Abstract:
Chronic Kidney Disease of unknown etiology
(CKDu) also named as Chronic Interstitial
Nephritis in Agricultural Communities (CINAC)
is a rapidly growing public health concern in
Sri Lanka (SL). Heat stress and agrochemical
exposure have been considered as the main
etiological factors. CINAC is mostly prevalent
only among dry zone farmers in SL, however the
fishing community in the same dryzone is exposed
to similar or higher heat stress. We postulated that
if heat stress is an essential risk factor in CINAC
prevalence, it should also be present in heat
exposed fishing community in the dry zone of Sri
Lanka. Therefore, we compared the renal markers
of a fishing cohort in Mannar (MFish, n = 149)
with sugarcane farming cohort in Buttala (BFarm,
n = 168) in rural SL. Elevated SCr in BFarm (8.9%)
was higher than MFish (4.5%), however SCr (P
= 0.64) and eGFr(P = 0.78) were not significantly
different between the two cohorts. Serum uric acid
was higher in MFish (4.7 mg/dl; Median) than
BFarm (4.2 mg/dl; Median) indicating higher
exposure to heat stress. However, albuminuria
(ACR ≥ 30 mg/g Cr) was higher in BFarm (9.5%)
than MFish (6.4%) confirming higher CINAC
prevalence among sugarcane farmers. Moreover,
urinary biomarkers KIM 1 was higher in BFarm
(841.6 pg/mg Cr) than MFish (667.8 pg/mg Cr)
but NGAL levels (1.87 & 1.93 ng/mg Cr) were
similar in both cohorts. It can be concluded that
declining renal functions were more predominant
among the farming community than in the fishing
community in spite of higher heat stress in dry
zone locations of Sri Lanka, and hence the farming
community is more susceptible to CKDu.
