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Kidney Week

Abstract: TH-PO420

Progression of Kidney Disease in Patients with CKD of Undetermined Etiology in Sri Lanka: Disease Natural History and Association with Water Source

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Hewavitharane, Pasan Malinda, General hospital (Teaching), Kandy, Sri Lanka., Anuradhapura, Sri Lanka
  • Anand, Shuchi, Stanford University, Stanford, California, United States
  • Chandrajith, Rohana, University of Peradeniya, Peradeniya, Sri Lanka
  • Nanayakkara, Nishantha, Teaching Hospital, Kandy, Kandy, Sri Lanka
  • Silva, Kalinga Tudor, University of Peradeniya, Peradeniya, Sri Lanka
  • Vlahos, Penny, University of Connecticut, Groton, Connecticut, United States

Chronic kidney disease of unknown etiology (CKDu) is occurring at high rates in Sri Lanka, without an identified cause or risk factors for progression. Prior GIS mapping and case-control studies have implicated shallow water well use as potentially causative, since water here could communicate with irrigated fields. We recruited a cohort of patients with CKDu from an endemic region in Sri Lanka to determine 1) natural history of disease, and 2) identify any modifiable risk factors for disease progression, with the hypothesis that persons experiencing faster progression may have ongoing or higher dose exposure to the putative causative agent(s).


We recruited 302 persons with CKDu, with the clinical criteria: CKD-EPI eGFR < 60 ml/min/1.73m2 on two tests at least 3 months apart, none to trace proteinuria on urine dipstick, and no self-reported diagnosis of diabetes. In addition to extensive baseline questionnaire and groundwater sampling, we undertook quarterly IDMS-calibrated serum creatinine testing. We used linear mixed models to test the association of three putative risk factors with eGFR decline over time, accounting for age and sex.


Over a median follow up 9.8 (25th-75th percentile 9.6, 10.7) months, 293 participants provided at least one serum test for eGFR assessment, with median eGFR slope -0.68 (25th-75th percentile -3.14 to 1.00) ml/min/1.73m2/year. 48 (16.4%) participants experienced eGFR decline > 5 ml/min/1.73m2/year. Participants who had never used water from a dug well had slower decline (eGFR slope 6 ml/min/1.73m2 higher (95%CI: 0.3-12.3 ml/min/1.73m2, p value: 0.04) (Figure 1).


Kidney function decline in surviving patients with CKDu in Sri Lanka is slow. No exposure to dug well water was associated with slower decline, and could be investigated as potential cause(s) or disease modifiers.


  • Other NIH Support