List of publications on CKDu, presenting various hypotheses on the aetiology of the disease, in the chronological order of publication

1. Hypotheses (published)
on
the aetiology of CKDu in Sri Lanka
Sachie Panawala
Ministry of Science Technology and Research
China-Sri Lanka Collaborative Grant Research Project – Conference
15 March 2016
Galle Face Hotel, Colombo

2. 22 May 2015 – Workshop on an Action Plan to prevent CKDu
Ministry of Special Projects

4. VI on Health and
Well-being

6. What led to formation of hypotheses for CKDu
Histopathological evidence
Insult of kidneys with one or more toxins

7. 2006
2007
2009
2008
2011
2013
First detection – mid 1990’s
2012
2014
Timeline of development hypotheses
Development of a case definition for CKDu SL
2015

8. Local Institutes that proposed hypotheses on CKDu
1. University of Peradeniya
2. Rajarata University of Sri Lanka
3. Ministry of Health
4. University of Kelaniya
5. University of Sri Jayawardenepura
6. University of Colombo
7. World Health Organization
8. IWMI
9. NWSDB

9. 2006
Organophosphates - RJ Peiris-John, JKP Wanigasuriya, AR
Wickremasinghe, WP Dissanayake and A
Hittarage.
Exposure to acetylcholinesterase-
inhibiting pesticides and chronic renal
failure (2006).
Ceylon Medical Journal Vol. 51, No. 1
Pesticides and
Fertilizers

10. 2007
Use of ayurvedic medicines - Wanigasuriya KP, Peiris-John
RJ, Wickremasinghe R, Hittarage A.
Chronic renal failure in North
Central Province of Sri Lanka: an
environmentally induced disease.
Transactions of the Royal Society of
Tropical Medicine and Hygiene
2007; 101: 1013-7.

11. 2007
genetic predisposition- Wanigasuriya KP, Peiris-John
RJ, Wickremasinghe R, Hittarage A.
Chronic renal failure in North
Central Province of Sri Lanka: an
environmentally induced disease.
Transactions of the Royal Society of
Tropical Medicine and Hygiene
2007; 101: 1013-7.

12. 2007
drinking well water - Wanigasuriya KP, Peiris-John
RJ, Wickremasinghe R, Hittarage A.
Chronic renal failure in North
Central Province of Sri Lanka: an
environmentally induced disease.
Transactions of the Royal Society of
Tropical Medicine and Hygiene
2007; 101: 1013-7.

13. 2007
snakebites - Wanigasuriya KP, Peiris-John
RJ, Wickremasinghe R, Hittarage A.
Chronic renal failure in North
Central Province of Sri Lanka: an
environmentally induced disease.
Transactions of the Royal Society of
Tropical Medicine and Hygiene
2007; 101: 1013-7.

14. 2007
fungal toxins (OA) - Wanigasuriya KP, Peiris-John
RJ, Wickremasinghe R, Hittarage A.
Chronic renal failure in North
Central Province of Sri Lanka: an
environmentally induced disease.
Transactions of the Royal Society of
Tropical Medicine and Hygiene
2007; 101: 1013-7.

15. 2007
bacterial toxins - Wanigasuriya KP, Peiris-John
RJ, Wickremasinghe R, Hittarage A.
Chronic renal failure in North
Central Province of Sri Lanka: an
environmentally induced disease.
Transactions of the Royal Society of
Tropical Medicine and Hygiene
2007; 101: 1013-7.

16. 2008
Cadmium - J. M. R. S. Bandara , D. M. A. N. Senevirathna, D.
M. R. S. B. Dasanayake, V. Herath, J. M. R. P.
Bandara, T. Abeysekara, K. H. Rajapaksha (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).
Geochem Envron & Health 30:3465–78

17. 2009
Fluoride and Aluminium - Illeperuma OA,
Dharmagunawardhane HA, Herath
KRP (2009)
Dissolution of aluminium from
substandard utensils under high
fluoride stress: A possible risk
factor for chronic renal failures in
the North- Central province.
Journal of the National Science
Foundation of Sri Lanka 37:219–222

18. 2011
drinking water in the field - Wanigasuriya KP, Peiris-John RJ,
Wickremasinghe R. (2011)
Chronic kidney disease of
unknown aetiology in Sri Lanka:
is cadmium a likely cause?
BMC Nephrology 2011; 12: 32-8.

19. 2011
smoking Wanigasuriya KP, Peiris-John RJ,
Wickremasinghe R.
Chronic kidney disease of unknown aetiology
in Sri Lanka: is cadmium a likely cause?
BMC Nephrology 2011; 12: 32-8.
being treated
for
hypertension
-
Wanigasuriya KP, Peiris-John RJ,
Wickremasinghe R.
Chronic kidney disease of unknown aetiology
in Sri Lanka: is cadmium a likely cause?
BMC Nephrology 2011; 12: 32-8.

20. 2011
cyanobacterial
toxins-
Dissananyake DM, Jayasekera JMKB, Ratnayake
P, Wickramasinghe W and Radella YA (2011)
The Short Term Effect of Cyanobacterial Toxin
Extracts on Mice Kidney
Proceedings of the Peradeniya University
Research Sessions, Sri Lanka, Vol. 16,
November 2011

21. 2012
prolonged
exposure of the
kidney to many
ionic
species
Jayasekera, J., Dissnayake DM, Ratnayake P,
Wikramasinghe, W, Radella, YA, Palugaswewa,
WB. (2012)
The effects from concentrated water on
reservoirs of high prevalence areas on CKD of
unknown origin in Sri Lanka. - In: Proceedings
of the Research Symposium on Chronic Kidney
Disease of Unknown Aetiology (CKDu), Sri
Lanka Medical Association, Colombo, 11 March
2012
(https://issuu.com/slmanews/docs/ckdu_abstr
act_book)

22. 2012
Exposure to sun,
heat stress and
dehydration
Dissananayake DM, Jayasekera JMKB,
Wimalasiri R, Ratnayake I, Dissanayake S
(2012)
Renal tubular functions of farmers of high
prevalence area for CKDu
In: Proceedings of the Research Symposium
on Chronic Kidney Disease of Unknown
Aetiology (CKDu), Sri Lanka Medical
Association, Colombo, 11 March 2012
(https://issuu.com/slmanews/docs/ckdu_a
bstract_book)

23. 2012
Chemical
Nephrotoxicity
aggravated by
Arsenic, Heavy
metals
Dahanayake KS, Wijewardahana KMRC ,
Jayasumana MACS, Paranagama P (2012)
Presence of high levels of arsenic in internal
organs of deceased patients with chronic
kidney disease of unknown aetiology (CKDu):
three case reports.
In: Proceedings of the Research Symposium on
Chronic Kidney Disease of Unknown Aetiology
(CKDu), Sri Lanka Medical Association,
Colombo, 11 March 2012
(https://issuu.com/slmanews/docs/ckdu_abstr
act_book)

24. 2012
Chemical
Nephrotoxicity
aggravated by
Arsenic, Heavy
metals
Fonseka SI , Jayalath K, Amarasinghe M,
Mahamithawa AMP, Senanayake VK,
Paranagama PA (2012)
Hardness and presence of arsenic in aquifers
of selected CKDu prevalent and other areas in
Sri Lanka
In: Proceedings of the Research Symposium on
Chronic Kidney Disease of Unknown Aetiology
(CKDu), Sri Lanka Medical Association,
Colombo, 11 March 2012
(https://issuu.com/slmanews/docs/ckdu_abstr
act_book)

25. 2012
drinking reservoir
water
Jayasekera JMKB, Dissananyake DM,
Ratnayake P, Wickramasinghe W,
Radella YA, Palugaswewa WB
Effect of concentrated water from
reservoirs of high prevalence area for
CKD of unknown origin in Sri Lanka on
mice
In: Proceedings of the Research
Symposium on Chronic Kidney Disease of
Unknown Aetiology (CKDu), Sri Lanka
Medical Association, Colombo, 11 March
2012
(https://issuu.com/slmanews/docs/ckdu_
abstract_book)

26. 2012
Multifactoral
origin
Kamani Wanigasuriya (2012)
Aetiological factors of Chronic Kidney
Disease in the North Central Province
of Sri Lanka: A review of evidence to-date
Journal of the College of Community
Physicians of Sri Lanka
Volume 17, No. 01

27. 2013
Chemical
Nephrotoxicity
aggravated by
Chronic repeated
dehydration.
Responsible
chemicals are
Arsenic, Heavy
metals,
Herbicides
(dehydration +
heavy metals)
M.A.C.S.Jayasumana, P.A.Paranagama, M.D.
Amarasinghe, K.M.R.C.Wijewardane,
K.S.Dahanayake, S.I.Fonseka,
K.D.L.M.P.Rajakaruna,
A.M.P.Mahamithawa,U.D.Samarasinghe,V.K
.Senanayake (2013)
Possible link of Chronic arsenic toxicity
with Chronic Kidney Disease of unknown
etiology in Sri Lanka
Journal of Natural Sciences Research
www.iiste.org
ISSN 2224-3186 (Paper) ISSN 2225-0921
(Online) Vol.3, No.1, 2013

28. 2013
As and Cd
(more emphasis
on Cd)
Nihal Jayatilake, Shanthi Mendis, Palitha
Maheepala, Firdosi R Mehta and On behalf
of the CKDu National Research Project
Team
Chronic kidney disease of uncertain
aetiology: prevalence and causative factors
in a developing country
BMC Nephrology 2013, 14:180

29. 2013
Low selenium or
other
micronutrients in
the diet
Nihal Jayatilake, Shanthi Mendis, Palitha
Maheepala, Firdosi R Mehta and On behalf
of the CKDu National Research Project
Team
Chronic kidney disease of uncertain
aetiology: prevalence and causative factors
in a developing country
BMC Nephrology 2013, 14:180

30. 2014
Maternal
malnutrition
Myles F. Elledge, Jennifer Hoponick
Redmon, Keith E. Levine, Rajitha J.
Wickremasinghe, Kamani P. Wanigasariya,
and Roshini J. Peiris-John. (2014).
Chronic Kidney Disease of Unknown
Etiology in Sri Lanka: Quest for
Understanding and Global Implications.
RTI Press Publication No. RB-0007-1405
Research Triangle Park, NC: RTI Press.
(https://www.rti.org/pubs/rb-0007-1405-
elledge.pdf)

31. 2014
Use of NSAIDs Myles F. Elledge, Jennifer Hoponick
Redmon, Keith E. Levine, Rajitha J.
Wickremasinghe, Kamani P. Wanigasariya,
and Roshini J. Peiris-John. (2014).
Chronic Kidney Disease of Unknown
Etiology in Sri Lanka: Quest for
Understanding and Global Implications.
RTI Press Publication No. RB-0007-1405
Research Triangle Park, NC: RTI Press.
(https://www.rti.org/pubs/rb-0007-1405-
elledge.pdf)

32. 2014
low calcium
intake
Myles F. Elledge, Jennifer Hoponick
Redmon, Keith E. Levine, Rajitha J.
Wickremasinghe, Kamani P. Wanigasariya,
and Roshini J. Peiris-John. (2014).
Chronic Kidney Disease of Unknown
Etiology in Sri Lanka: Quest for
Understanding and Global Implications.
RTI Press Publication No. RB-0007-1405
Research Triangle Park, NC: RTI Press.
(https://www.rti.org/pubs/rb-0007-1405-
elledge.pdf)

33. 2014
chronic
undernutrition
Myles F. Elledge, Jennifer Hoponick
Redmon, Keith E. Levine, Rajitha J.
Wickremasinghe, Kamani P. Wanigasariya,
and Roshini J. Peiris-John. (2014).
Chronic Kidney Disease of Unknown
Etiology in Sri Lanka: Quest for
Understanding and Global Implications.
RTI Press Publication No. RB-0007-1405
Research Triangle Park, NC: RTI Press.
(https://www.rti.org/pubs/rb-0007-1405-
elledge.pdf)
low BMI

34. 2014
Glyphosate, Hard
Water and
Nephrotoxic
Metals
Jayasumana, Channa; Gunatilake, Sarath
and Senanayake, Priyantha (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. 2014 Feb;
11(2): 2125–2147.

35. 2014
Oxidative stress Sayanthooran, S., Magana-Arachchi, D.N.,
Sooriyapathirana, S.D.S.S, Abeysekera, T.
and Gunarathne, L. (2014).
Oxidative stress markers in chronic kidney
disease: gene expression analysis in a Sri
Lankan population. In: Proceedings of the
second International Symposium on Driving
Research Towards Economy: Opportunities
and Challenges, Peradeniya, 13-14th
November 2014- 31

36. 2015
Landscape
hydrogeology
Manthrithilake, Herath (2015)
CKDu : Are we shooting the right target?
Proceedings: Importance of Groundwater
Monitoring in Sri Lanka, 17 July 2015,
Colombo
(Along with Panabokke, C.R.)

37. Other Hypotheses Not Yet Published
1. Uranium
2. UV irradiation
3. Hanta Viral infection
4. Leptospirosis (silent spp)