Abstract:
Chronic kidney disease of uncertain etiology (CKD-u) is an important public
health issue in Sri Lanka and around the world, but published evidence of the progression of this
disease is scanty. Our aim is to analyze the progression patterns and the associated risk factors of
definite and probable CKD-u cases. This observational study was based on records of CKD-u
cohort from 2005-14 at Girandurukotte, an endemic area for CKD-u in Uva Province, Sri Lanka.
Data (rate of progression, survival, and risk factors) were analyzed using R statistical software.
CKD-u cases (379) were included in analyses based on the adequacy of variables. Mean age was
53 years, male-to-female ratio of 2.5:1, and smoking were significant risk factors (P <0.10) for
CKD-u progression. Males had 2.3 times hazard for CKD-u survival than females, and males who
smoked had 2.57 times risk of CKD-u progression than nonsmoking males. Faster eGFR decline
rate of >5 mL/min/1.73 m2
/year have been identified in 25% of the sample (n = 100); this group is
significantly younger than the slower progression group (mean age 46 years) and was at an early
stage at the time of presentation (mean eGFR 76.02). CKD-u progression was not equal in all
patients but faster in young people who presented at earlier stages. Continuous exposure to environ- mental risk factors may influence the rate of progression. Females have higher CKD-u survival rates
than males. Tobacco smoking was associated with a lower survival of CKD-u but could be a
proxy indicative of other exposures.
