Hantavirus infection as a risk factor for chronic kidney disease of unknown aetiology (CKDu) and its prevalence in endemic areas of Sri Lanka since 2010 according to a retrospective serological analysis

Hantavirus infection as a risk factor for chronic kidney disease of unknown aetiology (CKDu) and its prevalence in endemic areas of Sri Lanka since 2010 according to a retrospective serological analysis

Chandika D. Gamage1​, Shanika Nanayakkara2​,3​, Yomani D. Sarathkumara1​,4​, Devinda S. Muthusinghe5​,6​, Kenta Shimizu7​, Jiro Arikawa7​, Sithumini M. W. Lokupathirage5​,6​, Nishantha Nanayakkara8​, Lishanthe Gunarathne9​, Rohana Chandrajith10​, Kouji H. Harada3​, Akio Koizumi3​,11​, Kumiko Yoshimatsu5​,6

 

Abstract

Background : Chronic kidney disease of unknown aetiology (CKDu) is a major public health problem in Sri Lanka, especially among agrarian communities. Although the cause of CKDu is still unknown, hantavirus infection has been proposed as a risk factor.

Methods : This study was performed using serological samples collected from two CKDu-endemic areas, Anuradhapura (2010) and Badulla districts (2010 and 2016), and a non-endemic area, Matale (2016) district. The presence of anti-Thailand orthohan- tavirus IgG antibodies was investigated in serum samples. Hantavirus seroprevalence and demographic data were epidemio- logically analysed.

Results : Seroprevalence was higher in CKDu patients (40.6–60.0%) and healthy individuals in CKDu-endemic areas (17.6– 25.5%) than in healthy individuals in non-endemic areas (3.0%). Statistically significant odds ratios (ORs) for hantavirus infec- tion in CKDu patients were detected in CKDu-endemic areas [ORs: 3.2 and 3.1; 95%confidence interval (CI): 1.8–5.5 and 1.8–5.2 in Anuradhapura and Badulla districts in 2010; and OR: 4.4, 95%CI: 2.3–8.5 in 2016 in Badulla district). Furthermore, the OR for hantavirus infection in Badulla district has increased in the last decade from 3.1 (95% CI: 1.8–5.3) to 4.4 (95% CI: 2.3–8.5).

Conclusion : Hantavirus infection has been prevalent in two distant CKDu-endemic areas since 2010. The observed significant association of hantavirus seropositivity with CKDu indicates a possible role of hantavirus infection in CKDu pathogenesis.

Keyword(s) : chronic kidney disease of unknown aetiology (CKDu) , hantavirus , retrospective serological analysis and Sri Lanka

 

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