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Published in: BMC Nephrology 1/2014

Open Access 01-12-2014 | Correspondence

Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka – lessons learned from the WHO CKDu population prevalence study

Authors: Jennifer Hoponick Redmon, Myles F Elledge, Donna S Womack, Rajitha Wickremashinghe, Kamani P Wanigasuriya, Roshini J Peiris-John, Joseph Lunyera, Kristin Smith, James H Raymer, Keith E Levine

Published in: BMC Nephrology | Issue 1/2014

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Abstract

The recent emergence of an apparently new form of chronic kidney disease of unknown aetiology (CKDu) has become a serious public health crisis in Sri Lanka. CKDu is slowly progressive, irreversible, and asymptomatic until late stages, and is not attributable to hypertension, diabetes, or other known aetiologies. In response to the scope and severity of the emerging CKDu health crisis, the Sri Lanka Ministry of Health and the World Health Organization initiated a collaborative research project from 2009 through 2012 to investigate CKDu prevalence and aetiology. The objective of this paper is to discuss the recently published findings of this investigation and present additional considerations and recommendations that may enhance subsequent investigations designed to identify and understand CKDu risk factors in Sri Lanka or other countries.
Literature
1.
go back to reference Athuraliya NTC, Abeysekera TDJ, Amerasinghe PH, Kumarasiri R, Bandara P, Karunaratne U, Milton AH, Jones AL: Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney Int. 2011, 80: 1212-1221.CrossRefPubMed Athuraliya NTC, Abeysekera TDJ, Amerasinghe PH, Kumarasiri R, Bandara P, Karunaratne U, Milton AH, Jones AL: Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney Int. 2011, 80: 1212-1221.CrossRefPubMed
2.
go back to reference Senevirathna L, Abeysekara T, Nanayakkara S, Chandrajith R, Ratnatunga N, Harada K, Hitomi T, Komiya T, Muso E, Koizumi A: 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. 2012, 17: 191-198.CrossRefPubMed Senevirathna L, Abeysekara T, Nanayakkara S, Chandrajith R, Ratnatunga N, Harada K, Hitomi T, Komiya T, Muso E, Koizumi A: 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. 2012, 17: 191-198.CrossRefPubMed
3.
go back to reference Peiris-John RJ, Wanigasuriya JKP, Wickremasinghe AR, Dissanayake WP, Hittarage A: Exposure to acetylcholinesterase-inhibiting pesticides and chronic renal failure. Ceylon Med J. 2006, 51 (1): 42-43.PubMed Peiris-John RJ, Wanigasuriya JKP, Wickremasinghe AR, Dissanayake WP, Hittarage A: Exposure to acetylcholinesterase-inhibiting pesticides and chronic renal failure. Ceylon Med J. 2006, 51 (1): 42-43.PubMed
4.
go back to reference Wanigasuriya KP, Peiris H, Ileperuma N, Peiris-John RJ, Wickremasinghe R: Could ochratoxin a in food commodities be the cause of chronic kidney disease in Sri Lanka?. Trans R Soc Trop Med Hyg. 2008, 102: 726-728.CrossRefPubMed Wanigasuriya KP, Peiris H, Ileperuma N, Peiris-John RJ, Wickremasinghe R: Could ochratoxin a in food commodities be the cause of chronic kidney disease in Sri Lanka?. Trans R Soc Trop Med Hyg. 2008, 102: 726-728.CrossRefPubMed
5.
go back to reference Bandara JMRS, Wijewardena HVP, Liyanege J, Upul MA, Bandara JMUA: Chronic renal failure in Sri Lanka caused by elevated dietary cadmium: trojan horse of the green revolution. Toxicol Lett. 2010, 198: 33-39.CrossRefPubMed Bandara JMRS, Wijewardena HVP, Liyanege J, Upul MA, Bandara JMUA: Chronic renal failure in Sri Lanka caused by elevated dietary cadmium: trojan horse of the green revolution. Toxicol Lett. 2010, 198: 33-39.CrossRefPubMed
6.
go back to reference Jayasumana MACS, Paranagama PA, Amarasinghe MD, Wijewardane KMRC, Dahanayake KS, Fonseka SI, Rajakaruna KDLMP, Mahamithawa AMP, Samarasinghe UD, Senanyake VK: Possible link of chronic arsenic toxicity with chronic kidney disease of unknown etiology in Sri Lanka. J Nat Sci Res. 2013, 3 (1): 64-73. Jayasumana MACS, Paranagama PA, Amarasinghe MD, Wijewardane KMRC, Dahanayake KS, Fonseka SI, Rajakaruna KDLMP, Mahamithawa AMP, Samarasinghe UD, Senanyake VK: Possible link of chronic arsenic toxicity with chronic kidney disease of unknown etiology in Sri Lanka. J Nat Sci Res. 2013, 3 (1): 64-73.
7.
go back to reference Chandrajith R, Dissanayake CB, Ariyarathna T, Herath HMJMK, Padmasiri JP: Dose-dependent Na and Ca in fluoride-rich drinking water —another major cause of chronic renal failure in tropical arid regions. Sci Total Environ. 2011, 409: 671-675.CrossRefPubMed Chandrajith R, Dissanayake CB, Ariyarathna T, Herath HMJMK, Padmasiri JP: Dose-dependent Na and Ca in fluoride-rich drinking water —another major cause of chronic renal failure in tropical arid regions. Sci Total Environ. 2011, 409: 671-675.CrossRefPubMed
8.
go back to reference Johnson RJ, Sanchez-Lozada LG: Chronic kidney disease: mesoamerican nephropathy—new clues to the cause. Nat Rev Nephrol. 2013, 9: 560-561.CrossRefPubMed Johnson RJ, Sanchez-Lozada LG: Chronic kidney disease: mesoamerican nephropathy—new clues to the cause. Nat Rev Nephrol. 2013, 9: 560-561.CrossRefPubMed
9.
go back to reference Roncal Jimenez CA, Ishimoto T, Lanaspa MA, Rivard CJ, Nakagawa T, Ejaz AA, Cicerchi C, Inaba S, Le M, Miyazaki M, Glaser J, Correa-Rotter R, Gonzalez MA, Aragon A, Wesseling C, Sanchez-Lozada LG, Johnson RJ: Fructokinase activity mediates dehydration-induced renal injury. Kidney International. 2013 Roncal Jimenez CA, Ishimoto T, Lanaspa MA, Rivard CJ, Nakagawa T, Ejaz AA, Cicerchi C, Inaba S, Le M, Miyazaki M, Glaser J, Correa-Rotter R, Gonzalez MA, Aragon A, Wesseling C, Sanchez-Lozada LG, Johnson RJ: Fructokinase activity mediates dehydration-induced renal injury. Kidney International. 2013
10.
go back to reference Chandrajith R, Nanayakkara S, Itai K, Aturaliya TNC, Dissanayake CB, Abeysekera TDJ, Harada K, Watanabe T, Koizumi A: Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: geographical distribution and environmental implications. Environ Geochem Health. 2011, 33: 267-278.CrossRefPubMed Chandrajith R, Nanayakkara S, Itai K, Aturaliya TNC, Dissanayake CB, Abeysekera TDJ, Harada K, Watanabe T, Koizumi A: Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: geographical distribution and environmental implications. Environ Geochem Health. 2011, 33: 267-278.CrossRefPubMed
11.
go back to reference Wanigasuriya KP: Aetiological factors of chronic kidney disease in the north central province of Sri Lanka: a review of evidence to-date. J College Community Physicians Sri Lanka. 2012, 17 (1): 15-20.CrossRef Wanigasuriya KP: Aetiological factors of chronic kidney disease in the north central province of Sri Lanka: a review of evidence to-date. J College Community Physicians Sri Lanka. 2012, 17 (1): 15-20.CrossRef
12.
go back to reference World Health Organization (WHO): Chronic Kidney Disease of Unknown Aetiology (CKDu); A New Threat to Health. 2008, Sri Lanka: WHO Country Office for Sri Lanka World Health Organization (WHO): Chronic Kidney Disease of Unknown Aetiology (CKDu); A New Threat to Health. 2008, Sri Lanka: WHO Country Office for Sri Lanka
13.
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
14.
go back to reference Levey AS, Coresh J: Chronic kidney disease. Lancet. 2012, 378 (9811): 165-180.CrossRef Levey AS, Coresh J: Chronic kidney disease. Lancet. 2012, 378 (9811): 165-180.CrossRef
15.
go back to reference Eknoyan G, Hostetter T, Bakris GL, Hebert L, Levey AS, Parving H, Steffes MW, Toto R: Proteinuria and other markers of chronic kidney disease: a position statement of the national kidney foundation (NKF) and the national institute of diabetes and digestive and kidney diseases (NIDDK). Am J Kidney Dis. 2003, 42: 617-622.CrossRefPubMed Eknoyan G, Hostetter T, Bakris GL, Hebert L, Levey AS, Parving H, Steffes MW, Toto R: Proteinuria and other markers of chronic kidney disease: a position statement of the national kidney foundation (NKF) and the national institute of diabetes and digestive and kidney diseases (NIDDK). Am J Kidney Dis. 2003, 42: 617-622.CrossRefPubMed
16.
go back to reference Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A, NGAL Meta-analysis Investigator Group: Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009, 54: 1012-1024.CrossRefPubMed Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A, NGAL Meta-analysis Investigator Group: Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009, 54: 1012-1024.CrossRefPubMed
17.
go back to reference Lacquaniti A, Donato V, Pintaudi B, Di Vieste G, Chirico V, Buemi A, Di Benedetto A, Arena A, Buemi M: “Normoalbuminuric” diabetic nephropathy: tubular damage and NGAL. Acta Diabetol. 2013, 50 (6): 935-942.CrossRefPubMed Lacquaniti A, Donato V, Pintaudi B, Di Vieste G, Chirico V, Buemi A, Di Benedetto A, Arena A, Buemi M: “Normoalbuminuric” diabetic nephropathy: tubular damage and NGAL. Acta Diabetol. 2013, 50 (6): 935-942.CrossRefPubMed
18.
go back to reference Jha V, Parameswaran S: Community-acquired acute kidney injury in tropical countries. Nat Rev Nephrol. 2013, 9: 278-290.CrossRefPubMed Jha V, Parameswaran S: Community-acquired acute kidney injury in tropical countries. Nat Rev Nephrol. 2013, 9: 278-290.CrossRefPubMed
19.
go back to reference Kim JH, Kim GW, Lee MY, Shin JY, Shin YG, Koh SB, Chung CH: Role of HbA1c in the screening of diabetes mellitus in a Korean rural community. Diabetes Metabol J. 2012, 36: 37-42.CrossRef Kim JH, Kim GW, Lee MY, Shin JY, Shin YG, Koh SB, Chung CH: Role of HbA1c in the screening of diabetes mellitus in a Korean rural community. Diabetes Metabol J. 2012, 36: 37-42.CrossRef
20.
go back to reference Connally NP, Yousey-Hindes K, Meek J: Selection of neighborhood controls for a population-based lyme disease case–control study by using a commercial marketing database. Am J Epidemiol. 2013, 178 (2): 276-279.CrossRefPubMed Connally NP, Yousey-Hindes K, Meek J: Selection of neighborhood controls for a population-based lyme disease case–control study by using a commercial marketing database. Am J Epidemiol. 2013, 178 (2): 276-279.CrossRefPubMed
21.
go back to reference Wacholder S, Silverman DT, McLaughlin JK, Mandel JS: Selection of controls in case–control studies. Am J Epidemiol. 1992, 135 (9): 1029-1041.PubMed Wacholder S, Silverman DT, McLaughlin JK, Mandel JS: Selection of controls in case–control studies. Am J Epidemiol. 1992, 135 (9): 1029-1041.PubMed
22.
go back to reference Nanayakkara S, Senevirathna STMLD, Abeysekara T, Chandrajith R, Ratnatunga N, Gunarathne EDL, Yan J, Hitomi T, Muso E, Komiya T, Harada KH, Liu W, Kobayashi H, Okuda H, Sawatari H, Matsuda F, Yamada R, Watanabe T, Miyataka H, Himeno S, Koizumi A: 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. 2013, Nanayakkara S, Senevirathna STMLD, Abeysekara T, Chandrajith R, Ratnatunga N, Gunarathne EDL, Yan J, Hitomi T, Muso E, Komiya T, Harada KH, Liu W, Kobayashi H, Okuda H, Sawatari H, Matsuda F, Yamada R, Watanabe T, Miyataka H, Himeno S, Koizumi A: 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. 2013,
23.
go back to reference Hernan MA, Hernandez-Diaz S, Robins JM: A structural approach to selection bias. Epidemiology. 2004, 15 (5): 615-625.CrossRefPubMed Hernan MA, Hernandez-Diaz S, Robins JM: A structural approach to selection bias. Epidemiology. 2004, 15 (5): 615-625.CrossRefPubMed
24.
go back to reference Blumenthal UJ, Fleisher JM, Esrey SA, Peasey A, World Health Organization (WHO): Epidemiology: a Tool for the Assessment of Risk, in Water Quality: Guidelines, Standards and Health. Edited by: Fewtrell L, Bartram J. 2001, London, UK: IWA Publishing Blumenthal UJ, Fleisher JM, Esrey SA, Peasey A, World Health Organization (WHO): Epidemiology: a Tool for the Assessment of Risk, in Water Quality: Guidelines, Standards and Health. Edited by: Fewtrell L, Bartram J. 2001, London, UK: IWA Publishing
25.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP: The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ. 2007, 85 (11): 867-872.CrossRefPubMedPubMedCentral von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP: The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ. 2007, 85 (11): 867-872.CrossRefPubMedPubMedCentral
26.
go back to reference Sanderson S, Tatt ID, Higgins JPT: Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007, 36: 666-676.CrossRefPubMed Sanderson S, Tatt ID, Higgins JPT: Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007, 36: 666-676.CrossRefPubMed
27.
go back to reference Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M: Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007, 18 (6): 805-835.CrossRefPubMed Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M: Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007, 18 (6): 805-835.CrossRefPubMed
28.
go back to reference Crouse DL, Goldberg MS, Ross NA, Chen H, Labreche F: Postmenopausal breast cancer is associated with exposure to traffic-related air pollution in Montreal, Canada: a case–control study. Environ Health Perspect. 2010, 118 (11): 1578-1583.CrossRefPubMedPubMedCentral Crouse DL, Goldberg MS, Ross NA, Chen H, Labreche F: Postmenopausal breast cancer is associated with exposure to traffic-related air pollution in Montreal, Canada: a case–control study. Environ Health Perspect. 2010, 118 (11): 1578-1583.CrossRefPubMedPubMedCentral
29.
go back to reference Speer SA, Semenza JC, Kurosaki T, Anton-Culver H: Risk factors for acute myeloid leukemia and multiple myeloma: a combination of GIS and case–control studies. J Environ Health. 2002, 64 (7): 9-16.PubMed Speer SA, Semenza JC, Kurosaki T, Anton-Culver H: Risk factors for acute myeloid leukemia and multiple myeloma: a combination of GIS and case–control studies. J Environ Health. 2002, 64 (7): 9-16.PubMed
30.
go back to reference Townes LR, Mwandama D, Mathanga DP, Wilson ML: Elevated dry-season malaria prevalence associated with fine-scale spatial patterns of environmental risk: a case–control study of children in rural Malawi. Malar J. 2013, 12: 407-CrossRefPubMedPubMedCentral Townes LR, Mwandama D, Mathanga DP, Wilson ML: Elevated dry-season malaria prevalence associated with fine-scale spatial patterns of environmental risk: a case–control study of children in rural Malawi. Malar J. 2013, 12: 407-CrossRefPubMedPubMedCentral
31.
go back to reference Wu J, Chen G, Liao Y, Song X, Pei L, Wang J, Zheng X: Arsenic levels in the soil and risk of birth defects: a population-based case–control study using GIS technology. J Environ Health. 2011, 74 (4): 20-25.PubMed Wu J, Chen G, Liao Y, Song X, Pei L, Wang J, Zheng X: Arsenic levels in the soil and risk of birth defects: a population-based case–control study using GIS technology. J Environ Health. 2011, 74 (4): 20-25.PubMed
33.
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): 1-7. 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): 1-7.
34.
go back to reference Ministry of Environment Sri Lanka: National Implementation Plan under the Stockholm Convention on POPs for Sri Lanka. 2001, Sri Lanka: Ministry of Environment Sri Lanka Ministry of Environment Sri Lanka: National Implementation Plan under the Stockholm Convention on POPs for Sri Lanka. 2001, Sri Lanka: Ministry of Environment Sri Lanka
35.
go back to reference Cheng W, Yao H, Zhang H, Tao X: Influences of cadmium on grain mineral nutrient contents of two rice genotypes differing in grain cadmium accumulation. Rice Sci. 2009, 16 (2): 151-156.CrossRef Cheng W, Yao H, Zhang H, Tao X: Influences of cadmium on grain mineral nutrient contents of two rice genotypes differing in grain cadmium accumulation. Rice Sci. 2009, 16 (2): 151-156.CrossRef
36.
go back to reference Javanshir A, Shapoori M, Moezzi F: Impact of water hardness of cadmium absorption by four freshwater mollusks physa fontinalis, anodonta cygnea, corbicula fluminea and dreissena polymorpha from south Caspian Sea region. J Food Agri Environ. 2011, 9 (2): 763-767. Javanshir A, Shapoori M, Moezzi F: Impact of water hardness of cadmium absorption by four freshwater mollusks physa fontinalis, anodonta cygnea, corbicula fluminea and dreissena polymorpha from south Caspian Sea region. J Food Agri Environ. 2011, 9 (2): 763-767.
37.
go back to reference Wang MY, Chen AK, Wong MH, Qiu RL, Ye ZH: Cadmium accumulation in and tolerance or rice (Oryza sativa L.) varieties with different rates of radial oxygen loss. Environ Pollut. 2011, 159: 1730-1736.CrossRefPubMed Wang MY, Chen AK, Wong MH, Qiu RL, Ye ZH: Cadmium accumulation in and tolerance or rice (Oryza sativa L.) varieties with different rates of radial oxygen loss. Environ Pollut. 2011, 159: 1730-1736.CrossRefPubMed
38.
go back to reference Premarathna HMP, Hettiarachchi GM, Indraratne SP: Trace Metal Concentration in Crops and Soils Collected from Intensively Cultivated Areas of Sri Lanka. 2011, Sri Lanka: Pedologist, 230-240. Premarathna HMP, Hettiarachchi GM, Indraratne SP: Trace Metal Concentration in Crops and Soils Collected from Intensively Cultivated Areas of Sri Lanka. 2011, Sri Lanka: Pedologist, 230-240.
39.
go back to reference Andreu V, Gimeno-Garcia E: Evolution of heavy metals in marsh areas under rice farming. Environ Pollut. 1999, 104: 271-282.CrossRef Andreu V, Gimeno-Garcia E: Evolution of heavy metals in marsh areas under rice farming. Environ Pollut. 1999, 104: 271-282.CrossRef
40.
go back to reference Bandara JMRS, Senevirathna DMAN, Dasanayake DMRSB, Herath V, Bandara JMRP, Abeysekara T, Rajapaksha KH: 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. 2008, 30 (5): 465-478.CrossRefPubMed Bandara JMRS, Senevirathna DMAN, Dasanayake DMRSB, Herath V, Bandara JMRP, Abeysekara T, Rajapaksha KH: 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. 2008, 30 (5): 465-478.CrossRefPubMed
41.
go back to reference Zeng F, Mao Y, Cheng W, Wu F, Zhang G: Genotypic and environmental variations in chromium, cadmium and lead concentrations in rice. Environ Pollut. 2008, 153: 309-314.CrossRefPubMed Zeng F, Mao Y, Cheng W, Wu F, Zhang G: Genotypic and environmental variations in chromium, cadmium and lead concentrations in rice. Environ Pollut. 2008, 153: 309-314.CrossRefPubMed
42.
go back to reference Giuffre De Lopez Camelo L, de Miguez SR, Marban L: Heavy metals input with phosphate fertilizers used in Argentina. Sci Total Environ. 1997, 204: 245-250.CrossRefPubMed Giuffre De Lopez Camelo L, de Miguez SR, Marban L: Heavy metals input with phosphate fertilizers used in Argentina. Sci Total Environ. 1997, 204: 245-250.CrossRefPubMed
43.
go back to reference Nziguheba G, Smolders E: Inputs of trace elements in agricultural soils via phosphate fertilizers in European countries. Sci Total Environ. 2008, 390: 53-57.CrossRefPubMed Nziguheba G, Smolders E: Inputs of trace elements in agricultural soils via phosphate fertilizers in European countries. Sci Total Environ. 2008, 390: 53-57.CrossRefPubMed
44.
go back to reference World Health Organization (WHO): Chronic Kidney Disease of Unknown Origin (CKDu): National Research Programme for Chronic Kidney Disease of unknown origin (CKDu) in Sri Lanka, World Health Organization (WHO) and M.o.H.N. 2009, Sri Lanka: Epidemiology Unit, Editors, 11- World Health Organization (WHO): Chronic Kidney Disease of Unknown Origin (CKDu): National Research Programme for Chronic Kidney Disease of unknown origin (CKDu) in Sri Lanka, World Health Organization (WHO) and M.o.H.N. 2009, Sri Lanka: Epidemiology Unit, Editors, 11-
45.
go back to reference Redmon JH, Elledge MF, Womack DS, Wickremashinghe R, Wanigasuriya KP, Peiris-John RJ, Lunyera J, Smith K, Raymer JH, Levine KE: Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka – lessons learned from the WHO CKDu population prevalence study. BMC Nephrol. 2014 Redmon JH, Elledge MF, Womack DS, Wickremashinghe R, Wanigasuriya KP, Peiris-John RJ, Lunyera J, Smith K, Raymer JH, Levine KE: Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka – lessons learned from the WHO CKDu population prevalence study. BMC Nephrol. 2014
46.
go back to reference World Health Organization: Global Status Report on Noncommunicable Diseases 2010. World Health Organization. 2011, Geneva, Switzerland: WHO Press World Health Organization: Global Status Report on Noncommunicable Diseases 2010. World Health Organization. 2011, Geneva, Switzerland: WHO Press
47.
go back to reference Final Mission Report: Research on Kidney Disease of Uncertain Aetiology (CKDu) in Sri Lanka; National CKDu Project. 2013, Geneva: World Health Organization Final Mission Report: Research on Kidney Disease of Uncertain Aetiology (CKDu) in Sri Lanka; National CKDu Project. 2013, Geneva: World Health Organization
Metadata
Title
Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka – lessons learned from the WHO CKDu population prevalence study
Authors
Jennifer Hoponick Redmon
Myles F Elledge
Donna S Womack
Rajitha Wickremashinghe
Kamani P Wanigasuriya
Roshini J Peiris-John
Joseph Lunyera
Kristin Smith
James H Raymer
Keith E Levine
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2014
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/1471-2369-15-125

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