patients with chronic kidney disease showed that differentially expressed orthologous genes such as hemoglobin-α2, PDZ-binding kinase, and DNA topoisomerase II-α were identified in infected mice fed with low-dose and high-dose adenine, respectively, revealing differentially expressed signatures identical to those found in the datasets and may serve as markers of aggravated kidney progression. This study indicates that background subclinical leptospirosis, when subjected to various degrees of subsequent secondary nephrotoxic injury, may predispose to exacerbated fibrosis, mimicking the pathophysiological process of progressive chronic kidney disease.NEW & NOTEWORTHY Leptospira-infected mice followed by secondary nephrotoxic injury exacerbated immune/inflammatory responses and renal fibrosis. Comparison with the murine model revealed candidates involved in the progression of renal fibrosis in chronic kidney disease (CKD). Comparative transcriptome study suggests that secondary nephrotoxic injury in Leptospira-infected mice recapitulates the gene expression signatures found in CKD patients. This study indicates that secondary nephrotoxic injury may exacerbate CKD in chronic Leptospira infection implicating in the progression of CKD of unknown etiology.
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Affiliation(s)
- Li-Fang Chou
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ting-Wen Chen
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Huang-Yu Yang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Yang Chang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chieh Hung
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shen-Hsing Hsu
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Ying Tsai
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Ching Ko
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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21
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Kulathunga MRDL, Wijayawardena MAA, Naidu R. Heavy metal(loid)s and health risk assessment of Dambulla vegetable market in Sri Lanka. ENVIRONMENTAL MONITORING AND ASSESSMENT 2021; 193:230. [PMID: 33772647 DOI: 10.1007/s10661-021-09020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
Vegetables are essential for a healthy diet in humans. However, vegetables can carry harmful metal(loid) contaminants such as As, Cd and Pb which are deleterious to health in the long term. It has been postulated that long-term heavy metal(loid) exposure by vegetable consumption is associated with chronic kidney disease of unknown aetiology (CKDu) that prevails in North Central Province of Sri Lanka. We performed a human health risk assessment to identify if there is any link between heavy metal(loid) exposure from vegetable consumption and the prevalence of CKDu. The study includes a survey of food consumption in CKDu-impacted areas and determination of the heavy metal(loid) contents of market vegetables. We found that Solanum tuberosum (potato) and Momordica charantia (bitter gourd) accumulated Pb to a greater extent than other vegetables and exceeded the permissible concentration for foodstuffs. The Cd content of Solanum melongena (Brinjal) also exceeded permissible levels. However, the As content was below permissible levels for all the vegetables tested. The weekly total heavy metal(loid) intake of Cd, As and Pb in vegetables in CKDu-impacted areas was lower than permissible limits. The consumption of an average amount of vegetables does not pose a chronic health risk to the consumers. There was no evidence of a link between the consumption of heavy metal(loid)s in vegetables and CKDu. Since, few vegetables showed marked heavy metal(loid) accumulation, periodical monitoring of heavy metal(loid) concentrations in vegetables will be beneficial for avoidance of future possible health risks.
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Affiliation(s)
- M R D L Kulathunga
- Global Centre for Environmental Remediation (GCER), The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Fruit Research and Development Institute, Kananwila, Horana, Sri Lanka.
| | - M A Ayanka Wijayawardena
- Global Centre for Environmental Remediation (GCER), The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Ravi Naidu
- Global Centre for Environmental Remediation (GCER), The University of Newcastle, Callaghan, NSW, 2308, Australia
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW, 2308, Australia
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22
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Risk Assessment of Trace Element Contamination in Drinking Water and Agricultural Soil: A Study in Selected Chronic Kidney Disease of Unknown Etiology (CKDu) Endemic Areas in Sri Lanka. J CHEM-NY 2021. [DOI: 10.1155/2021/6627254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Unexplained or unclear etiology of chronic kidney disease (CKDu) has been reported in Sri Lanka’s North Central Province (NCP) for more than two decades. Meanwhile, high exposure to heavy metals/metalloids and their accumulation are recognized as the origin of many acute and chronic diseases in certain vulnerable human tissues including kidneys. This study evaluates the contamination status of heavy metals/metalloids of the drinking water and agricultural soil in two CKDu endemic areas compared with a reference area in Sri Lanka based on common indexes and attribute of the commonly used fertilizers evaluated to identify the basic sources of toxic metals in the agricultural soil. Mean concentrations of heavy metals/metalloids such as Mn, Co, As, Cd, Pb, Cu, Zn, and Fe in drinking water of CKDu endemic areas were far below Sri Lankan water quality standards (permissible limits). In addition, all sampling locations dropped below the medium range of the heavy metal pollution index of water (HPI 15–40). Geoaccumulation indexes (Igeo) of soil reveal that paddy soil in CKDu endemic areas is being moderately polluted with toxic metals/metalloids such as As, Pb, Cu, Ni, Cr, Zn, and Cd. On the other hand, the application of fertilizers, which contained a high dose of toxic metals, could be the driving force for agricultural soil pollution, and limitless application of low-quality fertilizer would lead to more soil contamination with heavy metals. Hence, hazardous metals can be incorporated into the food chains via contaminated paddy soil.
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23
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Redmon JH, Levine KE, Lebov J, Harrington J, Kondash AJ. A comparative review: Chronic Kidney Disease of unknown etiology (CKDu) research conducted in Latin America versus Asia. ENVIRONMENTAL RESEARCH 2021; 192:110270. [PMID: 33035557 DOI: 10.1016/j.envres.2020.110270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The incidence of chronic kidney disease of unknown or uncertain etiology (CKDu) is recognized as a global non-communicable health crisis. The goal of this work is to compare the types of research studies in Latin America and Asia, two regions with increasing CKDu incidence. METHODS A comparative literature review was conducted to evaluate the CKDu research design for peer-reviewed articles published from 2015 to 2019. Full texts were reviewed to identify study location, study type, study design, risk factors evaluated, and if applicable, sample type and number. RESULTS In Asia and Latin America, 82 and 65 articles were identified in total, respectively, with 55 field studies in Asia versus 34 in Latin America. In Asia, research was focused on drinking water (34), heavy metals (20), and agrochemical product usage (19) as potential risk factors. In Latin America, research focused mostly on heat stress/dehydration (36) and agrochemical product usage (18) as potential CKDu risk factors. Biological samples were collected more frequently than environmental samples, especially in Latin America. DISCUSSION Research to pinpoint the risk factors associated with CKDu to date is not standardized and typically limited in geographical scope. The emphasis of CKDu research varies by geographic region, with a greater priority placed on water quality and chemical exposure in Asia, versus dehydration and heat stress in Latin America. Using a harmonized approach to CKDu research would yield improved understanding of the risk factors associated with CKDu and how they compare across affected regions.
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Affiliation(s)
| | | | - Jill Lebov
- RTI International, Research Triangle Park, NC, USA
| | | | - A J Kondash
- RTI International, Research Triangle Park, NC, USA
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24
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Faleel RA, Jayawardena UA. Progression of potential etiologies of the chronic kidney disease of unknown etiology in Sri Lanka. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, TOXICOLOGY AND CARCINOGENESIS 2020; 38:362-383. [PMID: 33356855 DOI: 10.1080/26896583.2020.1852012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Chronic kidney disease of unknown etiology (CKDu) is a major health issue in agricultural areas in Sri Lanka. Despite many attempts to identifying causative factors of CKDu, the real cause/s remain/s elusive to date. Understanding the progression of potential etiologies may provide valuable insight into this quest. Literature relevant to CKDu addresses several etiologies, including quality of drinking water in the affected areas including hardness, fluoride, ionicity, agrochemical and heavy metal contaminations, consumption of contaminated food, and the genetic makeup of vulnerable populations. Progression of the etiologies revealed persistent interest in heavy metals of multiple origins: waterborne, foodborne, or soilborne. Secondary factors, such as water hardness, fluoride, and ionicity appear to act synergistically, aggravating the role of heavy metals on the onset, and the progression of CKDu. Demographical factors, such as male sex, over 50 years of age, agriculture-related occupation, and the consumption of contaminated water and food are intricately related with the disease progression while other minor risk factors such as smoking, alcohol consumption, etc. exasperate the disease condition. Since, none of these etiologies are examined adequately, conducting laboratory exposure studies under in-vivo and in-vitro settings to understand their role in CKDu is crucial.
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Affiliation(s)
- Ranaa Aqeelah Faleel
- Department of Zoology, Faculty of Natural Sciences, The Open University of Sri Lanka, Nawala, Sri Lanka
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25
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Exploring the Root Cause for Chronic Kidney Disease of Unknown Etiology (CKDu) via Analysis of Metal Ion and Counterion Contaminants in Drinking Water: A Study in Sri Lanka. J CHEM-NY 2020. [DOI: 10.1155/2020/8670974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The introduction of elevated amounts of foreign ions into the blood may lead to impairment of the filtration membrane of kidneys and chronic kidney damage. In order to assess the risk of consumption of drinking water (dug well water) in chronic kidney disease of unknown etiology (CKDu), affected areas in Sri Lanka, trace metals, and other counterions in water samples obtained from dug wells were analyzed and compared with a reference area. Drinking water could be the major source that is responsible for entering nephrotoxic ion contaminants into the human body. To achieve the objective, drinking water samples were collected from dug wells in two CKDu endemic areas and a reference area where no CKDu patients were found in a dry season. In the Wewelketiya area (one of the endemic areas), Cd concentrations in 60% of water samples and Pb concentrations in 40% of water samples have exceeded the maximum limit given by Sri Lanka water quality standards. Fluoride concentrations also have exceeded the permissible limits of more than 80% of collected water samples in both CKDu endemic areas. However, none of the water samples in reference areas has reported that Cd, Pb, and fluoride are beyond their maximum permissible limits. Hence, people in the particular CKDu endemic areas are at risk of kidney tissue damage due to long-term exposure to drinking water with elevated levels of some metal ions and counterions.
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26
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McDonough LK, Meredith KT, Nikagolla C, Middleton RJ, Tan JK, Ranasinghe AV, Sierro F, Banati RB. The water chemistry and microbiome of household wells in Medawachchiya, Sri Lanka, an area with high prevalence of chronic kidney disease of unknown origin (CKDu). Sci Rep 2020; 10:18295. [PMID: 33106529 PMCID: PMC7589467 DOI: 10.1038/s41598-020-75336-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
Chronic kidney disease (CKD) of unknown etiology (CKDu) mostly affects agricultural communities in Central America, South Asia, Africa, but likely also in North America and Australia. One such area with increased CKDu prevalence is the Medawachchiya District Secretariat Division of the Anuradhapura District in the North Central Province of Sri Lanka. Recent research has focused on the presence of various microbial pathogens in drinking water as potential causal or contributing factors to CKDu, yet no study to date has performed a more comprehensive microbial and water chemistry assessment of household wells used for domestic water supply in areas of high CKDu prevalence. In this study, we describe the chemical composition and total microbial content in 30 domestic household wells in the Medawachchiya District Secretariat Division. While the chemical composition in the tested wells mostly lies within standard drinking water limits, except for high levels of fluoride (F), magnesium (Mg), sodium (Na), chloride (Cl) and calcium (Ca) in some samples, we find a frequent presence of cyanotoxin-producing Microcystis, confirming earlier studies in Sri Lanka. Since the total microbial content of drinking water also directly influences the composition of the human gut microbiome, it can be considered an important determinant of health. Several bacterial phyla were previously reported in the gut microbiome of patients with CKD. Using these bacteria phyla to define operational taxonomic units, we found that these bacteria also occur in the microbiome of the sampled well water. Based on available environmental data, our study demonstrates associations between the abundances of these bacteria with geographical distribution, well water temperature and likely fertilizer use in the local surface water catchment area of the individual household wells. Our results reinforce the recommendation that household wells with stagnant or infrequently used water should be purged prior to use for drinking water, bathing and irrigation. The latter is suggested because of the reported potential accumulation of bacterial toxins by agricultural crops. The observation that bacteria previously found in chronic kidney disease patients are also present in household wells requires a more detailed systematic study of both the human gut and drinking water microbiomes in CKDu patients, in relation to disease prevalence and progression.
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Affiliation(s)
- Liza K McDonough
- Australian Nuclear Science and Technology Organisation (ANSTO), New Illawarra Rd, Lucas Heights, NSW, 2234, Australia. .,School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Karina T Meredith
- Australian Nuclear Science and Technology Organisation (ANSTO), New Illawarra Rd, Lucas Heights, NSW, 2234, Australia
| | - Chandima Nikagolla
- School of Civil and Environmental Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Ryan J Middleton
- Australian Nuclear Science and Technology Organisation (ANSTO), New Illawarra Rd, Lucas Heights, NSW, 2234, Australia
| | - Jian K Tan
- Australian Nuclear Science and Technology Organisation (ANSTO), New Illawarra Rd, Lucas Heights, NSW, 2234, Australia.,Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Asanga V Ranasinghe
- National Renal Disease Prevention and Research Unit, Ministry of Health, Colombo 10, Sri Lanka
| | - Frederic Sierro
- Australian Nuclear Science and Technology Organisation (ANSTO), New Illawarra Rd, Lucas Heights, NSW, 2234, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard B Banati
- Australian Nuclear Science and Technology Organisation (ANSTO), New Illawarra Rd, Lucas Heights, NSW, 2234, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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27
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De Broe ME, Vervaet BA. Is an Environmental Nephrotoxin the Primary Cause of CKDu (Mesoamerican Nephropathy)? PRO. KIDNEY360 2020; 1:591-595. [PMID: 35372944 PMCID: PMC8815546 DOI: 10.34067/kid.0003172020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/11/2020] [Indexed: 05/17/2023]
Affiliation(s)
- Marc E. De Broe
- Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
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Balasubramanya S, Stifel D, Horbulyk T, Kafle K. Chronic kidney disease and household behaviors in Sri Lanka: Historical choices of drinking water and agrochemical use. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100862. [PMID: 32097769 DOI: 10.1016/j.ehb.2020.100862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/17/2020] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
This paper examines whether there are systematic differences in the historical behaviors of households that are affected and unaffected by chronic kidney disease (CKD) in Sri Lanka pertaining to their water source choices, water treatment practices, and agrochemical use. This analysis is motivated by the Sri Lankan government's largest policy response to this epidemic - to encourage communities to switch from untreated well water to publicly provided alternatives. We use recall methods to elicit information on the drinking water source and treatment choices of households over an 18-year period from 2000-2017. Our analysis is based on a survey of 1497 rural ground-water dependent households in the most CKD-affected areas of the 10 districts of Sri Lanka with the highest prevalence of CKD. Our main findings are that (a) households that have ever used a pump to extract (typically deep) drinking water from a household well are more likely to be affected by CKD; (b) we fail to find a relationship between disease status and households' use of buckets to extract (typically shallow) groundwater from their wells; and (c) those who have ever treated their shallow well water by boiling it are less likely to be affected by CKD. We also find that a greater share of CKD affected households historically used agrochemicals, used wells that were geographically removed from surface water sources, and displayed lower proxies of wealth. The implications of these findings are fourfold. First, since the systematic differences in the historical patterns of water sources and treatments used by CKD affected and non-affected households are modest, the sources of water and the treatment practices themselves may not be the sole risk factors in developing CKD. Second, although we find a negative association between boiling water and the probability of CKD, it is not obvious that a public policy campaign to promote boiling water is an appropriate response. Third, the hydrochemistry of deep and shallow well water needs to be better understood in order to shed light on the positive relationship between deep well water and disease status, and on why boiling shallow but not deep well water is associated with a lower probability of CKD. Fourth, there is a need for a deeper understanding of other risk factors and of the efficacy of preventative programs that provide alternative sources of household drinking water.
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Affiliation(s)
- Soumya Balasubramanya
- Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka.
| | - David Stifel
- Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka; Lafayette College, Easton, PA, United States
| | - Ted Horbulyk
- Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka; University of Calgary, Calgary, Alberta, Canada
| | - Kashi Kafle
- Economics Research Group, International Water Management Institute-CGIAR, Pelawatte, Western Province, Sri Lanka
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Kafle K, Balasubramanya S, Horbulyk T. Prevalence of chronic kidney disease in Sri Lanka: A profile of affected districts reliant on groundwater. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 694:133767. [PMID: 31756806 DOI: 10.1016/j.scitotenv.2019.133767] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/03/2019] [Accepted: 08/03/2019] [Indexed: 05/24/2023]
Abstract
This analysis provides new estimates of chronic kidney disease (CKD) prevalence - including CKD of unknown etiology (CKDu) - across ten districts most affected by CKD in Sri Lanka, including an examination of rural households' historical reliance on groundwater consumption. A carefully designed household survey provides information on whether these households self-reported having a member in the decade prior to 2018, who had been clinically diagnosed with CKD. Households were classified according to whether or not they had used groundwater (from household wells, agro-wells or springs) as their primary source for drinking or cooking for at least five years between 1999 and 2018. More than 98% of households reported having consumed groundwater as their primary source of drinking or cooking water for at least five of those years and >15% of households reported having at least one CKD-affected member in the ten-year period up to 2018, but these numbers varied across and within districts. The reported characteristics of symptomatic individuals reveal that the incidence of CKD was significantly higher among females (62%) than males (38%). In addition to CKD, about 63% of symptomatic individuals had hypertension and about one-third of them also had diabetes. About 33% of the symptomatic individuals had neither diabetes nor hypertension, where this group most closely fits commonly used definitions of CKDu. With a survey response of over 8000 households comprising as many as 30,000 individuals, these data illustrate the scale of CKD in the most-affected districts of Sri Lanka on an aggregate basis as well as revealing differences across districts and at the sub-district level.
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Affiliation(s)
- Kashi Kafle
- International Water Management Institute (IWMI), 127 Sunil Mawatha, Battaramulla, Colombo, Sri Lanka.
| | - Soumya Balasubramanya
- International Water Management Institute (IWMI), 127 Sunil Mawatha, Battaramulla, Colombo, Sri Lanka.
| | - Ted Horbulyk
- International Water Management Institute (IWMI), 127 Sunil Mawatha, Battaramulla, Colombo, Sri Lanka; University of Calgary, Canada.
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John O, Gummidi B, Tewari A, Muliyil J, Ghosh A, Sehgal M, Bassi A, Prinja S, Kumar V, Kalra OP, Kher V, Thakur J, Ramakrishnan L, Pandey C, Sivakumar V, Dhaliwal R, Khanna T, Kumari A, Sharma J, Malakondiah P, Jha V. Study to Test and Operationalize Preventive Approaches for CKD of Undetermined Etiology in Andhra Pradesh, India. Kidney Int Rep 2019; 4:1412-1419. [PMID: 31701050 PMCID: PMC6829197 DOI: 10.1016/j.ekir.2019.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/08/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION High prevalence of chronic kidney disease (CKD) not associated with known risk factors has been reported from coastal districts of Andhra Pradesh. The Study to Test and Operationalize Preventive Approaches for Chronic Kidney Disease of Undetermined Etiology in Andhra Pradesh (STOP CKDu AP) aims to ascertain the burden (prevalence and incidence) of CKD, the risk factor profile, and the community perceptions about the disease in the Uddanam area of Andhra Pradesh. METHODS Study participants will be sampled from the Uddanam area using multistage cluster random sampling. Information will be collected on the demographic profile, occupational history, and presence of conventional as well as nonconventional risk factors. Glomerular filtration rate (GFR) will be estimated using the Chronic Kidney Disease Epidemiology Collaboration equation, and proteinuria will be measured. All abnormal values will be confirmed by repeat testing after 3 months. Cases of CKD not associated with identified etiologies will be identified. Biospecimens will be stored to explore future hypotheses. The entire cohort will be followed up every 6 months to determine the incidence of CKD and to identify risk factors for decline in kidney function. Qualitative studies will be performed to understand the community perceptions and expectations with respect to the interventions. IMPLICATIONS CKD is an important public health challenge in low- and middle-income countries. This study will establish the prevalence and determine the incidence of CKD not associated with known risk factors in a reported high-burden region, and will provide insights to help design targeted health systems responses. The findings will contribute to the policy development to tackle CKD in the region and will permit international comparisons with other regions with similar high prevalence.
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Affiliation(s)
- Oommen John
- George Institute for Global Health, University of New South Wales, New Delhi, India
| | - Balaji Gummidi
- George Institute for Global Health, University of New South Wales, New Delhi, India
| | - Abha Tewari
- George Institute for Global Health, University of New South Wales, New Delhi, India
| | - J.P. Muliyil
- Department of Community Health, Christian Medical College, Vellore, India
| | - Arpita Ghosh
- George Institute for Global Health, University of New South Wales, New Delhi, India
| | - Meena Sehgal
- The Energy and Resources Institute, New Delhi, India
| | - Abhinav Bassi
- George Institute for Global Health, University of New South Wales, New Delhi, India
| | - Shankar Prinja
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Kumar
- Deparment of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Om P. Kalra
- Pandit B D Sharma University of Health Sciences, Rohtak, India
| | - Vijay Kher
- Kidney and Urology Institute, Medanta Hospital, Gurgaon, India
| | - J.S. Thakur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lakshmy Ramakrishnan
- Department of Biochemistry, All Indian Institute of Medical Sciences, New Delhi, India
| | - C.M. Pandey
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - V. Sivakumar
- Deparment of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - R.S. Dhaliwal
- Non-communicable Disease Division, Indian Council of Medical Research, New Delhi, India
| | - Tripti Khanna
- Non-communicable Disease Division, Indian Council of Medical Research, New Delhi, India
| | - Aruna Kumari
- Department of Health, Government of Andhra Pradesh, Andhra Pradesh, India
| | | | - Poonam Malakondiah
- Department of Health Medical and Family Welfare, Government of Andhra Pradesh, Andhra Pradesh, India
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- George Institute for Global Health, University of Oxford, Oxford, UK
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