|
1
|
Pett J, Mohamed F, Knight J, Linhart C, Osborne NJ, Taylor R. Two decades of chronic kidney disease of unknown aetiology (CKDu) research: Existing evidence and persistent gaps from epidemiological studies in Sri Lanka. Nephrology (Carlton) 2021; 27:238-247. [PMID: 34704321 PMCID: PMC9298898 DOI: 10.1111/nep.13989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/10/2021] [Revised: 09/29/2021] [Accepted: 10/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic Kidney Disease of unknown origin (CKDu) excludes known primary renal conditions or systemic disease (such as diabetes mellitus or hypertension). Prominence of CKDu has been noted for some decades in Sri Lanka, especially among men in particular rural areas, prompting many studies directed towards environmental causation. This article critically reviews relevant primary studies. METHODS Articles for this literature review (n = 86) were found by searching Medline, Embase, Global Health and ProQuest databases over 2000-2020 utilizing a standard algorithm. Articles were critiqued according to criteria for diagnosis of CKDu, aetiological agents investigated, analytic methods employed and findings. RESULTS Criteria for diagnosis of CKDu varied significantly, including pre-selection by proteinuria, eGFR and biopsy proven interstitial nephritis. Prevalence studies have been largely conducted in the North Central Province, with recent studies demonstrating the presence of CKDu in other regions. Aetiological factors investigated in primary studies included water source, use of agrochemicals, agricultural work, heavy metals, snake bites, ayurvedic medication, heat stress, infectious diseases and usage of tobacco and betel leaf. There is no conclusive evidence for any one aetiological agent despite consistent evidence of distal factors such as male sex, rural residence and farming. CONCLUSIONS The current body of evidence for any aetiological agent as the cause of CKDu in Sri Lanka is limited. Further research with stronger study designs is necessary to increase knowledge of aetiology of CKDu in Sri Lanka to identify and eliminate exposure to possible causative agent(s) prior to concluding that the disease is multifactorial.
Collapse
Affiliation(s)
- Jennifer Pett
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine University of Peradeniya, Kandy, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health, University of Peradeniya, Peradeniya, Sri Lanka.,Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Biomedical Informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, The University of Sydney, Sydney, NSW, Australia
| | - John Knight
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Christine Linhart
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas J Osborne
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Richard Taylor
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|