Abstract
Chronic kidney disease of unknown aetiology (CKDu), which is widespread in the North Central Province (NCP) of Sri Lanka, is not associated with commonly known factors such as diabetes, hypertension, and glomerulonephritis. The pathogenicity of CKDu is not well understood, but people with a low body mass index (BMI) and mineral and nutrient deficiencies are more vulnerable to develop CKDu. To understand this situation, the relationship between BMI and the estimated glomerular filtration rate (eGFR) was investigated in people with CKDu in comparison with unaffected age-matched control groups in disease-endemic areas of the NCP. This community-based cross-sectional study was performed in Medirigiriya in the Polonnaruwa district of Sri Lanka, which has one of the highest densities of patients with CKDu. The data for identifying demographic factors and the relationship between CKDu and BMI were investigated by using a validated survey questionnaire. Findings indicated that the group with the highest number of people affected with CKDu (i.e. eGFR of less than 60 mL/min/1.73 m2) had the lowest BMI compared to those with normal eGFR. The majority affected were male farmers. The severity of the disease was inversely associated with BMI values and had a higher prevalence of smoking and alcohol consumption. In addition, those who consume water from household dug wells had significantly lower eGFR (p < 0.0001). A linear regression analysis revealed a significant positive association between lower eGFR and lower BMI (p < 0.001). We hypothesised that the low BMI in those with CKDu may have increased susceptibility to develop CKDu, in the presence of exposure to multiple nephrotoxins and adverse conditions.
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Acien, A. N., Tellez-Plaza, M., Guallar, E., Muntner, P., Silbergeld, E., Jaar, B., et al. (2009). Blood cadmium and lead and chronic kidney disease in US adults: A joint analysis. American Journal of Epidemiology, 170(9), 1156–1164.
Athuraliya, N. T., Abeysekera, T. D., Amerasinghe, P. H., Kumarasiri, R., Bandara, P., Karunaratne, U., et al. (2011). Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney International, 80(11), 1212–1221. https://doi.org/10.1038/ki.2011.258.
Bays, H. E., Chapman, R., & Grandy, S. (2007). The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: Comparison of data from two national surveys. International Journal of Clinical Practice, 61(5), 737–747.
Bras, G., & Ross, M. H. (1964). Kidney disease and nutrition in the rat. Toxicology and Applied Pharmacology, 6(3), 247–262.
Calle, E. E., Thun, M. J., Petrelli, J. M., Rodriguez, C., & Heath, C. W., Jr. (1999). Body-mass index and mortality in a prospective cohort of US adults. New England Journal of Medicine, 341(15), 1097–1105.
Chandrajith, R., Dissanayake, C. B., Ariyarathna, T., Herath, H. M., & Padmasiri, J. P. (2011). Dose-dependent Na and Ca in fluoride-rich drinking water–another major cause of chronic renal failure in tropical arid regions. Science of the Total Environment, 409(4), 671–675. https://doi.org/10.1016/j.scitotenv.2010.10.046.
Chang, T.-J., Zheng, C.-M., Wu, M.-Y., Chen, T.-T., Wu, Y.-C., Wu, Y.-L., et al. (2018). Relationship between body mass index and renal function deterioration among the Taiwanese chronic kidney disease population. Scientific Reports, 8(1), 6908.
Cohen, E., Fraser, A., Goldberg, E., Milo, G., Garty, M., & Krause, I. (2013). Association between the body mass index and chronic kidney disease in men and women. A population-based study from Israel. Nephrology Dialysis Transplantation, 28(Suppl 4), iv130–iv135. https://doi.org/10.1093/ndt/gft072.
Dudina, A., Cooney, M. T., Bacquer, D. D., Backer, G. D., Ducimetière, P., Jousilahti, P., et al. (2011). Relationships between body mass index, cardiovascular mortality, and risk factors: A report from the SCORE investigators. European Journal of Cardiovascular Prevention & Rehabilitation, 18(5), 731–742.
Goudarzi, G., Alavi, N., Geravandi, S., Idani, E., Behrooz, H. R. A., Babaei, A. A., et al. (2018). Health risk assessment on human exposed to heavy metals in the ambient air PM10 in Ahvaz, southwest Iran. International Journal of Biometeorology, 62(6), 1075–1083. https://doi.org/10.1007/s00484-018-1510-x.
Goudarzi, G., Alavi, N., Geravandi, S., Yari, A. R., Aslanpour Alamdari, F., Dobaradaran, S., et al. (2019). Ambient particulate matter concentration levels of Ahvaz, Iran, in 2017. Environmental Geochemistry and Health, 41(2), 841–849. https://doi.org/10.1007/s10653-018-0182-0.
Herath, H. M. A., Kawakami, T., Nagasawa, S., Serikawa, Y., Motoyama, A., Chaminda, G. G. T., et al. (2018). Arsenic, cadmium, lead, and chromium in well water, rice, and human urine in Sri Lanka in relation to chronic kidney disease of unknown etiology. Journal of Water and Health, 16(2), 212–222. https://doi.org/10.2166/wh.2018.070.
Hsu, C.-Y., McCulloch, C. E., Iribarren, C., Darbinian, J., & Go, A. S. (2006). Body mass index and risk for end-stage renal disease. Annals of Internal Medicine, 144(1), 21–28.
Idani, E., Geravandi, S., Akhzari, M., Goudarzi, G., Alavi, N., Yari, A. R., et al. (2018). Characteristics, sources, and health risks of atmospheric PM10-bound heavy metals in a populated middle eastern city. Toxin Reviews. https://doi.org/10.1080/15569543.2018.1513034.
Iorember, F. M. (2018). Malnutrition in chronic kidney disease. Frontiers in pediatrics, 6.
Jayasumana, C., Paranagama, P., Agampodi, S., Wijewardane, C., Gunatilake, S., & Siribaddana, S. (2015). Drinking well water and occupational exposure to Herbicides is associated with chronic kidney disease, in Padavi-Sripura, Sri Lanka. Environmental Health, 14(1), 6.
Jayatilake, N., Mendis, S., Maheepala, P., & Mehta, F. R. (2013). Chronic kidney disease of uncertain aetiology: Prevalence and causative factors in a developing country. BMC Nephrology, 14(1), 180.
Jayawardena, R., Thennakoon, S., Byrne, N., Soares, M., Katulanda, P., & Hills, A. (2014). Energy and nutrient intakes among Sri Lankan adults. International Archives of Medicine, 7(1), 34.
JMP (2013). In S. I. Inc (Ed.), (V13.0 ed.). SAS Campus Drive, Cary, NC, USA.
KDIGO (2013). Kidney disease: Improving global out-comes. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl, 3(1), 30–150.
Kimmons, J. E., Blanck, H. M., Tohill, B. C., Zhang, J., & Khan, L. K. (2006). Associations between body mass index and the prevalence of low micronutrient levels among US adults. Medscape General Medicine, 8(4), 59.
Levey, A. S., Coresh, J., Bolton, K., Culleton, B., Harvey, K. S., Ikizler, T. A., et al. (2002). K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. American Journal of Kidney Diseases, 39(2 Suppl 1).
Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. L., Castro, A. F., Feldman, H. I., et al. (2009). A new equation to estimate glomerular filtration rate. Annals of Internal Medicine, 150(9), 604–612.
Levine, K. E., Redmon, J. H., Elledge, M. F., Wanigasuriya, K. P., Smith, K., Munoz, B., et al. (2016). Quest to identify geochemical risk factors associated with chronic kidney disease of unknown etiology (CKDu) in an endemic region of Sri Lanka—A multimedia laboratory analysis of biological, food, and environmental samples. Environmental Monitoring and Assessment, 188(10), 548. https://doi.org/10.1007/s10661-016-5524-8.
Liu, K., Zhang, W., Dai, Z., Wang, M., Tian, T., Liu, X., et al. (2018). Association between body mass index and breast cancer risk: Evidence based on a dose–response meta-analysis. Cancer Management and Research, 10, 143.
Lu, J. L., Kalantar-Zadeh, K., Ma, J. Z., Quarles, L. D., & Kovesdy, C. P. (2014). Association of body mass index with outcomes in patients with CKD. Journal of the American Society of Nephrology, 25(9), 2088–2096.
Mohammadi, M. J., Yari, A. R., Saghazadeh, M., Sobhanardakani, S., Geravandi, S., Afkar, A., et al. (2018). A health risk assessment of heavy metals in people consuming Sohan in Qom, Iran. Toxin Reviews, 37(4), 278–286.
Nanayakkara, S., Stmld, S., Abeysekera, T., Chandrajith, R., Ratnatunga, N., Edl, G., et al. (2014). An integrative study of the genetic, social and environmental determinants of chronic kidney disease characterized by tubulointerstitial damages in the North Central Region of Sri Lanka. Journal of Occupational Health, 56(1), 28–38.
Nomura, I., Kato, J., & Kitamura, K. (2009). Association between body mass index and chronic kidney disease: A population-based, cross-sectional study of a Japanese community. Vascular Health and Risk Management, 5, 315.
Pennemans, V., De Winter, L. M., Munters, E., Nawrot, T. S., Van Kerkhove, E., Rigo, J.-M., et al. (2011). The association between urinary kidney injury molecule 1 and urinary cadmium in elderly during long-term, low-dose cadmium exposure: A pilot study. Environmental Health, 10(1), 77.
Ranasinghe, C., Gamage, P., Katulanda, P., Andraweera, N., Thilakarathne, S., & Tharanga, P. (2013). Relationship between body mass index (BMI) and body fat percentage, estimated by bioelectrical impedance, in a group of Sri Lankan adults: A cross sectional study. BMC Public Health, 13(1), 797.
Rango, T., Jeuland, M., Manthrithilake, H., & McCornick, P. (2015). Nephrotoxic contaminants in drinking water and urine, and chronic kidney disease in rural Sri Lanka. Science of the Total Environment, 518–519, 574–585. https://doi.org/10.1016/j.scitotenv.2015.02.097.
Shankar, A., Leng, C., Chia, K. S., Koh, D., Tai, E. S., Saw, S. M., et al. (2008). Association between body mass index and chronic kidney disease in men and women: Population-based study of Malay adults in Singapore. Nephrology, Dialysis, Transplantation, 23(6), 1910–1918. https://doi.org/10.1093/ndt/gfm878.
Siriwardhana, E. R. I., Perera, P. A., Sivakanesan, R., Abeysekara, T., Nugegoda, D. B., & Weerakoon, K. G. (2014). Is the staple diet eaten in Medawachchiya, Sri Lanka, a predisposing factor in the development of chronic kidney disease of unknown etiology?-A comparison based on urinary β 2-microglobulin measurements. BMC Nephrology, 15(1), 103.
Tsai, T.-L., Kuo, C.-C., Pan, W.-H., Chung, Y.-T., Chen, C.-Y., Wu, T.-N., et al. (2017). The decline in kidney function with chromium exposure is exacerbated with co-exposure to lead and cadmium. Kidney International, 92(3), 710–720.
Wang, Y., Gao, X., Pedram, P., Shahidi, M., Du, J., Yi, Y., et al. (2016). Significant beneficial association of high dietary selenium intake with reduced body fat in the coding study. Nutrients, 8(1), 24.
WHO. (2008). Guidelines for drinking water quality. Switzerland: World health organization. Geneva.
WHO (2018). BMI classification. Retrieved May 10, 2018.
Wijetunge, S., Ratnatunga, N., Abeysekera, T., Wazil, A., & Selvarajah, M. (2015). Endemic chronic kidney disease of unknown etiology in Sri Lanka: Correlation of pathology with clinical stages. Indian Journal of Nephrology, 25(5), 274.
Wimalawansa, S. J. (2014). Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: Causes, solutions, and recommendations. Environmental Health and Preventive Medicine, 19(6), 375–394. https://doi.org/10.1007/s12199-014-0395-5.
Wimalawansa, S. J. (2016a). Effect of water hardness on non-communicable diseases, including chronic kidney disease of multifactorial origin (CKDmfo/CKDuo). Journal of Environment and Health Science, 2(1), 1–11.
Wimalawansa, S. J. (2016b). The role of ions, heavy metals, fluoride, and agrochemicals: Critical evaluation of potential aetiological factors of chronic kidney disease of multifactorial origin (CKDmfo/CKDu) and recommendations for its eradication. Environmental Geochemistry and Health, 38(3), 639–678. https://doi.org/10.1007/s10653-015-9768-y.
Zaman, S. B., Hossain, N., & Rahman, M. (2018). Associations between Body Mass Index and Chronic Kidney Disease in Type 2 Diabetes Mellitus Patients: Findings from the Northeast of Thailand. Diabetes & Metabolism Journal, 42(4), 330–337. https://doi.org/10.4093/dmj.2017.0052.
Acknowledgements
We are grateful to Mr. Kim Cloyvas, The University of Newcastle, for his assistance with the statistics. We also acknowledge Dr. Malin Methasooriya, Renal Unit, Base Hospital Polonnaruwa, and Dr. Thilina, MOH office, Medirigiriya Hospital, for providing us with the database concerning CKD patients. M.R.D.L. Kulathunga is thankful to The University of Newcastle, Australia, for providing UNIPRS and UNRSC scholarship and higher degree research candidate funding support. The authors have no conflicts of interest or competing financial interest to declare.
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Kulathunga, M.R.D.L., Wijayawardena, M.A.A., Naidu, R. et al. Association between body mass index and estimated glomerular filtration rate in patients with chronic kidney disease of unknown aetiology in Sri Lanka. Environ Geochem Health 42, 2645–2653 (2020). https://doi.org/10.1007/s10653-019-00472-7
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DOI: https://doi.org/10.1007/s10653-019-00472-7