Sri Lanka: Stop Hoodwinking The Public Over Kidney Disease
By Amarasiri de Silva -February 10, 2014
Dr. Amarasiri de Silva
The disease picture in Sri Lanka is fast changing. An increase in sedentary occupations, less physical exercise and new dietary practices are seen as factors that have contributed to an increase in cardiovascular diseases, diabetes and obesity, especially in urban areas. Ecological changes and the use of agrochemicals have led to asthma, various cancers, and kidney disease in rural areas. These non-communicable diseases [i.e. cardiovascular, etc. as well as asthma, etc.] have become the major disease category in the country over recent decades. The latest addition to the list is Chronic Kidney Disease with an unknown causation [aetiology] or CKDu.
CKDu is something new, and it is spreading in many tropical countries. The production and development [pathogenesis] of this type of kidney disease is unknown and is not linked to traditional factors such as hypertension and diabetes. One explanation for the emergence and spread of CKDu is that it is due to global warming [that exacerbates dehydration, which is linked to kidney failures and stone disease]. In Sri Lanka, it has been suggested that the cause is ecological change brought about by the green revolution, which has seen the introduction of many new agricultural practices, such as the application of pesticides and chemical fertilizers, and new water management and irrigation systems. Some have even postulated that the chemical and biological warfare that occurred during the secessionist war fought by the LTTE against Government forces introduced deadly chemicals into the ecosystem of the northern region. Because of the difficulties involved in identifying of the cause of the disease, it has become known as CKDu, or CKD with unknown aetiology or ‘u’.
CKDu seems to have been first identified in the 1980s in a hospital in Anuradhapura. Records show that the first death of a patient identified as having the disease occurred in 1993. Since then, the disease has been reported in many parts of the northern regions of Sri Lanka, and has spread into the districts of Badulla and Hambantota. In 2010, there were 20,336 confirmed CKDu patients in Sri Lanka (MOH data 2010). The largest proportion of these patients was reported from Anuradhapura District (8,044 cases or 39.5%), while Badulla District (4,656 or 22.9%), Mulaitive and Vavuniya Districts (1,287 or 6.3%), Kurunegala District (1,251 or 6.1%) and Ampara District (977 or 4.8%) recorded the second, third, fourth, and fifth highest numbers of patients respectively. CKDu has become the most researched and highly debated disease category in contemporary Sri Lanka.
