Skip to main content
Top
Published in: BMC Nephrology 1/2024

Open Access 01-12-2024 | Chronic Kidney Disease | Research

Decreasing incidence of hospital diagnosed CKD/CKDu in North Central Province of Sri Lanka: is it related to provision of drinking water reverse osmosis plants?

Authors: Asanga Venura Ranasinghe, Lakshmi C. Somatunga, Gardiye Weligamage Gamini Priyantha Kumara, Ranamuka Henayage Karunarathna, Ambepitiyawaduge Pubudu De Silva, Jayaprakara Mudiyanselage Chathurika Nayani Gunawardena, Sembu Kuttige Champika Ruwan Kumari, Mohamed Shali Fathima Sarjana, Mannikawadumesthri Vipula Chandu De Silva

Published in: BMC Nephrology | Issue 1/2024

Login to get access

Abstract

Background

We assessed the possible impact of provision of reverse osmosis (RO) water on the incidence of hospital diagnosed CKD/CKDu in North Central Province (NCP) of Sri Lanka.

Methods

An ecological study was conducted on data from 2010–2020 on the incidence of hospital diagnosed CKD/CKDu, CKD/CKDu screening and provision of drinking water RO plants in NCP. Analysis was conducted using descriptive statistics, ANOVA and chi-square test.

Results

The annual incidence of hospital diagnosed CKD/CKDu (per 100 000 population) in 2010–2013, 2014–2016 and 2017–2020 periods in Anuradhapura district were 129.07, 331.06 and 185.57 (p = 0.002) while in Polonnaruwa district these were 149.29, 326.12 and 296.73 (p = 0.04) respectively. In NCP provision of RO plants commenced after 2011 and the decline in the incidence of hospital diagnosed CKD/CKDu was seen in 25 of the 29 Divisional Secretary Divisions when more than 20% of the families received access to drinking RO water projects.

Conclusions

The annual incidence of hospital diagnosed CKD/CKDu increased in NCP from 2010 to 2016 and continuously decreased thereafter. Continuous declining of CKD/CKDu incidence was seen after more than 20% of the families received access to drinking water RO plants.
Literature
1.
go back to reference Abeysekera DTDJ, Kaiyoom SAA, Dissanayake SU. Place of peritoneal dialysis in the management of renal failure patients admitted to General Hospital Kandy. In: Kandy Society of Medicine 18th Annual Academic Conference. 1996. Abeysekera DTDJ, Kaiyoom SAA, Dissanayake SU. Place of peritoneal dialysis in the management of renal failure patients admitted to General Hospital Kandy. In: Kandy Society of Medicine 18th Annual Academic Conference. 1996.
2.
go back to reference Ranasinghe AV, Kumara GWGP, Karunarathna RH, et al. 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. 2019;20:338.CrossRefPubMedPubMedCentral Ranasinghe AV, Kumara GWGP, Karunarathna RH, et al. 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. 2019;20:338.CrossRefPubMedPubMedCentral
3.
go back to reference Jayatilake N, Mendis S, Maheepala P, Mehta FR. Chronic kidney disease of uncertain aetiology: prevalence and causative factors in a developing country. BMC Nephrol. 2013;14:180.CrossRefPubMedPubMedCentral Jayatilake N, Mendis S, Maheepala P, Mehta FR. Chronic kidney disease of uncertain aetiology: prevalence and causative factors in a developing country. BMC Nephrol. 2013;14:180.CrossRefPubMedPubMedCentral
4.
go back to reference Jayasumana C, Gunatilake S, Senanayake P. 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. 2014;11:2125–47.CrossRefPubMedPubMedCentral Jayasumana C, Gunatilake S, Senanayake P. 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. 2014;11:2125–47.CrossRefPubMedPubMedCentral
5.
go back to reference Jayasumana C, Gajanayake R, Siribaddana S. Importance of arsenic and pesticides in epidemic chronic kidney disease in Sri Lanka. BMC Nephrol. 2014;15:124.CrossRefPubMedPubMedCentral Jayasumana C, Gajanayake R, Siribaddana S. Importance of arsenic and pesticides in epidemic chronic kidney disease in Sri Lanka. BMC Nephrol. 2014;15:124.CrossRefPubMedPubMedCentral
6.
go back to reference Chandrajith R, Nanayakkara S, Itai K, et al. Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: geographic distribution and environmental implications. Environ Geochem Health. 2011;33:267–78.CrossRefPubMed Chandrajith R, Nanayakkara S, Itai K, et al. Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: geographic distribution and environmental implications. Environ Geochem Health. 2011;33:267–78.CrossRefPubMed
7.
go back to reference Wanigasuriya KP, Peiris-John RJ, Wickremasinghe R. Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause? BMC Nephrol. 2011;12:32.CrossRefPubMedPubMedCentral Wanigasuriya KP, Peiris-John RJ, Wickremasinghe R. Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause? BMC Nephrol. 2011;12:32.CrossRefPubMedPubMedCentral
8.
go back to reference Herath C, Jayasumana C, De Silva PMCS, De Silva PHC, Siribaddana S, De Broe ME. Kidney diseases in agricultural communities: A case against heat-stress nephropathy. Kidney Int Rep. 2018;3:271–80.CrossRefPubMed Herath C, Jayasumana C, De Silva PMCS, De Silva PHC, Siribaddana S, De Broe ME. Kidney diseases in agricultural communities: A case against heat-stress nephropathy. Kidney Int Rep. 2018;3:271–80.CrossRefPubMed
9.
go back to reference Manage PM. Cyanotoxins: A hidden cause of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka – A review. Sri Lanka J Aquat Sci. 2019;24(1):1–10.MathSciNetCrossRef Manage PM. Cyanotoxins: A hidden cause of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka – A review. Sri Lanka J Aquat Sci. 2019;24(1):1–10.MathSciNetCrossRef
10.
go back to reference Ranasinghe HRALN, Lokuge LDMN, Edirisinghe JC, Bandara L. Water treatment, preventive measures and the chronic kidney disease in the farming community in Sri Lanka. J Agric Sci-Sri Lanka. 2015;10:98–108. Ranasinghe HRALN, Lokuge LDMN, Edirisinghe JC, Bandara L. Water treatment, preventive measures and the chronic kidney disease in the farming community in Sri Lanka. J Agric Sci-Sri Lanka. 2015;10:98–108.
11.
go back to reference De Silva MWA. Drinking water and CKD of unknown etiology in Sri Lanka: A community perspective. Ann Nutr Metab. 2020;76(suppl 1):37–42.CrossRefPubMed De Silva MWA. Drinking water and CKD of unknown etiology in Sri Lanka: A community perspective. Ann Nutr Metab. 2020;76(suppl 1):37–42.CrossRefPubMed
12.
go back to reference Imbulana S, Oguma K, Takizawa S. Evaluation of groundwater quality and reverse osmosis water treatment plants in the endemic areas of Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka. Sci Total Environ. 2020;745:140716.ADSCrossRefPubMed Imbulana S, Oguma K, Takizawa S. Evaluation of groundwater quality and reverse osmosis water treatment plants in the endemic areas of Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka. Sci Total Environ. 2020;745:140716.ADSCrossRefPubMed
13.
go back to reference Cooray T, Wei Y, Zhong H, Zheng L, Weragoda SK, Weerasooriya R. Assessment of groundwater quality in CKDu affected areas of Sri Lanka: implications for drinking water treatment. Int J Environ Res Public Health. 2019;16(10):1698.CrossRefPubMedPubMedCentral Cooray T, Wei Y, Zhong H, Zheng L, Weragoda SK, Weerasooriya R. Assessment of groundwater quality in CKDu affected areas of Sri Lanka: implications for drinking water treatment. Int J Environ Res Public Health. 2019;16(10):1698.CrossRefPubMedPubMedCentral
14.
go back to reference Wimalawansa SJ. Effect of water hardness on non-communicable diseases, including chronic kidney disease of multifactorial origin (CKDmfo/CKDuo). J Environ Health Sci. 2016;2(1):1–11.CrossRef Wimalawansa SJ. Effect of water hardness on non-communicable diseases, including chronic kidney disease of multifactorial origin (CKDmfo/CKDuo). J Environ Health Sci. 2016;2(1):1–11.CrossRef
15.
go back to reference Imbulana S, Oguma K, Yakizawa S. Evaluation of ground water quality and reverse osmosis water treatment plants in the endemic areas of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. Sci Total Environ. 2020;745:140716.ADSCrossRefPubMed Imbulana S, Oguma K, Yakizawa S. Evaluation of ground water quality and reverse osmosis water treatment plants in the endemic areas of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. Sci Total Environ. 2020;745:140716.ADSCrossRefPubMed
16.
go back to reference Horbulyk T, Kafle K, Balasubramanya S. Community response to the provision of alternative water supplies: A focus on chronic kidney disease of unknown aetiology (CKDu) in rural Sri Lanka. Water International. 2021;46(1):37–58.CrossRef Horbulyk T, Kafle K, Balasubramanya S. Community response to the provision of alternative water supplies: A focus on chronic kidney disease of unknown aetiology (CKDu) in rural Sri Lanka. Water International. 2021;46(1):37–58.CrossRef
17.
go back to reference De Silva MWA. Drinking water and chronic kidney disease of unknown aetiology in Anuradhapura. Sri Lanka Anthropology & Medicine. 2019;26(3):311–27.CrossRef De Silva MWA. Drinking water and chronic kidney disease of unknown aetiology in Anuradhapura. Sri Lanka Anthropology & Medicine. 2019;26(3):311–27.CrossRef
18.
go back to reference Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int. 2005;67:2089–100.CrossRefPubMed Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int. 2005;67:2089–100.CrossRefPubMed
19.
20.
go back to reference World Health Organization. Expert Consultation on Chronic Kidney Disease of Unknown Etiology. 2016. World Health Organization. Expert Consultation on Chronic Kidney Disease of Unknown Etiology. 2016.
21.
go back to reference Palihawadana P, Hewage R, Maathu S, et al. Screening Guidelines, Chronic Kidney Disease of Sri Lanka 2017. 2nd ed. Colombo: Epidemiology Unit, Ministry of Health; 2017. Palihawadana P, Hewage R, Maathu S, et al. Screening Guidelines, Chronic Kidney Disease of Sri Lanka 2017. 2nd ed. Colombo: Epidemiology Unit, Ministry of Health; 2017.
22.
go back to reference Census of Population and Housing of Sri Lanka 2011. Colombo: Department of Census and Statistics. 2012. Census of Population and Housing of Sri Lanka 2011. Colombo: Department of Census and Statistics. 2012.
23.
go back to reference Ruwanpathirana T, Senanayake S, Gunawardana N, et al. Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology. BMC Public Health. 2019;19:763.CrossRefPubMedPubMedCentral Ruwanpathirana T, Senanayake S, Gunawardana N, et al. Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology. BMC Public Health. 2019;19:763.CrossRefPubMedPubMedCentral
24.
go back to reference Rannan-Eliya RP, Wijemunige N, Perera P, et al. Prevalence of diabetes and pre-diabetes in Sri Lanka: a new global hotspot–estimates from the Sri Lanka Health and Ageing Survey 2018/2019. BMJ Open Diab Res Care. 2023;11:e003160.CrossRefPubMedPubMedCentral Rannan-Eliya RP, Wijemunige N, Perera P, et al. Prevalence of diabetes and pre-diabetes in Sri Lanka: a new global hotspot–estimates from the Sri Lanka Health and Ageing Survey 2018/2019. BMJ Open Diab Res Care. 2023;11:e003160.CrossRefPubMedPubMedCentral
25.
go back to reference Senanayake S, Ruwanpathirana T, Gunawardena N. Hypertension in a rural community in Sri Lanka: prevalence, associated factors and its effect on the renal profile. J Hypertens. 2019;37(9):1805–12.CrossRefPubMed Senanayake S, Ruwanpathirana T, Gunawardena N. Hypertension in a rural community in Sri Lanka: prevalence, associated factors and its effect on the renal profile. J Hypertens. 2019;37(9):1805–12.CrossRefPubMed
26.
go back to reference Athuraliya TN, Abeysekera DT, Amerasinghe PH, Kumarasiri PV, Dissanayake V. Prevalence of chronic kidney disease in two tertiary care hospitals: high proportion of cases with uncertain aetiology. Ceylon Med J. 2009;54(1):23–5.CrossRefPubMed Athuraliya TN, Abeysekera DT, Amerasinghe PH, Kumarasiri PV, Dissanayake V. Prevalence of chronic kidney disease in two tertiary care hospitals: high proportion of cases with uncertain aetiology. Ceylon Med J. 2009;54(1):23–5.CrossRefPubMed
27.
go back to reference Bu LK, Jia PP, Li WG, Li YZ, Li TY, Pei DS. Probiotics mitigate kidney damage after exposure to Sri Lanka’s local groundwater from chronic kidney disease with uncertain etiology (CKDu) prevalent area in zebrafish. Aquat Toxicol. 2023;262:106671.CrossRefPubMed Bu LK, Jia PP, Li WG, Li YZ, Li TY, Pei DS. Probiotics mitigate kidney damage after exposure to Sri Lanka’s local groundwater from chronic kidney disease with uncertain etiology (CKDu) prevalent area in zebrafish. Aquat Toxicol. 2023;262:106671.CrossRefPubMed
28.
go back to reference Athuraliya NT, Abeysekera TD, Amerasinghe PH, et al. Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney Int. 2011;80(11):1212–21.CrossRefPubMed Athuraliya NT, Abeysekera TD, Amerasinghe PH, et al. Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney Int. 2011;80(11):1212–21.CrossRefPubMed
29.
go back to reference Nanayakkara S, Komiya T, Ratnatunga N, et al. Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka. Environ Health Prev Med. 2012;17:213–21.CrossRefPubMed Nanayakkara S, Komiya T, Ratnatunga N, et al. Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka. Environ Health Prev Med. 2012;17:213–21.CrossRefPubMed
30.
go back to reference Nanayakkara S, Senevirathna ST, Karunaratne U, et al. Evidence of tubular damage in the very early stage of chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka: a cross-sectional study. Environ Health Prev Med. 2012;17:109–17.CrossRefPubMed Nanayakkara S, Senevirathna ST, Karunaratne U, et al. Evidence of tubular damage in the very early stage of chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka: a cross-sectional study. Environ Health Prev Med. 2012;17:109–17.CrossRefPubMed
31.
go back to reference Glaser J, Lemery J, Rajagopalan B, et al. Climate change and the emergent epidemic of CKD from heat stress in rural communities: the case for heat stress nephropathy. Clin J Am Soc Nephrol. 2016;11:1472–83.CrossRefPubMedPubMedCentral Glaser J, Lemery J, Rajagopalan B, et al. Climate change and the emergent epidemic of CKD from heat stress in rural communities: the case for heat stress nephropathy. Clin J Am Soc Nephrol. 2016;11:1472–83.CrossRefPubMedPubMedCentral
32.
go back to reference Roncal-Jimenez C, Lanaspa MA, Jensen T, Sanchez-Lozada LG, Johnson RJ. Mechanisms by which dehydration may lead to chronic kidney disease. Ann Nutr Metab. 2015;66(suppl 3):10–3.CrossRefPubMed Roncal-Jimenez C, Lanaspa MA, Jensen T, Sanchez-Lozada LG, Johnson RJ. Mechanisms by which dehydration may lead to chronic kidney disease. Ann Nutr Metab. 2015;66(suppl 3):10–3.CrossRefPubMed
33.
go back to reference Ramirez-Rubio O, McClean MD, Amador JJ, Brooks DR. An epidemic of chronic kidney disease in Central America: an overview. J Epidemiol Community Health. 2013;67:1–3.CrossRefPubMed Ramirez-Rubio O, McClean MD, Amador JJ, Brooks DR. An epidemic of chronic kidney disease in Central America: an overview. J Epidemiol Community Health. 2013;67:1–3.CrossRefPubMed
34.
go back to reference Abraham G, Agarwal SK, Gowrishankar S, Vijayan M. Chronic kidney disease of unknown etiology: hotspots in India and other Asian countries. Nephrol. 2019;39(3):272–7. Abraham G, Agarwal SK, Gowrishankar S, Vijayan M. Chronic kidney disease of unknown etiology: hotspots in India and other Asian countries. Nephrol. 2019;39(3):272–7.
35.
go back to reference Madero M, Aguilar D, Rana A, Escobar A, Villa A, Obrador G. Decreased kidney function among rural population in Tierra Blanca Mexico: a cross-sectional study. J Am Soc Nephrol. 2017;28:529. Madero M, Aguilar D, Rana A, Escobar A, Villa A, Obrador G. Decreased kidney function among rural population in Tierra Blanca Mexico: a cross-sectional study. J Am Soc Nephrol. 2017;28:529.
36.
go back to reference El Minshawy O. End-stage renal disease in the El-Minia Governorate, upper Egypt: an epidemiological study. Saudi J Kidney Dis Transpl. 2011;22(5):1048–54.PubMed El Minshawy O. End-stage renal disease in the El-Minia Governorate, upper Egypt: an epidemiological study. Saudi J Kidney Dis Transpl. 2011;22(5):1048–54.PubMed
37.
go back to reference Hassen W, Abid S, Achours A, Maaroufi K, Creppy EE, Bacha H. Ochratoxin A and human nephropathy in Tunisia: a ten years survey Annales de Toxicology. Analitique. 2003;15(1):21–9. Hassen W, Abid S, Achours A, Maaroufi K, Creppy EE, Bacha H. Ochratoxin A and human nephropathy in Tunisia: a ten years survey Annales de Toxicology. Analitique. 2003;15(1):21–9.
38.
go back to reference Pearce N, Caplin B. Let’s take the heat out of the CKDu debate: more evidence is needed. Occup Environ Med. 2019;76(6):357–9.CrossRefPubMed Pearce N, Caplin B. Let’s take the heat out of the CKDu debate: more evidence is needed. Occup Environ Med. 2019;76(6):357–9.CrossRefPubMed
39.
go back to reference Wesseling C, Glaser J, Rodríguez-Guzmán J, et al. Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress. Rev Panam Salud Publica. 2020;44:e15.CrossRefPubMedPubMedCentral Wesseling C, Glaser J, Rodríguez-Guzmán J, et al. Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress. Rev Panam Salud Publica. 2020;44:e15.CrossRefPubMedPubMedCentral
40.
go back to reference John O, Gummudi B, Jha A, et al. Chronic Kidney Disease of Unknown Etiology in India: What Do We Know and Where We Need to Go. Kidney Int Rep. 2021;6(11):2743–51.CrossRefPubMedPubMedCentral John O, Gummudi B, Jha A, et al. Chronic Kidney Disease of Unknown Etiology in India: What Do We Know and Where We Need to Go. Kidney Int Rep. 2021;6(11):2743–51.CrossRefPubMedPubMedCentral
41.
go back to reference Campese VM. The unresolved epidemic of chronic kidney disease of uncertain origin (CKDu) around the world: a review and new insights. Clinical Nephrology. 2021;95(2):65.CrossRefPubMed Campese VM. The unresolved epidemic of chronic kidney disease of uncertain origin (CKDu) around the world: a review and new insights. Clinical Nephrology. 2021;95(2):65.CrossRefPubMed
Metadata
Title
Decreasing incidence of hospital diagnosed CKD/CKDu in North Central Province of Sri Lanka: is it related to provision of drinking water reverse osmosis plants?
Authors
Asanga Venura Ranasinghe
Lakshmi C. Somatunga
Gardiye Weligamage Gamini Priyantha Kumara
Ranamuka Henayage Karunarathna
Ambepitiyawaduge Pubudu De Silva
Jayaprakara Mudiyanselage Chathurika Nayani Gunawardena
Sembu Kuttige Champika Ruwan Kumari
Mohamed Shali Fathima Sarjana
Mannikawadumesthri Vipula Chandu De Silva
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2024
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-024-03534-w

Other articles of this Issue 1/2024

BMC Nephrology 1/2024 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.