10% of Sri Lanka’s population afflicted with Chronic Kidney Disease - report

Around 10% of Sri Lanka’s population is afflicted with Chronic Kidney Disease, the Chief Patron of All-island Kidney Patients’ Association Nephrologist Sanjaya Heiyanthuduwa says.

Dr. Heiyanthuduwa expressed that the increase in diabetes among the population is the major cause of the increased figures of kidney patients.

“Especially, diabetes is the main factor affecting kidney damage in Sri Lanka. Better diabetes control should be done to prevent kidney disease in these patients,” he said.

“Additionally, adherence to medical advice and proper attendance at clinics are very important. The intake of excessive salt, sugar, and oil in food should be reduced. A healthy person should consume around three and a half liters of water per day in order to avoid this disease,” Dr. Heiyanthuduwa added.

According to statistics from the National Kidney Foundation in the United States, 10 percent of the world’s population is affected by chronic kidney disease and it is the 12th most common cause of death. Millions die annually due to a lack of access to affordable treatment.

Furthermore, according to an analysis by the Global Burden of Disease Study in 2019, chronic kidney disease (CKD) has increased by 40 percent over the past 30 years and is one of the fastest-rising major causes of death. Common precursors to CKD include diabetes and hypertension – diseases increasingly endemic to urbanising populations.

But across rural Sri Lanka, there’s a relatively new phenomenon; “chronic kidney disease of unknown aetiology (cause)” (CKDu). A flurry of scientific research studies has provided no concrete reason as to why as many as 22.9 percent of residents in several “hotspot” areas in the north-central districts of Polonnaruwa and Anuradhapura, plus some neighbouring districts, are suffering from acute kidney damage or failure, a recent report published on ‘Al Jazeera’ news mentioned.

On a national level, 10 to 15 percent of Sri Lankans are impacted by kidney diseases, according to Nishad Jayasundara, who is from a farming community in Sri Lanka and now works as an environmental toxicologist at Duke University in Durham, North Carolina, US, and specifically researches the causes of CKDu, it added.

“[The disease] disproportionately impacts farming communities,” Jayasundara tells Al Jazeera. “The current estimates indicate that more than 20,000 people [in Sri Lanka] are at end-stage kidney failure, with no alternatives left, while 6 to 10 percent of the population in impacted communities are diagnosed with CDKu.”

A lack of early symptoms

While CKD has identifiable symptoms, such as weight loss and poor appetite, swollen ankles or hands, shortness of breath and itchy skin, early on, CKDu is asymptomatic until the latter stages of the disease, so early detection is nearly impossible, say doctors. By the time a patient receives a diagnosis, the disease is usually untreatable.

Even when symptoms do appear, they usually include back pain, swelling in the arms and legs and “body aches”, not uncommon for farmers and fishermen used to hard manual labour.

Dr S B A M Mujahith is a nephrologist – a doctor who specialises in treating kidney diseases – at Batticaloa Teaching Hospital on Sri Lanka’s eastern coast. He grew up just 50km down the coast from Batticaloa in the town of Nintavur and this played an important role in his career choice: “It was a community investment,” he tells Al Jazeera.

CKDu was first identified as an issue in Sri Lanka in the 1990s. There’s a geographical link, says Mujahith – some parts of the eastern and north-central provinces seemed especially hard hit. Many, like himself, wanted to investigate further and identify the causes.

A World Health Organisation (WHO) team even came to investigate the causes of CKDu in the 2010s, but ultimately the study was inconclusive.

Mujahith likes to use the term “chronic interstitial nephritis in agricultural communities” (CINAC) since the disease is rather specific to the nation’s agricultural workers. It affects mainly men – most patients live and work in poor agricultural communities and may be exposed to toxic agrochemicals through work, inhalation, and ingesting contaminated water and food, explains Mujahith.

Sri Lanka, a small tropical nation with a population of about 22 million people, is undergoing the fifth year of the worst economic crisis in its history. The result has been limited access to medicine and food which hinders treatment and management of the disease, particularly in remote and under-served places such as Ambagaswewa, the report said.

--With agencies inputs