characteristic features of patients with CKD and CKDu in Girandurukotte and Wilgamuwa, SriLanka

Abstract

Chronic Kidney Disease of uncertain aetiology (CKDu) is an endemic disease among agricultural workers in SriLanka. This study was designed to find the unique characteristics of CKDu in Girandurukotte and Wilgamuwa. A detailed questionnaire survey was carried out on life style and clinical history of biopsy proved non-dialysis CKDu patients (n=119) from Girandurukotte and Wilgamuwa regional hospitals and healthy controls from the endemic and non-endemic areas. Although nearly half of the patients (45.4%) were in advanced stages of CKD (stage 3b or above), their mean blood pressure was normal. According to renal function tests, 66.4% of CKDu patients had increased serum creatinine while 34.5% had increased uric acid. As found in other CKD patients, alkaline phosphatase in serum was higher, possibly due to bone diseases, while higher amylase may be due to reduced renal excretion. These patients had no signs of systemic inflammation, based on C-reactive protein (< 6 mg L -1 ) and low white cell count (7279 cells/mm3 ). According to vitamin D and hormone results, 62% CKDu patients had low levels of vitamin D (< 30 ng mL-1 ) while other hormones (TSH, PTH, Ferritin, Calcitonin, Aldosterone) were normal. According to the osmolality findings, more than 50% of CKDu patients had increased serum osmolality while 63% had normal urine osmolality. The odds ratio indicated that family history of CKD, chewing betel, malaria history, being a male and in the age group 40 – 60 years were significant potential risk factors for CKDu in this area compared to controls. As noted in this study, there were no apparent major differences between CKDu and CKD. Further, evaluations of these findings will help proper patient management.