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Socio-economic determinants of Chronic Kidney Diseases of uncertain etiology (CKDu) in the Uva Province, Sri Lanka: a cross-sectional study

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Abstract

CKDu is one of the most serious health problems in Sri Lanka. The country’s Uva Province (UP) faces an increasing number of CKDu patients. Therefore, this study develops a statistical model to identify the socio-economic determinants of CKDu in UP, Sri Lanka. This cross-sectional study draws on a questionnaire survey conducted with 229 farmers, of which 24% were CKDu patients, to ascertain the socio-economic predictors that contribute to CKDu. The relationship between socio-economic risk factors and CKDu was delineated using a logistic regression model and by analyzing odds ratios. The highest risk of CKDu was observed among participants who consume agrochemical-applied foods (OR 7.9657, 95% CI = 2.2205, 28.5755) and potentially contaminated drinking water (OR 3.3693, 95% CI = 1.5540, 7.3053). Furthermore, age (OR 1.1097 95% CI = 1.0542, 1.1680), gender (OR 4.4980, 95% CI = 1.1406, 17.7382), and education level (OR 21.1018, 95% CI = 1.7753, 250.8250) were also identified as significant risk factors.

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References

  • Abeysekara T (2015) Chronic kidney disease of uncertain etiology (CKDu) - causes, consequences and remedies. International Conference of Sabaragamuwa University of Sri Lanka, 19-20th November 2015, Berjaya Hotel Colombo, Sri Lanka

  • Abeywickrama HM, Wimalasiri S, Koyam Y, Uchiyama M, Shimizu U, Kakihara N, Nanayakkara N (2020) Quality of life and symptom burden among chronic kidney disease of uncertain etiology (CKDu) patients in Girandurukotte, Sri Lanka. Int J Environ Res Public Health 17:4041. https://doi.org/10.3390/ijerph17114041

    Article  Google Scholar 

  • Athuraliya NT, Abeysekera TD, Amerasinghe PH, Kumarasiri R, Bandara P, Karunaratne U, Jones AL (2011) Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney Int 80:1212–1221. https://doi.org/10.1038/ki.2011.258

    Article  Google Scholar 

  • Balasooriya S, Munasinghe H, Herath AT, Diyabalanage S, Ileperuma OA, Manthrithilake H, Daniel C, Amann K, Zwiener C, Barth JA, Chandrajith R (2019) Possible links between groundwater geochemistry and chronic kidney disease of unknown etiology (CKDu): an investigation from the Ginnoruwa region in Sri Lanka. Expo Health 1–12. https://doi.org/10.1007/s12403-019-00340-w

  • Bandara J, Senevirathna D, Dasanayake D, Herath V, Bandara J, Abeysekara T, Rajapaksha K (2008) Chronic renal failure among farm families in cascade irrigation systems in Sri Lanka associated with elevated dietary cadmium levels in rice and freshwater fish (Tilapia). Environ Geochem Health 30:465–478. https://doi.org/10.1007/s10653-007-9129-6

    Article  CAS  Google Scholar 

  • Bandara J, Wijewardena H, Liyanege J, Upul M, Bandara J (2010) Chronic renal failure in Sri Lanka caused by elevated dietary cadmium: Trojan horse of the green revolution. Toxicol Lett 198:33–39. https://doi.org/10.1016/j.toxlet.2010.04.016

    Article  CAS  Google Scholar 

  • Carney EF (2020) The impact of chronic kidney disease on global health. Nat Rev Nephrol 16:251–251

    Article  Google Scholar 

  • Chandrajith R, Dissanayake C, Ariyarathna T, Herath H, Padmasiri J (2011) Dose-dependent Na and Ca in fluoride-rich drinking water—another major cause of chronic renal failure in tropical arid regions. Sci Total Environ 409:671–675. https://doi.org/10.1016/j.scitotenv.2010.10.046

    Article  CAS  Google Scholar 

  • Chandrajith R, Nanayakkara S, Itai K, Aturaliya TN, Dissanayake CB, Abeysekera T, Harada K, Watanabe T, Koizumi A (2011) Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: geographic distribution and environmental implications. Environ Geochem Health 33:267–278. https://doi.org/10.1007/s10653-010-9339-1

    Article  CAS  Google Scholar 

  • Codreanu I, Perico N, Sharma SK, Schieppati A, Remuzzi G (2006) Prevention programmes of progressive renal disease in developing nations. Nephrology 11:321–328. https://doi.org/10.1111/j.1440-1797.2006.00587.x

    Article  Google Scholar 

  • Cooray T, Wei Y, Zhong H, Zheng L, Weragoda SK, Weerasooriya R (2019) Assessment of groundwater quality in CKDu affected areas of Sri Lanka: implications for drinking water treatment. Int J Environ Res Public Health 16:1698. https://doi.org/10.3390/ijerph16101698

    Article  CAS  Google Scholar 

  • de Alwis AA, Panawala PV (2019) A review of the national response to CKDu in Sri Lanka. Sri Lanka J Soc Sci 42:83–100. https://doi.org/10.4038/sljss.v42i2.7966

    Article  Google Scholar 

  • Department of Census and Statistics (2002) Headcount index and population below poverty line by DS Division: Sri Lanka, 2002

  • Dharma-Wardana MW, Amarasiri SL, Dharmawardene N, Panabokke CR (2015) Chronic kidney disease of unknown aetiology and ground-water ionicity: study based on Sri Lanka. Environ Geochem Health 37:221–231. https://doi.org/10.1007/s10653-014-9641-4

  • El Nahas AM, Bello AK (2005) Chronic kidney disease: the global challenge. The Lancet 365:331–340. https://doi.org/10.1016/s0140-6736(05)17789-7

    Article  Google Scholar 

  • Espeland M (2016) Chronic Kidney Disease (CKD) in Sri Lanka: evaluation of status, practices and potential pollutants. Norwegian University of LIfe Sciences, Ås

    Google Scholar 

  • Fernando IAAM, Ranasinghe DMSHK, Udayakantha PMP, Bandara WMP (2016) Investigation of multiple drivers and their impact on chronic kidney disease unidentified-a case study in Padaviya Divisional Secretariat, Sri Lanka. In: Proceedings of International Forestry and Environment Symposium (21)

  • Fitria L, Prihartono NA, Ramdhan DH, Wahyono TYM, Kongtip P, Woskie S (2020) Environmental and occupational risk factors associated with chronic kidney disease of unknown etiology in West Javanese rice farmers, Indonesia. Int J Environ Res Public Health 17:4521. https://doi.org/10.3390/ijerph17124521

    Article  CAS  Google Scholar 

  • Goldstein D (2015) Chronic kidney disease of uncertain etiology (CKDu) - Causes, consequences and remedies. International Conference of Sabaragamuwa University of Sri Lanka, 19–20th November 2015, Berjaya Hotel Colombo, Sri Lanka

  • González-Quiroz M, Pearce N, Caplin B, Nitsch D (2018) What do epidemiological studies tell us about chronic kidney disease of undetermined cause in Meso-America? A systematic review and meta-analysis. Clin Kidney J 11:496–506. https://doi.org/10.1093/ckj/sfx136

    Article  Google Scholar 

  • Gunatilake SK, Samaratunga SS, Rubasinghe RT (2014) Chronic kidney disease (CKD) in Sri Lanka-current research evidence justification: a review. Sabaragamuwa Univ J 13:31–58. https://doi.org/10.4038/suslj.v13i2.7680

    Article  Google Scholar 

  • Hittarage A (2004) Chronic renal disease in north central province of Sri Lanka. Anuradhapura Medical Journal 3–5

  • Ileperuma O, Dharmagunawardhane H, Herath K (2009) Dissolution of aluminium from sub-standard utensils under high fluoride stress: a possible risk factor for chronic renal failure in the North-Central Province. J Natl Sci Found 37:219. https://doi.org/10.4038/jnsfsr.v37i3.1217

    Article  CAS  Google Scholar 

  • Jayasekara KB, Dissanayake DM, Sivakanesan R, Ranasinghe A, Karunarathna RH, Kumara GWGP (2015) Epidemiology of chronic kidney disease, with special emphasis on chronic kidney disease of uncertain etiology, in the north central region of Sri Lanka. J Epidemiol 25:275–280. https://doi.org/10.2188/jea.je20140074

    Article  Google Scholar 

  • Jayasinghe YKRT (2011) Chronic kidney disease risk factor identification-secondary data analysis. International Water Management Institute (IWMI) reports.

  • Jayasumana C, Gunatilake S, Senanayake P (2014) Glyphosate, hard water and nephrotoxic metals: are they the culprits behind the epidemic of chronic kidney disease of unknown etiology in Sri Lanka? Int J Environ Res Public Health 11:2125–2147. https://doi.org/10.3390/ijerph110202125

    Article  Google Scholar 

  • 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. Environ Health 14:1–10. https://doi.org/10.1186/1476-069x-14-6

    Article  Google Scholar 

  • Jayasumana C, Paranagama PA, Amarasinghe MD, Wijewardane KM, Dahanayake KS, Fonseka SI, Rajakaruna KD, Mahamithawa AM, Samarasinghe UD, Senanayake VK (2013) Possible link of chronic arsenic toxicity with chronic kidney disease of unknown etiology in Sri Lanka. J Nat Sci Res 3:1

  • Jayatilake N, Mendis S, Maheepala P, Mehta FR (2013) Chronic kidney disease of uncertain aetiology: prevalence and causative factors in a developing country. BMC Nephrol 14:180. https://doi.org/10.1186/1471-2369-14-180

    Article  Google Scholar 

  • Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, Zeeuw DD, Hostetter TH, Lameire N, Eknoyan G (2005) Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 67:2089–2100. https://doi.org/10.1111/j.1523-1755.2005.00365.x

    Article  Google Scholar 

  • Levine KE, Redmon JH, Elledge MF, Wanigasuriya KP, Smith K, Munoz B, Waduge VA, Periris-John RJ, Sathiakumar N, Harrington JM, Womack DS (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. Environ Monit Assess 188:548. https://doi.org/10.1007/s10661-016-5524-8

    Article  CAS  Google Scholar 

  • Mahalingasivam V, Caplin B (2019) Chronic kidney disease of undetermined aetiology: tens of thousands of premature deaths, yet too much remains unknown. Nephrol Dial Transplant 34:1839–1841. https://doi.org/10.1093/ndt/gfz014

    Article  Google Scholar 

  • McClean M, Amador JJ, Laws R, Kaufman JS, Weiner DE, Sanchez-Rodriguez J, Brooks D (2012) Biological sampling report: investigating biomarkers of kidney injury and chronic kidney disease among workers in Western Nicaragua Boston: University School of Public Health: Compliance Advisor Ombudman

  • Nanayakkara S, Stmld S, Abeysekera T, Chandrajith R, Ratnatunga N, Edl G, Yan J, Hitomi T, Muso E, Komiya T, Harada KH (2013) 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. J Occup Health 13:0172

  • Noble A, Amerasinghe P, Manthrithilake H, Arasalingam S (2014) Review of literature on chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. IWMI Reports 10(5337/2014):206

    Google Scholar 

  • Osborne N, Kaur H, Pett J, Dissanayake D, Jayasekara K, Mohamed F, Knight J, Rahman B, Taylor R (2019) Relationship between access to piped water and CKDu: a conditional autoregressive model. Environ Epidemiol 3:297

    Article  Google Scholar 

  • Parameswaran S, Rinu PK, Kar SS, Harichandrakumar KT, James TD, Priyamvada PS, Haridasan S, Mohan S, Radhakrishnan J. A (2020) A newly recognized endemic region of CKD of undetermined etiology (CKDu) in South India—“Tondaimandalam Nephropathy” Kidney Int Rep 5:2066–2073

  • Perera W, Dayananda M, Liyanage J (2020) 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 1:1–9. https://doi.org/10.1155/2020/8670974

  • Piyathilake IDUH, Udayakumara EPN, Ranaweera LV, Gunatilake SK (2021) Modeling predictive assessment of carbon storage using InVEST model in Uva province, Sri Lanka. Model Earth Syst Environ 1-11.https://doi.org/10.1007/s40808-021-01207-3

  • Poulter NR, Mendis S (2009) Finalized Multidisciplinary Research Proposal on Chronic Kidney Disease of Unknown Etiology of Uncertain Aetiology (CKDu) in Sri Lanka. Colombo: WHO Country Office

  • Pry JM, Jackson W, Rupasinghe R, Lishanthe G, Badurdeen Z, Abeysekara T, Chandrajith R, Smith W, Wickramasinghe S (2019) A pilot study of behavioral, environmental, and occupational risk factors for chronic kidney disease of unknown etiology in Sri Lanka. BioRxiv. https://doi.org/10.1101/837393

    Article  Google Scholar 

  • Rajapakshe SM, Weragoda SK, Kawakami T, Weerasekara WBMLI (2018) Study of evidences on chronic kidney disease due to unknown etiology based on environmental, social, economic and health patterns of selected population. In: International Conference on Sustainable Built Environment, Singapore, pp 99–106

  • Rajapakshe S, Weragoda S, Kawakami T, Weerasekara W (2020) Study of evidences on chronic kidney disease due to unknown etiology based on environmental, social, economic and health patterns of selected population. Int Conf Sustain Built Environ 99–106. https://doi.org/10.1007/978-981-13-9749-3_9

  • Ranasinghe AV, Kumara GW, Karunarathna RH, De Silva AP, Sachintani KG, Gunawardena JM, Kumari SK, Sarjana MS, Chandraguptha JS, De Silva MV (2019) The incidence, prevalence and trends of Chronic Kidney Disease and Chronic Kidney Disease of uncertain aetiology (CKDu) in the North Central Province of Sri Lanka: an analysis of 30,566 patients. BMC Nephrol 20:1–11. https://doi.org/10.1186/s12882-019-1501-0

  • Rathnayake R, Henagamage A, Premetilake M, Udagedara D (2018) Correlation of ground water fluoride with total hardness and total alkalinity in CKDu prevalent areas in Uva province. In: Proceedings of the International Research Conference of Uva Wellassa University, Sri Lanka. 253

  • Redmon JH, Levine KE, Lebov J, Harrington J, Kondash A (2020) A comparative review: chronic kidney disease of unknown etiology (CKDU) research conducted in Latin AMERICA versus Asia. Environ Res 192:110270. https://doi.org/10.1016/j.envres.2020.110270

    Article  CAS  Google Scholar 

  • Redmon JH, Elledge MF, Wanigasuriya KP, Wickremasinghe R, Levine KE (2016) Deciphering chronic kidney disease of unknown etiology in Sri Lanka. In. RTI Press Publication, 105–126 https://doi.org/10.3768/rtipress.2016.bk.0017.1608.7

  • Senevirathna L, Abeysekera T, Nanayakkara S, Chandrajith R, Ratnatunga N, Harada KH, Hitomi T, Komiya T, Muso E, Koizumi A (2012) Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka. Environ Health Prev Med 17:191–198. https://doi.org/10.1007/s12199-011-0237-7

    Article  Google Scholar 

  • UPC (2019) Five year vision oriented integrated sustainable development plan of Uva province. Deputy Chief Secretary (Planning), Deputy Chief Secretary (Planning) Office, Uva Provincial Council, Kings Street, Badulla, Sri Lanka

  • Wanasinghe W, Gunarathna M, Herath H, Jayasinghe G (2018) Drinking water quality on chronic kidney disease of unknown aetiology (CKDu) in Ulagalla Cascade, Sri Lanka. Sabaragamuwa Univ J 16:17–27. https://doi.org/10.4038/suslj.v16i1.7714

    Article  Google Scholar 

  • Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, Coggeshall M (2016) Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1459–1544. https://doi.org/10.1016/s0140-6736(14)61682-2

    Article  Google Scholar 

  • Wanigasuriya K (2012) Aetiological factors of chronic kidney disease in the North Central Province of Sri Lanka: A review of evidence to-date. J Coll Commun Phys Sri Lanka. https://doi.org/10.4038/jccpsl.v17i1.4931

    Article  Google Scholar 

  • Wanigasuriya KP, Peiris-John RJ, Wickremasinghe R, Hittarage A (2007) Chronic renal failure in North Central Province of Sri Lanka: an environmentally induced disease. Trans R Soc Trop Med Hyg 101:1013–1017. https://doi.org/10.1016/j.trstmh.2007.05.006

    Article  Google Scholar 

  • Wanigasuriya KP, Peiris-John RJ, Wickremasinghe R (2011) Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause? BMC Nephrol 12:32. https://doi.org/10.1186/1471-2369-12-32

    Article  Google Scholar 

  • Wanigasuriya K (2014) Update on uncertain etiology of chronic kidney disease in Sri Lanka's north-central dry zone. MEDICC Rev 16:61–65. https://doi.org/10.37757/mr2014.v16.n2.10

  • Wasana HM, Aluthpatabendi D, Kularatne W, Wijekoon P, Weerasooriya R, Bandara J (2016) Drinking water quality and chronic kidney disease of unknown etiology (CKDu): synergic effects of fluoride, cadmium and hardness of water. Environ Geochem Health 38:157–168. https://doi.org/10.1007/s10653-015-9699-7

    Article  CAS  Google Scholar 

  • Weerasekara C, Sulochana M (2018) Impact of food pattern and socio-economic factors on chronic kidney disease of unknown etiology in North Central Province. 4th International Conference on Social Sciences, Research Centre for Social Sciences, Faculty of Social Sciences, University of Kelaniya, Sri Lanka

  • Weragoda S, Kawakami T, Motoyama A, Kodithukakku S (2013) Is groundwater in dry zone, Sri Lanka Safe to Drink? Sri Lanka, Collaborative Research

  • Wimalawansa SJ (2014) Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: causes, solutions, and recommendations. Environ Health Prev Med 19:375–394. https://doi.org/10.1007/s12199-014-0395-5

    Article  Google Scholar 

  • Wimalawansa SJ (2016) 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. Environ Geochem Health 38:639–678. https://doi.org/10.1007/s10653-015-9768-y

    Article  CAS  Google Scholar 

  • Wimalawansa SA, Wimalawansa SJ (2014) Agrochemical-related environmental pollution: Effects on human health Global Journal of Biology. Agric Health Sci 3:72–83

    Google Scholar 

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Acknowledgements

Editorial assistance from Mr. A.N.M. Salgado, University of Peradeniya, was highly appreciated.

Funding

This study was funded by the World Bank and Sri Lankan government’s Accelerating Higher Education Expansion and Development (AHEAD) project (AHEAD/DOR/STEM/33).

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Authors and Affiliations

  1. Faculty of Graduate Studies, Sabaragamuwa University of Sri Lanka, Belihiloya, Sri Lanka

    I. D. U. H. Piyathilake & J. L. P. C. Randika

  2. Department of Physical Sciences & Technology, Faculty of Applied Sciences, Sabaragamuwa University of Sri Lanka, Belihuloya, Sri Lanka

    R. M. K. T. Rathnayaka

  3. Department of Natural Resources, Faculty of Applied Sciences, Sabaragamuwa University of Sri Lanka, Belihuloya, Sri Lanka

    E. P. N. Udayakumara, L. V. Ranaweera & S. K. Gunatilake

  4. Department of Geology, University of Peradeniya, Peradeniya, Sri Lanka

    C. B. Dissanayake

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  1. I. D. U. H. Piyathilake
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Contributions

Study conception and design and critical revision: Prof. S. K. Gunatilake, Dr. E. P. N. Udayakumara, Dr. L. V. Ranaweera, Prof. C. B. Dissanayake.

Acquisition of data, analysis and interpretation of data, and drafting of the manuscript: Mr. I. D. U. H. Piyathilake, Mr. J. L. P. C. Randika, Prof. R. M. K. T. Rathnayake.

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Piyathilake, I.D.U.H., Randika, J.L.P.C., Rathnayaka, R.M.K.T. et al. Socio-economic determinants of Chronic Kidney Diseases of uncertain etiology (CKDu) in the Uva Province, Sri Lanka: a cross-sectional study. J Environ Stud Sci 12, 782–793 (2022). https://doi.org/10.1007/s13412-022-00780-y

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