Kidney Week

Abstract: TH-PO1029

Zooming In on the Outliers: A Case-Control Study Characterizing Drinking Water and Agricultural Practices Among Women in Kidney Disease Endemic and Nonendemic Regions in Sri Lanka

Session Information

• Women's Health and Kidney Diseases
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Women's Health and Kidney Diseases

• 2200 Women's Health and Kidney Diseases

Authors

• Contreras Nieves, Marimar, Stanford University School of Medicine, Stanford, California, United States

Marimar Contreras Nieves, MD, MS

• Hewapathiranage, Santhushya, National Hospital Kandy, Kandy, CP, Sri Lanka

Santhushya Hewapathiranage, MSc

• Zabel, Fiona Quin, University of Connecticut, Storrs, Connecticut, United States

Fiona Quin Zabel

• Yu, Xue, Stanford University School of Medicine, Stanford, California, United States

Xue Yu, MS

• Baron, Kyla Danielle, Howard University, Washington, District of Columbia, United States

Kyla Danielle Baron, MPH

• Vlahos, Penny, University of Connecticut, Storrs, Connecticut, United States

Penny Vlahos, PhD

• Montez-Rath, Maria E., Stanford University School of Medicine, Stanford, California, United States

Maria E. Montez-Rath, PhD

• Anand, Shuchi, Stanford University School of Medicine, Stanford, California, United States

Shuchi Anand, MD, MS

• Nanayakkara, Nishantha, National Hospital Kandy, Kandy, CP, Sri Lanka

Nishantha Nanayakkara, MD, DrMed, MBBS

Background

Chronic kidney disease of unknown etiology (CKDu) disproportionately affects men, though exposures appear similar across affected and unaffected. With the hypothesis that studying women—considered outliers in CKDu—may help to parse exposures, we conducted a case-control study among women.

Methods

We identified cases from prospective studies in Wilgamuwa, a CKDu endemic area, and two control groups from Wilgamuwa and Hasalaka, a non-endemic area. Cases had eGFR 20–59 mL/min/1.73 m² with ≥30% decline or progression to <15 mL/min/1.73 m², and were age-matched (±10 years) to controls with normal eGFR.

Results

Among 30 women with declining eGFR, mean age was 53 (SD 8) years, and mean eGFR 37 (SD 30) mL/min/1.73 m². 46% of cases, 40% of endemic but none of non-endemic area controls reported family history of kidney disease. Cases more often reported heat exhaustion (OR=19.3; p=0.017) than non-endemic area, and handling pesticides (OR=12.6; p=0.011) than endemic area controls. Natural fertilizer use in the home garden was less common among cases than in controls (OR=0.05; p=0.008). Cases’ well samples had higher fluoride, nitrate, sulfate, calcium, and vanadium than controls (Fig. 1). Pesticide levels >1 ppb, particularly diazinon, were more frequent in case wells.

Conclusion

Our study focused on women affected by CKD continuing to experience kidney function decline confirmed prior data from men indicating self-reported heat exposure was an important correlate, but also provided evidence for differences in home garden exposures, pesticide handling, and drinking water inorganic and organic chemicals.

Figure 1. Comparison of inorganic chemical concentrations in drinking water between cases and controls

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025j31m5hfw