Gunawickrama SHNP*, Hewavitharana KIG, Silva ARN, Nanayakkara PGCL, Gunawickrama KBS and Jayasekara JMKB
Objective: Risk factors among chronic kidney disease (CKD)/ chronic kidney disease of unknown aetiology (CKDu) patients were followed in Padaviya (PDV), and Girandurukotte/ Mahiyanganaya (GK/MH) of Sri Lanka, where CKDu was endemic. The studies profiled risk factor data pertaining to CKD and assessed risk factor association with renal dysfunction in the areas concerned. Methods: Data of initiation risk factors (IRF) that existed prior to diagnosis, progression risk factors and demography were collected in cross sectional studies at PDV, and GK/MH separately. Subject participation was volunteer and preceded informed consent. Control and CKD/CKDu groups were identified using serum creatinine based estimated glomerular filtration rate followed by verification of renal status with urine albumin to creatinine ratio obtained from spot samples. Data were analysed as compared to control with chi-square goodness of fit test and odds ratio. Results: Among IRF, both chi-square and odds ratio revealed (p<0.05) that hypertension associated disease development in GK/MH. In PDV, autoimmune diseases, systemic infections mostly multiple episodes of malaria, and leptospirosis, urinary tract infections and family history of kidney disease associated it (p<0.05). Nevertheless, IRF prevalence was higher in endemic control of PDV (85.7%), nonendemic control of PDV (71.4%), and endemic control of GK/MH (41.7%) as well. In PDV and GK/MH, 3.5% and 14.5% of CKD/CKDu patients did not report any IRF respectively. Odds of CKD/CKDu development increased among males and field farmers, and with low level of education, agrochemical usage, and with domestic usage of dug-well water. Conclusion: The results suggest that the disease in Padaviya, and Girandurukotte/ Mahiyanganaya areas may not be explained by traditional risk factors alone, and certain demographic factors such as education level, occupational application of agrochemicals, and domestic usage of dug-well water appeared to be influencing it.