Chronic Kidney Disease - The Reality
January 20, 2017, 8:13 pm
Since about the year 2000, chronic kidney disease of unknown etiology (CKDu) also called Chronic Renal Failure has been reported to occur in North Central Province (NCP). Now it is reported in 11 districts There are some families in which both parents have died of CKDu and the children are helpless. The families of the CKDu patients have become destitute as it is mostly the bread winners of the families who are affected. Hence, taking immediate action to control CKDu is of paramount importance. It is because of the gravity of the problem that President Maithripala Sirisena in 2014 appointed a task force to take necessary action to take preventive and welfare measures to the benefit of the affected community.
CKDU is considered to be of multi-factorial origin. A review by the International Water Management Institute (IWMI) (ref. IWMI Working Paper 158) indicates that no specific substance/compound has been proved to cause CKDu. Research studies carried out to-date suggest that consumption of contaminated water is the main cause of this disease. Therefore, it is important to provide pure water to all CKDu affected and surrounding villages.
Hence, the Task Force (TF) appointed by the President need to have an affective programme to supply good quality water to those in the CKDu affected areas. To achieve this objective it is necessary to know the number of the affected people in the different DS divisions. According to the website of the Presidential Task Force, in 2015, there were approximately 70,000 CKDu patients. At a meeting held recently the President of Sri Lanka has said that there are 400,000 CKDu affected patients in the country.. No one for certain knows at least the approximate number of CKDu patients in the country and its distribution..However, one of the recommendations of the International Expert Consultation on Chronic Kidney Disease of Unknown Etiology held in Colombo, in April 2016, was to establish community-based disease surveillance to understand the burden, geographical distribution and time trends of CKDu in Sri Lanka. It is the responsibility of Presidential Task Force (PTF) to initiate this study.
During the last few years, some professionals have proposed numerous activities to prevent/control CKDu. For example there was a proposal to remove the topsoil in NCP. Someone suggested to stop the farmers from cultivating in those regions, at least till there is some remedy. There was also a proposal to move these people to other areas, at least till the problem is sorted. How impractical and unrealistic these proposals are? Some agrochemicals including Glyphosate (G) have been banned, although there is no clear evidence that G causes CKDu. Banning of this herbicide it is claimed has caused the plantation sector a loss of around Rs 5 billion last year.
Prevention of CKDu is important. Hence, various strategies have been implemented to prevent occurrence of CKDu. These strategies are mainly aimed at providing good quality water. When some promoted Reverse Osmosis (RO) plants to provide good quality water, some others were saying that it is expensive and the water from RO plants lack nutrients. Rainwater harvesting was suggested and some were of the opinion that rainwater like RO water lack nutrients and expensive. With the present drought in all these 11 districts, CKDu will affect more people, While all these arguments/discussions are going on thousands of people in 11 districts are seriously affected.. Those concerned, specially the PTF need to see that appropriate actions are taken as early as possible to assist the long suffering patients. Finding solutions to the CKDu problem based on available knowledge, must receive the highest priority by the Presidential Task Force. The International Expert Consultation on CKDu held in Colombo, in April 2016 made 17 recommendations but no action appear to have been taken by the Presidential Task Force to implement these recommendations.
Dr C.S. Weeraratna
csweera@sltnet.lk
