Chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka: A story of the sufferings and plea for “effective” help

1. Chronic kidney disease of unknown aetiology
(CKDu) in Sri Lanka: A story of the sufferings and
plea for “effective” help
Chethmi Wijewardana
Vienna International School
2021

2. What is CKDU
• CKDu or Chronic Kidney Disease of Unknown aetiology is a type of
chronic kidney disease. The cause is unknown
• It mainly affects marginalized agricultural communities in specific areas of
the world
• Currently, CKDu occurs mainly in Sri Lanka and Central America,
although additional hotspots are identified almost daily
• It is a fatal progressive loss of kidney function that has killed over 40,000
people in the last decade
• Reduction of household income and cost of treatment has impacted
hugely on socio-economics of the affected communities

3. CKDu: Potential causes
Drinking water
Heavy metals
As, Cd
Agrochemicals
Pesticides/ Fertilizer
Less water
intake Genetic
predisposition
Infectious
diseases
Leptospirosis
Hard water
Heat stress

4. The normal kidney and its function
• The kidneys perform the
essential function of removing
waste products from the blood
and regulating the water fluid
and electrolyte levels
• We have two kidneys and each
one is made up of a million of
functional units called nephrons
• The function of the kidney can
be measured by Glomerular
filtration rate (GFR) which
shows the filtration efficiency of
the kidney
Figure by University of Michigan

5. Chronic Kidney Disease
Stage 1
• GFR >90
• No
symptoms
• Normal
function
Stage 2
• GFR 60-89
• No
symptoms
• Function
mildly
reduced
Stage 3
• GFR 30-59
• Some
symptoms
• Function
moderately
reduced
Stage 4
• GFR 15-29
• Advanced
disease
• Require
treatment
Stage 5
• GFR <15
• End stage
disease
• Dialysis/
transplant
or death

6. CKDu in Sri Lanka
• Sri Lanka is a tropical island located in the
Indian sub continent with a population around
22 million
• Agriculture sector contributes about 7% to the
economy and 27% of the population engages in
this sector
• The disease is mainly concentrated in the North
central province where the majority are farming
community.
• However, recently, it has started spreading
towards the south of the country

7. Mission
• A fact finding mission was done in Sri
Lanka in 2019 summer. Based in
Kandy, in the central hills of the
country
• Three hospitals were visited
• Kandy: Consultant Nephrologist
• Anuradapura: Support NGO
• Girandurukotte: Patient clinic
• Patient visits were done
• Anuradapura:
• Rambewa: Patient 1
• Giradurukotte:
• Girandurukotte: Patient 2 & 3
• Dehiattakandiya: Patient 4 & 5
Anuradapura
Kandy
Girandurukotte
❶
❷❸
Girandurukotte
Dehiattakandiya
Anuradhapura
Rambewa
❹❺

8. Hospitals
Kandy Hospital
• Point of contact: Dr Nishantha
Nanayakkara, consultant
nephrologist
• A major teaching hospital
• Has facilities for dialysis and
kidney transplantation
• A referral centre for CKDu
patients
• A research center for CKDu
• Provide support regional hospitals
Anuradhapura Hospital
• A major teaching hospital
• Has facilities for dialysis
• A referral centre for CKDu
patients
• A research center for CKDu
Girandurukotte Hospital
• A regional hospital
• Has facilities for
dialysis
• A specialized renal
unit

9. Hospital vs Home care
Hospital care
• Kidney transplantation
• Needs find a a matching
donor
• High cost for the surgery
and medicines thereafter
• Hemo dialysis
• Needs frequent visits to
hospitals with facilities
• For rural farming
community, this is difficult
Home care
• Peritoneal dialysis
• Can be done at home
• Can be employed
• Less hospital visits
• Needs good sanitary conditions
• Infections (peritonitis)
Image: National Kidney Foundation

10. Home care: Patient data
Patient 1 Patient 2 Patient 3 Patient 4 Patient 5
Age Late 50s Early 50s Early 50s Early 60s Early 30s
Sex Female Male Male Male Female
Farmer or not Teacher
No or very low income
No access to clean water
Late diagnosis
Severe symptoms
Dialysis at home
Clean home sanitation
Urgent support needed

11. Filling the gaps
Clean water
Medical
supplies
Employment
opportunities
Hospital
upgrades

12. Way forward…
“Patient 1 died last year since she could not afford to go to the hospital nor could
improve her house sanitary conditions to have dialysis done at home. She was taking
care of her eight year old grandchild who lost her parents.”
• We need to support the affected communities urgently and effectively
• Improving mental health and employability of the CKDu patients is very
important
• The assistance should be provided directly to the affected communities
or through reliable and trusted agencies in a sustainable manner
• Research should be strengthened to identify the cause/s of CKDu

13. Who to contact
• Dr NishanthaNanyakkara, Prof. SanjayaAdikari, Mr Nalaka Elladeniya, Dr. Lishantha Gunarathna, Mr
Shalanka Randeniya, Mr Salida Kandapola, Nephrology & Transplant Unit, Kandy, Staff at Girandurukotte
hospital, Kidney Protection Foundation, Tokyo cement group, Life plus group and my family who supportedto
carry out this mission
• All of you who took time today to listen to my presentation
Acknowledgement
• Dr Nishantha Nanyakkara, consultant nephrologist, Nephrology & Transplant Unit,
Kandy Teaching Hospital
• Dr Lishantha Gunarathna, Girandurukotte hospital
• Kidney Protection Foundation, Anuradhapura Teaching Hospital
• Mr Nalaka Elladeniya, Life plus Facebook group