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Agidew MM, Abebe EC, Muche ZT, Mengstie MA, Mulu AT, Admasu FT, Teklemariam AB, Zewde EA, Temesgen GB, Ayele T, Kassie AB, Baye ND, Dejenie TA. Evaluation of liver function biomarkers, blood pressure, and anthropometric parameters among chronic kidney disease patients: Laboratory-based cross-sectional study in Northwest Ethiopia. Metabol Open 2023; 19:100254. [PMID: 37681054 PMCID: PMC10480547 DOI: 10.1016/j.metop.2023.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023] Open
Abstract
Background Chronic kidney disease (CKD) is a non-communicable disease leading to a progressive decline in kidney functions and complications like liver disorders. Serum levels of liver parameters such as aminotransferases and bilirubin are important biomarkers for the diagnosis of liver diseases. Studies on the effect of CKD with and without end-stage renal disease (ESRD) on the levels of liver biomarkers in Ethiopia are limited. Hence, this study aimed to assess liver biomarkers, blood pressure (BP) and anthropometric indices in CKD patients attending a renal clinic of Felege Hiwot Comprehensive Specialized Hospital(FHCSH) in Bahir Dar, Ethiopia. Method A hospital-based cross-sectional study was conducted among 100 CKD patients attending the renal clinic of FHCSH in Bahir Dar, Ethiopia. Data were collected using a structured questionnaire through face-to-face interview. BP and anthropometric parameters were measured based on the standard procedures. About 5 ml of serum was used to analyzeliver parameter using automated chemistry analyzer. All data analyses such as independent sample t-testand one-way ANOVA were done using SPSS version 25.0. Besides, Pearson's correlation analysis and multiple linear regression were done to identify predictors of liver biomarkers in CKD patients. P-value< 0.05 were considered statistically significant. Results The mean serum levels of AST and ALT were significantly lower in CKD patients under dialysis when compared to CKD patients with no dialysis (p < 0.05). These enzymes were positively and negatively correlated with eGFRand the severity of CKD, respectively. However, there were no significant differences in bilirubin level between different stages of CKD. There was also a significant increase (p < 0.05) in the levels of AST and ALT with BMI.There was also a significant rise of SBP and DBP in CKD patients under dialysis compared to CKD patients not in dialysis. Conclusion Aminotransferases were significantly lower in CKD patients undergoing dialysis than in CKD patients not undergoing dialysis, warranting the need fora separate standard reference ranges or using other diagnostic criteria to diagnose liver comorbidities in CKD patients. The levels of AST and ALT in CKD patients were also significantly increased with BMI. Besides, BP was significantly elevated with the severity of CKD, indicating the more advanced the CKD is, the higher BP.
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Affiliation(s)
- Melaku Mekonnen Agidew
- Department of Medical Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Medical Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Zelalem Tilahun Muche
- Department Medical Physiology, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Medical Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anemut Tilahun Mulu
- Department of Medical Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fitalew Tadele Admasu
- Department of Medical Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Edgiet Abebe Zewde
- Department Medical Physiology, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gelagey Baye Temesgen
- Department of Medical Biochemistry, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - TeklieMengie Ayele
- Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Achenef Bogale Kassie
- Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Nega Dagnew Baye
- Department Anatomy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hewavitharana P, Schensul S, Lee E, Montez-Rath M, Senarathne S, Liu S, Harold K, Hewapathiranage S, Erandika N, Abeysundara HT, Yu X, Bhalla V, Fire A, Levin A, Anand S, Vlahos P, Chandrajith R, Nanayakkara N. Describing Natural History and Exploring Risk Factors for Kidney Function Decline in Persons With CKD of Uncertain Etiology in Sri Lanka. Kidney Int Rep 2023; 8:1430-1438. [PMID: 37441476 PMCID: PMC10334401 DOI: 10.1016/j.ekir.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Chronic kidney disease of uncertain etiology (CKDu) is a leading cause of death of adults in Sri Lanka's dry region. Methods We initiated the Kidney Progression Project (KiPP) to prospectively follow 292 persons with Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rate (eGFR) 20 to 60 ml/min per 1.73 m2 living in a CKDu endemic area. Using data from 3-year follow-up, we assessed kidney function decline (>30% from baseline eGFR), and the composite outcome of >30% eGFR decline, eGFR <15 ml/min or death, and explored the association of the 2 outcomes with baseline demographic, residential, and clinical parameters accounting for baseline eGFR. Results Median eGFR at enrollment was 28 ml/min among 71 women; 30 ml/min among 221 men; 91% to 99% had trace or no proteinuria during follow-up. At enrollment, median serum sodium, uric acid, and potassium were 143 mmol/l, 6.3 mg/dl, 4.5 meq/l, respectively among women; and 143 mmol/l, 6.9 mg/dl, 4.3 meq/l among men. Mean slope of eGFR decline was -0.5 (SD 4.9) ml/min/yr. In exploratory analyses, men with greater years of education and those living in northern region of the study area experienced lower likelihood of disease progression (hazard ratios [HR] 0.87 [0.77-0.98] per additional year and 0.33 [0.12-0.89] for northern versus other subregions, respectively). There was a suggestion that men drinking well water had higher likelihood and men living further away from reservoirs had lower likelihood of >30% decline in eGFR (HR 2.07 [0.95-4.49] for drinking well water versus not, and HR 0.58 [0.32-1.05] per kilometer distance, respectively). Conclusions The overall rate of kidney function decline was slow in this CKDu cohort, similar to other nonalbuminuric CKD, and event rates were similar among men and women. Further etiologic investigations could focus on specific residence locale and water use.
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Affiliation(s)
- Pasan Hewavitharana
- Center for Research, National Hospital Kandy, Sri Lanka
- Department of Nursing, Faculty of Health Sciences, The Open University of Sri Lanka, Kandy, Sri Lanka
| | - Stephen Schensul
- School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Edison Lee
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Maria Montez-Rath
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Sachintha Senarathne
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Sai Liu
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Kaitlin Harold
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | | | | | - Hemalika T.K. Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Xue Yu
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Vivek Bhalla
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Andrew Fire
- Department of Pathology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Shuchi Anand
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Penny Vlahos
- Department of Marine Sciences, University of Connecticut, Groton, Connecticut, USA
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Nishantha Nanayakkara
- Center for Research, National Hospital Kandy, Sri Lanka
- Nephrology and Kidney Transplant Unit, National Hospital Kandy, Sri Lanka
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Balasooriya S, Diyabalanage S, Yatigammana SK, Ileperuma OA, Chandrajith R. Major and trace elements in rice paddy soils in Sri Lanka with special emphasis on regions with endemic chronic kidney disease of undetermined origin. Environ Geochem Health 2022; 44:1841-1855. [PMID: 34282514 DOI: 10.1007/s10653-021-01036-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Environmental exposure to trace elements has been widely suspected as an etiological factor for the emergence of chronic kidney disease of undetermined origin (CKDu) that prevails in certain districts of the dry zone areas of Sri Lanka. Contaminated rice can be act as a host for potentially toxic trace elements that ultimately led to health hazards; thus, rice soils were investigated in detail, giving particular attentions to identified CKDu hotspots. A total of 102 rice soil samples were collected from main climatic zones viz. wet and dry zones including CKDu hotspots. In addition to pH, electrical conductivity and cation exchange capacity, acid extracted major and trace element contents in rice soils were determined by using ICP-MS. Significant differences were observed for Mn, Ni, Cu, Zn, and Pb contents between climatic zones. Arsenic and Pb contents in soils were lower than the levels reported in soils from other regions of the world, though significantly higher contents were observed in CKDu regions compared to non-endemic wet zone regions. Calculation of enrichment factor revealed that soils in both dry and wet zones were moderately enriched with As, Cd, and Pb, suggesting an influence of anthropogenic processes. Twenty percent of the wet zone samples showed significant enrichment of Ni, Cu, and Zn. Geo-accumulation index assorted that the studied soil samples were uncontaminated to moderately contaminated, implying that rice soils in both climatic zones are not alarmingly contaminated with toxic trace elements. However, regular and continuous monitoring of rice soil quality is extremely important.
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Affiliation(s)
- Shyamalie Balasooriya
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Saranga Diyabalanage
- Instrument Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sudharma K Yatigammana
- Department of Zoology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - O A Ileperuma
- Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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Jolly AM, Thomas J. Chronic kidney disease of unknown etiology in India: a comparative study with Mesoamerican and Sri Lankan nephropathy. Environ Sci Pollut Res Int 2022; 29:15303-15317. [PMID: 34984612 DOI: 10.1007/s11356-021-16548-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/11/2021] [Indexed: 06/14/2023]
Abstract
Chronic kidney disease of unknown etiology [CKDu] is a condition characterized by decline in kidney function and is not associated with diabetic nephropathy or hypertensive nephropathy. In this review, we have done a detailed literature analysis on CKDu in India, and then had a comparison with that of Mesoamerica and Sri Lanka. In India, CKDu became the second most common type of CKD after diabetic nephropathy. Silica was seen in the groundwater of both India and Sri Lanka, whereas in Mesoamerica silica exposure through particulate matter was seen among CKDu communities. DDE is a common agrochemical seen in both India and Sri Lanka. The risk factors vary from region to region and it is important to categorize CKDu population based on the risk factors to avoid misinterpretation of the condition as non-CKDu category and to evade further complications. More studies have to be conducted to reveal the detailed pathophysiological mechanisms and its relation with irrational exploitation of environmental resources.
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Affiliation(s)
- Aleeta Maria Jolly
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Jaya Thomas
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India.
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Nanayakkara N, Medagedara A, Hewavitharane P, Chandrajith R, K. Abeysundara H, Thatil RO, Thennakoon S, Mahanama B, Weerasuriya N, Thilakarathne A. Comparison of biochemical characteristics between an endemic and a nonendemic area for CKDu Sri Lanka. Environ Dis 2022. [DOI: 10.4103/ed.ed_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Arambegedara D, Jayasinghe S, Udagama P. Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review. Environ Sci Pollut Res Int 2022; 29:4893-4910. [PMID: 34799798 PMCID: PMC8604553 DOI: 10.1007/s11356-021-17316-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/27/2021] [Indexed: 05/08/2023]
Abstract
Increasing prevalence of endemic chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is a major health problem since the 1990s. Despite numerous studies on CKDu, research groups have been unable to develop a comprehensive approach to mitigate the disorder, and thereby to identify research gaps. We conducted a systematic literature review of 119 publications on CKDu in Sri Lanka from Pubmed, Google Scholar, and Scopus, published until end September 2020. A higher CKDu prevalence in the working population of the North Central Province was reported with recent studies indicating patients from non-endemic regions as well. A majority were etiological studies that recorded conflicting and inconclusive evidence on CKDu etiology. Studies on clinico-pathological, diagnostic, biochemical, and molecular biological aspects of CKDu, studies analyzing CKDu symptom burden, anthropological, and behavioral impacts of CKDu, were reviewed as well. A dearth of research exists on nutritional, demographical, immunological, and microbial aspects of CKDu. The overview of the reviewed literature indicated the absence of a comprehensive plan of action to mitigate this situation. Hence, we propose the "One Health" approach with a systems dynamics model as a potential way forward to alleviate the CKDu epidemic in Sri Lanka. This enables the representation of multiple causative agents (and interactions thereof) among environmental, animal, and human systems, in concert with the "exposome" that provides the totality of exposure the individual has undergone since birth.
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Affiliation(s)
- Dinushi Arambegedara
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka
| | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 8, Sri Lanka
| | - Preethi Udagama
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka.
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Krisher L, Butler-Dawson J, Schlosser K, Asensio C, Sinibaldi E, Yoder H, Dexter L, Dally M, Pilloni D, Cruz A, Jaramillo D, Newman LS. Body Composition, Anemia, and Kidney Function among Guatemalan Sugarcane Workers. Nutrients 2021; 13:3928. [PMID: 34836182 DOI: 10.3390/nu13113928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 01/01/2023] Open
Abstract
Rates of anemia among agricultural workers, who are also at risk for kidney injury and chronic kidney disease of unknown cause (CKDu), are unknown. We evaluated body composition through the sum of three skinfolds among 203 male sugarcane cutters and assessed the relationship of variables related to nutrition, anemia (hemoglobin < 13 g/dL), and elevated hemoglobin A1c (HbA1c ≥ 5.7%) with estimated glomerular filtration rate (eGFR) using linear regression. Eleven percent of workers were at the level of essential body fat (2-5%). Anemia was present among 13% of workers, 70% of which were normochromic normocytic, a type of anemia suggesting potential underlying chronic disease. Anemia was more common among those with lower BMI and fat free mass. The prevalence of elevated HbA1c was 21%. A moderate negative correlation was found between hemoglobin and HbA1c (Pearson's r = -0.32, p <0.01) which suggests that HbA1c values should be interpreted with caution in populations that have high rates of anemia. Twelve percent of workers had reduced kidney function with an eGFR < 90 mL/min/1.73 m2. On average, the eGFR was 18 mL/min per 1.73 m2 lower [(95% CI:-24, -12), p <0.01)] for those with anemia than those without, and 8 mL/min per 1.73 m2 lower among those with elevated HbA1c [(95% CI: -13, -2), p < 0.01]. Results will inform future studies examining the role of anemia in the evaluation of CKDu and interventions to improve nutrition for workers in low-resource settings.
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Gunasekara T, De Silva PMC, Herath C, Siribaddana S, Siribaddana N, Jayasumana C, Jayasinghe S, Cardenas-Gonzalez M, Jayasundara N. The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review. Int J Environ Res Public Health 2020; 17:E9522. [PMID: 33353238 PMCID: PMC7766480 DOI: 10.3390/ijerph17249522] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 12/25/2022]
Abstract
Chronic Kidney Disease (CKD) is a globally prevalent non-communicable disease with significant mortality and morbidity. It is typically associated with diabetes and hypertension; however, over the last two decades, an emergence of CKD of unknown etiology (CKDu) has claimed thousands of lives in several tropical agricultural communities. CKDu is associated with gradual loss of renal function without initial symptoms until reaching complete kidney failure and eventually death. The most impacted are young adult males of lower socio-economic strata. Since the disease progression can be successfully attenuated through early detection, the development of superior screening and management measures is of utmost importance. In contrast to the conventional biomarkers, novel biomarkers with improved sensitivity and specificity are being discussed as promising tools for early diagnosis of the disease. This review summarizes emerging novel biomarkers used in assessing CKD and discusses the current utility and diagnostic potential of such biomarkers for CKDu screening in clinical settings of different communities impacted by CKDu. Our goal is to provide a framework for practitioners in CKDu impacted regions to consider the use of these novel biomarkers through this synthesis. The increased use of these biomarkers will not only help to validate their diagnostic power further and establish potential prognostic value but may also provide critical insights into sites and mechanisms of renal damage.
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Affiliation(s)
- T.D.K.S.C. Gunasekara
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka;
| | - P. Mangala C.S. De Silva
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka;
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Chula Herath
- Department of Nephrology, Sri Jayawardenapura General Hospital, Sri Jayawardenepura Kotte 10100, Sri Lanka;
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Nipuna Siribaddana
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Sudheera Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Matara 81000, Sri Lanka;
| | - Maria Cardenas-Gonzalez
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Mexican Council of Science and Technology, Consejo Nacional de Ciencia y Tecnología, Mexico City 03940, Mexico
| | - Nishad Jayasundara
- The Nicholas School of the Environment, Duke University, Durham, NC 27708, USA;
- The School of Marine Sciences, University of Maine, Orono, ME 04469, USA
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Fernando BNTW, Sudeshika T, Hettiarachchi TW, Badurdeen Z, Abeysekara TDJ, Abeysundara HTK, Jayasinghe S, Ranasighe S, Nanayakkara N. Correction: Evaluation of biochemical profile of Chronic Kidney Disease of uncertain etiology in Sri Lanka. PLoS One 2020; 15:e0238279. [PMID: 32817721 PMCID: PMC7444529 DOI: 10.1371/journal.pone.0238279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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