Emerging Chronic Kidney Disease of uncertain aetiology (CKDu) among rural farming communities in Southern and Uva Provinces of Sri Lanka

TPS 723: Low and middle income countries: sanitation infections and other health effects, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Chronic Kidney Disease of uncertain aetiology (CKDu) is an endemic disease occurring in clustered farming communities in Sri Lanka. The current study used an environmental and clinical approach to find the causative factors responsible for CKDu development and discover potential biomarkers for early detection of CKDu in emerging provinces. Dissolved Oxygen, Salinity, Temperature, Conductivity, Total Dissolved Solids (TDS), pH, fluoride, nitrates, Orthophosphates and total hardness, heavy metals analysis and herbicide (i.e. glyphosate) residue analysis were performed. Diagnosis of CKDu using WHO guidelines and early detection of kidney injury using novel urine biomarkers KIM-1 and NGAL were also performed following standard methods. Water hardness was high in all study locations except controls. In most wells, fluoride levels were within limits however, certain wells were exceeded WHO drinking water standards for fluorides. Cadmium levels were within the national and WHO standards in all locations but detectable levels of cadmium were reported in CKDu emerging locations. Measureable levels of Glyphosate were detected in water samples. Albumin to Creatinine Ratio (ACR) and eGFR revealed three cases from Angunakolapelessa were at stage-3 kidney disease. Six cases from Matara, 52 cases from Angunakolapelessa and 77 cases from Bandagiriya were at stage-2 kidney disease. Whereas, 32 cases from Matara, 56 cases from Angunakolapelessa and 65 cases from Bandagiriya were at stage-1 kidney disease. Tubular damage predicted by urinary KIM-1 and NGAL were significantly correlated with high urinary ACR levels. Strikingly, early tubular damage as seen by higher urinary KIM-1 and NGAL was also observed in healthy farmers despite normal ACR levels (< 30 mg/g). Urinary tubular markers reconfirm tubulointerstitial disease with repeated tubular injury in farming communities. It is recommended that clean and safe water should be supplied to CKDu emerging provinces and relevant diagnosing methods should be implemented immediately for disease diagnosis and patient management.