Abstract:
Introduction
Chronic kidney disease of unknown etiology (CKD-u)
is a major health burden in Sri Lanka. Along with
uncertainties on etiology there are many other
unexplored aspects in this mysterious disease
including natural history, morbidity and mortality.
Girandurukotte, located in Uva province of Sri Lanka,
was identified as an endemic area in 2006 and
henceforth patients diagnosed as CKD-u were
registered and followed up at a specialized renal
clinic. Our aim was to analyze the correlation of
survival of CKD-u patients with chronic kidney
disease (CKD) stage at initial presentation and to
determine related lifestyle factors.
Method
This is a retrospective study. Recorded and available
data of all CKD-u patients (n=379) registered and
followed up in Girandurukotte renal clinic, during the
period of 2005 to 2014, was analyzed.
The disease was categorized into five clinical stages,
according to the Kidney Disease Outcomes Quality
Initiative (KDOQI) criteria based on the estimated
glomerular filtration rate.
Patients were observed for survival up to 2014
(maximum follow up period was 158 months). Data
was analyzed using R statistical software.
Discussion
A prospective study carried out in Medawachchiya,
Sri Lanka found that family history of chronic renal
disease and history of snake bite were significant
predictors for CKD-u (Wanigasooriya et al, 2007),
but according to our study in Girandurukotte, they
are not significant risk factors.
Results
Out of 379 (270 males and 109 females), majority were in stage 3 on
presentation. Mean age at presentation was 43 years (SD-6.5). All of them
were Sinhalese in ethnicity and belonged to rural communities.
10 patients were lost to follow up and 15 deaths were recorded during the
study period. Stage 1 had the highest survival rate, which progressively
decreased with advancing clinical stages.
Only gender showed a significant effect (p= 0.096, α=0.10) on
CKD-u. Males had 2.3 times risk for CKD-u than females.
Females had higher survival rate than males at all stages
Among males, smoking had a significant effect on CKD-u.
(p=0.0924, α=0.10). Smoking males have 2.57 times risk for
CKD-u, than non-smoking males.
Conclusion
This study confirmed that males are more prone to get CKD-u and females
have better survival rates.
Most patients are presented at late stages (stage 3 and 4) and stage 1 has
the highest survival rate among all stages, claiming that early identification
of the disease is vital for better outcome.
Smoking habit among males has a significant adverse effect on survival.
