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Prevalence of Chronic Kidney Disease of Uncertain Etiology Within Selected Farming Communities in Rural Sri Lanka.

Publication ,  Journal Article
Ekanayake, EMDV; De Silva, PMCS; Gunasekara, TDKSC; Thakshila, WAKG; Gunarathna, SD; Pinipa, RAI; Jayasinghe, S; Chandana, EPS; Wijewickrama, ES ...
Published in: Canadian journal of kidney health and disease
January 2023

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.We aimed to compare kidney health across three different farming communities in Sri Lanka to identify CKDu susceptibilities.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.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).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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Published In

Canadian journal of kidney health and disease

DOI

EISSN

2054-3581

ISSN

2054-3581

Publication Date

January 2023

Volume

10

Start / End Page

20543581231199013

Related Subject Headings

  • 3202 Clinical sciences
 

Citation

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Ekanayake, E. M. D. V., De Silva, P. M. C. S., Gunasekara, T. D. K. S. C., Thakshila, W. A. K. G., Gunarathna, S. D., Pinipa, R. A. I., … Jayasundara, N. (2023). Prevalence of Chronic Kidney Disease of Uncertain Etiology Within Selected Farming Communities in Rural Sri Lanka. Canadian Journal of Kidney Health and Disease, 10, 20543581231199012. https://doi.org/10.1177/20543581231199013
Ekanayake, E. M. D. V., P Mangala C. S. De Silva, T. D. K. S. C. Gunasekara, W. A. K. G. Thakshila, S. D. Gunarathna, R. A. I. Pinipa, Sudheera Jayasinghe, E. P. S. Chandana, E. S. Wijewickrama, and Nishad Jayasundara. “Prevalence of Chronic Kidney Disease of Uncertain Etiology Within Selected Farming Communities in Rural Sri Lanka.Canadian Journal of Kidney Health and Disease 10 (January 2023): 20543581231199012. https://doi.org/10.1177/20543581231199013.
Ekanayake EMDV, De Silva PMCS, Gunasekara TDKSC, Thakshila WAKG, Gunarathna SD, Pinipa RAI, et al. Prevalence of Chronic Kidney Disease of Uncertain Etiology Within Selected Farming Communities in Rural Sri Lanka. Canadian journal of kidney health and disease. 2023 Jan;10:20543581231199012.
Ekanayake, E. M. D. V., et al. “Prevalence of Chronic Kidney Disease of Uncertain Etiology Within Selected Farming Communities in Rural Sri Lanka.Canadian Journal of Kidney Health and Disease, vol. 10, Jan. 2023, p. 20543581231199012. Epmc, doi:10.1177/20543581231199013.
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. Canadian journal of kidney health and disease. 2023 Jan;10:20543581231199012.
Journal cover image

Published In

Canadian journal of kidney health and disease

DOI

EISSN

2054-3581

ISSN

2054-3581

Publication Date

January 2023

Volume

10

Start / End Page

20543581231199013

Related Subject Headings

  • 3202 Clinical sciences