Chronic kidney disease of uncertain aetiology: prevalence and causative factors in a developing country

摘要

Background This study describes chronic kidney disease of uncertain aetiology (CKDu), which cannot be attributed to diabetes, hypertension or other known aetiologies, that has emerged in the North Central region of Sri Lanka. Methods A cross-sectional study was conducted, to determine the prevalence of and risk factors for CKDu. Arsenic, cadmium, lead, selenium, pesticides and other elements were analysed in biological samples from individuals with CKDu and compared with age- and sex-matched controls in the endemic and non-endemic areas. Food, water, soil and agrochemicals from both areas were analysed for heavy metals. Results The age-standardised prevalence of CKDu was 12.9% (95% confidence interval [CI]?=?11.5% to 14.4%) in males and 16.9% (95% CI?=?15.5% to 18.3%) in females. Severe stages of CKDu were more frequent in males (stage 3: males versus females?=?23.2% versus 7.4%; stage 4: males versus females?=?22.0% versus 7.3%; P?39?years and those who farmed (chena cultivation) (OR [odds ratio]?=?1.926, 95% CI?=?1.561 to 2.376 and OR?=?1.195, 95% CI?=?1.007 to 1.418 respectively, P?P?P?P?P??0.05). Urine cadmium and arsenic concentrations in individuals with CKDu were at levels known to cause kidney damage. Food items from the endemic area contained cadmium and lead above reference levels. Serum selenium was Conclusions These results indicate chronic exposure of people in the endemic area to low levels of cadmium through the food chain and also to pesticides. Significantly higher urinary excretion of cadmium in individuals with CKDu, and the dose–effect relationship between urine cadmium concentration and CKDu stages suggest that cadmium exposure is a risk factor for the pathogensis of CKDu. Deficiency of selenium and genetic susceptibility seen in individuals with CKDu suggest that they may be predisposing factors for the development of CKDu.