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Abstract: TH-PO863

Lifestyle, Work, Clinical Parameters, and Kidney Function Decline in a Prospective Cohort With CKD of Uncertain Etiology in Sri Lanka

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Lee, Edison, Stanford University, Stanford, California, United States
  • Hewavitharane, Pasan Malinda, Kandy Teaching Hospital, Kandy, Sri Lanka
  • Liu, Sai, Stanford University, Stanford, California, United States
  • Harold, Kaitlin E., Stanford University, Stanford, California, United States
  • Hewapathiranage, Santhushya, University of Peradeniya, Peradeniya, Central, Sri Lanka
  • Anand, Shuchi, Stanford University, Stanford, California, United States
  • Montez-Rath, Maria E., Stanford University, Stanford, California, United States
  • Schensul, Stephen L., University of Connecticut School of Medicine, Farmington, Connecticut, United States
  • Vlahos, Penny, University of Connecticut College of Liberal Arts and Sciences, Storrs, Connecticut, United States
  • Nanayakkara, Nishantha, Kandy Teaching Hospital, Kandy, Sri Lanka
Background

Chronic kidney disease of unknown origin is a leading cause of death for adults living in the dry region of Sri Lanka and in other hotspots throughout the world.

Methods

In 2018, we initiated the Kidney Progression Project to prospectively follow 292 persons with CKDu and with CKD-EPI eGFR 20-60ml/min. Using data from 3 years of follow-up, we assessed the rate of kidney function decline by sex, and the association of rapid kidney function decline (>3ml/min annual decline) with baseline lifestyle, residence and clinical parameters.

Results

Median eGFR at enrollment was 28ml/min/1.73m2 among 71 women and 30ml/min/1.73m2 among 221 men; 91-99% had trace or no proteinuria during follow up. Among women, median serum Na was 143meq/L, uric acid was 6.3mg/dL, and K was 4.5meq/L. Among men, median serum Na was 143, uric acid was 6.9, and K was 4.3. Overall slope of decline was -0.5 [SD 4.9] ml/min/year; 30% of women and 17% of men experienced >3ml/min annual decline. Figure 1 depicts Kaplan-Meier curves for the composite outcome of 30% reduction in eGFR, eGFR<15% and death, stratified by sex. Self-reported hypertension was associated with rapid kidney function decline among men (OR 4.03 (1.81-8.95)); no other variables, e.g., family CKD history, tobacco use, farm work hours, agrochemical application, or serum sodium, were consistently associated with rapid kidney function decline.

Conclusion

Overall rate of kidney function decline was slow in this CKDu cohort, similar to other non albuminuric CKD (e.g., in CRIC cohort). Men and women had similar event rates, highlighting the need to re-examine the current understanding of CKDu as disproportionately affecting men. Many exposures were ubiquitous, and thus we could not identify distinct correlates of rapid kidney function loss, implying the need for control populations.

Kaplan-Meier curve showing the probability of (A) the composite outcome of death, eGFR < 15, or eGFR reduction greater than 30%, (B). eGFR reduction by greater than 30%

Funding

  • NIDDK Support