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Current status of CKD in Sri Lanka
Priyadarshana GDPK ( Senior Registrar/Nephrology, National Hospital Sri Lanka ), Mathu S ( Senior Registrar/Nephrology, National Hospital Sri Lanka ), Sheriff R ( Senior Medical Officer, Renal Unit, Western Infirmary), Abeysekara T ( Consultant Nephrologist / Teaching Hospital, Kandy ), Sheriff MHR ( Professor Of Medicine / Consultant Nephrologist/University of Colombo)

Sri Lanka is an island nation situated between latitudes 40-120 degrees north and longitudes 770-840 degrees and has a population of approximately 20 million. The communicable diseases of 1950s and 1960s such as malaria, filaria and tuberculosis are being fast replaced by non-communicable diseases like hypertension, diabetes, ischemic heart disease, cancers and renal disease in parallel with changing lifestyle, increasing urbanization and socioeconomic changes. Thus we see now a double burden of disease with an aging population.

No national chronic kidney disease database is available in Sri Lanka. The ongoing ethnic conflict has had a major impact on medical establishment and research; and contributed to slowdown in the growth of nephrology. Acute renal failure has been better documented and is largely due to snake bite, leptospirosis, drugs and obstetric causes.

In the initial descriptions in the 1970s (by MHRS) the cause of chronic kidney diseases was unknown in 40% cases, but was often presumed to be chronic glomerulonephritis. Other causes were chronic pyelonephritis, calculus disease and congenital kidney disease. Diabetes and hypertension accounted for less than 10%.
Currently, the major causes of chronic kidney disease in end stage renal failure programs in the country are type II diabetes mellitus, hypertension, chronic glomerulonephritis, chronic interstitial nephritis of unknown etiology, pyelonephritis, calculus disease and congenital kidney diseases (polycystic kidney disease & Alport syndrome) in that order. The percentage of unknown causes is less than half of what it was in the 70s, as renal biopsy and imaging procedures now permit precise diagnosis.
Interest in chronic kidney disease in Sri Lanka has been stimulated by the finding of a high prevalence of (biopsy proven) chronic interstitial kidney disease in the north-central and north-western provinces. The major contribution to this work has come from Kandy, especially by TA. The high prevalence amongst farmers has led to special clinics being set up for chronic kidney disease. Micro-epidemiological studies and studies looking for etiology are in progress.

These patients typically present with non-specific symptoms, moderate anemia and mild hypertension. The renal biopsy showed tubulo-interstitial disease in 84% of cases. The disease onset is in adolescence, and the proportion of cases developing chronic renal failure increases with increasing age indicating the progressive nature of the disease.

Speculation as to the etiology remains largely unknown but high water fluoride levels, exposure to agro-chemicals, possible exposure to contaminated aluminum and excessive alcohol consumption could all be playing important roles.

Although the prevalence of microalbuminuria in community studies was high in North Central Province, the 24-hour of urinary protein was usually less than 1g in almost all cases.

To conclude, the picture of CKD picture in Sri Lanka is similar to that described in the west except in these 2 provinces. This regional chronic tubulointerstitial disease of unknown etiology has recently received significant political and health authority attention. Diabetes and hypertension are the major causes of renal failure in urban areas and dialysis clinics both in public and private sectors.