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Abstract: TH-PO1061

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

Session Information

Category: CKD (Non-Dialysis)

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


  • Cardenas-Gonzalez, Mariana, Brigham and Women's Hospital , Boston, Massachusetts, United States
  • De silva, P. mangala C.s, Harvard Medical School, Malden, United States
  • Ekanayake, Dilini Vimarshani, University of Ruhuna, Sri Lanka, Matara, Sri Lanka
  • Wanniarachchi, Gayani Thakshila, University of Ruhuna, Sri Lanka, Matara, Sri Lanka
  • Srayoshi, Nandita, Harvard Institute of Medicine, Boston, Massachusetts, United States
  • Jayasinghe, Sudheera, University of Ruhuna, Galle, Sri Lanka
  • Chandana, Ediriweera patabandi Saman, University of Ruhuna, Matara, Sri Lanka
  • Jayasumana, Channa, Faculty of Medicine, Anuradhapura, Sri Lanka
  • Siribaddana, Sisira, Faculty of Medicine, Rajarata University of Sri Lanka, Nugegoda, Sri Lanka
  • Sabbisetti, Venkata, Brigham and Women's Hospital , Boston, Massachusetts, United States
  • Bonventre, Joseph V., Brigham and Women's Hospital, Boston, Massachusetts, United States

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.


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).


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).


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.