Naduni Erandika BSc,1 Rajitha Abeysekera MD,2 Sulochana Wijetunge MD,3 Hemalika Abeysundara PhD,4
Abdul Wazil MD,1 Neelakanthi Ratnatunga PhD,3 and Nishantha Nanayakkara MD1
CHRONIC KIDNEY DISEASE PREVALENCE IN SRI LANKA.
Sri Lanka is an island nation of 21 million people with a high burden of chronic kidney disease (CKD) due to diabetes and hypertension.1 CKD of unknown etiology (CKDu), which has been reported since the early 1990s, is a particular challenge in affected areas of rural Sri Lanka. It contributes to a significant proportion of the CKD burden, with a high prevalence observed among the young male farming population in endemic areas. CKDu is proposed to be a multifactorial disease that can interact with bio logical, environmental, genetic, and nutritional factors and human behavior.2 Although CKD is uniformly distributed across all 9 provinces, CKDu is restricted to localized areas in 6 provinces of Sri Lanka (North Central, North West, Uva, Eastern, Central, and North Province; Figure 1).3 Sri Lanka has a well-established renal transplant pro gram that has been operational since the first successful kidney transplant (KT) in 1985, with 9 hospitals per forming transplant surgeries, including 2 main centers in Colombo and Kandy. The majority of donors are living. A retrospective study conducted in 2014 in Sri Lanka reported that allograft survival at 1, 3, and 5 y after KT was 97.8%, 94.4%, and 93.5%, respectively.4 According to another study, the 1-y patient survival rate is 89.7% for living donors and 86.7% for deceased donors.5 In 2021, there were 233 KTs performed in government sector institutions (Table 1).6
Based on Table 1, nearly 30.5% of the transplants (n = 71) are performed in CKDu-affected provinces. Most living donors are emotionally motivated close fam ily members or associates who reside in the same area. Therefore, as Sri Lanka has a high rate of CKDu, a significant proportion of potential donors are residents in endemic CKDu areas. Given the familial clustering of CKDu, there is a possibility that a kidney donor for a transplant recipient might have subclinical early CKDu. Indeed, CKDu is not detectable in the early stages of routine clinical examinations, such as serum creatinine and urine albumin, besides histological evidence.7 Therefore, even after a careful predonation evaluation, it is possible that subclinical CKD can pass undetected among some kidney donors.8 It is therefore important to establish studies that evaluate the effectiveness of current protocols at identifying subclinical CKD in the context of unknown risk exposure.
