Kidney Week

Abstract: TH-PO1061

KIM-1 as an Early Biomarker of Kidney Injury in Agricultural Communities in Sri Lanka

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Cardenas-Gonzalez, Mariana, Brigham and Women's Hospital , Boston, Massachusetts, United States

Mariana Cardenas-Gonzalez,

• De silva, P. mangala C.s, Harvard Medical School, Malden, United States

P. mangala C.s De silva,

• Ekanayake, Dilini Vimarshani, University of Ruhuna, Sri Lanka, Matara, Sri Lanka

Dilini Vimarshani Ekanayake,

• Wanniarachchi, Gayani Thakshila, University of Ruhuna, Sri Lanka, Matara, Sri Lanka

Gayani Thakshila Wanniarachchi,

• Srayoshi, Nandita, Harvard Institute of Medicine, Boston, Massachusetts, United States

Nandita Srayoshi,

• Jayasinghe, Sudheera, University of Ruhuna, Galle, Sri Lanka

Sudheera Jayasinghe,

• Chandana, Ediriweera patabandi Saman, University of Ruhuna, Matara, Sri Lanka

Ediriweera patabandi Saman Chandana,

• Jayasumana, Channa, Faculty of Medicine, Anuradhapura, Sri Lanka

Channa Jayasumana,

• Siribaddana, Sisira, Faculty of Medicine, Rajarata University of Sri Lanka, Nugegoda, Sri Lanka

Sisira Siribaddana,

• Sabbisetti, Venkata, Brigham and Women's Hospital , Boston, Massachusetts, United States

Venkata Sabbisetti,

• Bonventre, Joseph V., Brigham and Women's Hospital, Boston, Massachusetts, United States

Joseph V. Bonventre,

Background

Chronic kidney disease of unknown etiology (CKDu) is common among agricultural communities in Sri Lanka (SL), with prevalence between 10–15%. No definitive causes for CKDu has been identified. Early detection through community screening is essential for estimating true prevalence and guiding preventive management.

Methods

Inhabitants of selected villages in SL who worked in rice, sugarcane or vegetables farming, and a village of fishermen were recruited (647, male 61%, mean age 44.7 y). Estimated GFR, urine albumin, and KIM-1, were measured. Logistic regression analysis was used to determine the odds ratios for underlying kidney proximal tubule (PT) injury (urinary KIM>250 pg/mg creat).

Results

Kidney disease, defined by GFR<60 ml/min and/or albuminuria >300 mg/mg, was present in 9% of the population. KIM-1 negatively correlated with eGFR, positively correlated with urine albumin (r~0.2; p<0.01, for both). KIM-1 levels were elevated in 27% of the population who had no defined kidney disease, indicating that these subjects have underlying PT injury and may be more prone to developing CKD.
KIM-1 levels were higher in farmers than in fishermen (151±75 vs 36±21 pg/mg; p=0.01). Among farmers, vegetable farmers had the highest levels (310±54 pg/mg; p<0.01). Wasgamuwa, an endemic CKDu rice farmer community, had the highest percentage of kidney disease (24%) and higher levels of KIM-1 when compared to Agunukolapallassa, a non-endemic CKDu rice farmer community (454±93 vs 50±20 pg/mg; p<0.01). Importantly, 62% of Wasgamuwa farmers had KIM-1 levels >250 pg/mg, indicating that a significant fraction of this population may have subclinical kidney injury.
Farmers have ~5 times higher risk of having underlying PT injury than fishermen, independent of age, sex, diabetes and hypertension (OR 4.8, 95%CI: 2.6 to 8.9; p<0.01). Among farmers, vegetable farmers were twice at risk of having underlying PT injury than sugarcane farmers, after adjusting for age, sex, diabetes, hypertension and farming duration (OR 2, 95%CI, 1.2 to 3.9; p=0.04).

Conclusion

KIM-1 is a potential biomarker for screening populations at risk for underlying kidney injury in endemic and non-endemic areas of CKDu in SL.