Mini Symposium on Outlook on Chronic Kidney Disease of unknown etiology (CKDu) was held on 15th of August 2016 at National Institute of Fundamental Studies (NIFS), Kandy. It was conducted together with Sri Lankan CKDu research experts to give an overview of the ground status of CKDu research to the outside expert group visited Sri Lanka.
හදුනා නොගත් වකුගඩු රෝගය පිළිබද කුඩා පර්යේෂණ සැසියක් මහනුවර ජාතික මූලික අධ්යයන ආයතනයේදී අගෝස්තු 15 දින පැවැත්වුනි. හදුනා නොගත් වකුගඩු රෝගය පිළිබද පර්යේෂණ සිදු කරන ශ්රී ලාංකීය විද්යාඥයින් සමග එකතුව සංවිධානය කරන ලද මෙහි අරමුණ වූයේ හදුනා නොගත් වකුගඩු රෝගය පිළිබද සිදු කරන දේශිය පර්යේෂණ පිළිබද විදේශීය විද්යාඥයින් දැනුවත් කිරීමයි.
Mini Symposium on Outlook on Chronic Kidney Disease of unknown etiology (CKDu) was held on 15th of August 2016 at National Institute of Fundamental Studies (NIFS), Kandy. It was conducted together with Sri Lankan CKDu research experts to give an overview of the ground status of CKDu research to the outside expert group visited Sri Lanka. The outside expert group was consists of 9 U.S scientists, one Belgium scientist, one Cuban scientist and one from El-Salvador. The primary aim was to exchange information and framework development to study the relationship of epidemiological, hydrological, and social factors contributing to chronic kidney disease (CKDu) in Sri Lanka. This Mini Symposium was organized by Dr. Meththika Vithanage, Dr. D.N. Magana-Arachchi and the Science Education and Dissemination Unit of the National Institute of Fundamental Studies with the support of the US National Science Foundation (Hydrological Sciences) & National Institute of Environmental Health Sciences. Prof. Tissa Illangasekare, Colorado School of Mines, USA and Prof. Sarath Gunatilake, California State University, USA were leading the outside expert group.
CKDu is believed to be an environmentally induced problem, due to its remarkable geographic distribution and based on histopathological evidences. It has been noted that many hypotheses have been proposed as causative factor for CKDu. Higher fluoride levels and high dissolved solids are common in well water in the endemic region. Dr. Tilak Abeysekera, Centre for Education, Research & Training on Kidney Diseases (CERTKid), University of Peradeniya gave an insightful presentation on the story of CKDu so far indicating the statistics regarding the spreading of this epidemic disease in Northern Central province in Sri Lanka. According to his research data, CKDu is male dominating and is 2.34 times than in women. About 93% of patients with CKDu consume water from shallow dug wells which indicates the importance of looking at soil-water interaction. He has identified Hypertension as an important risk factor for CKDu progression. Stop smoking and alcohol, provision of good quality water, dietary management, and management of anemia, hypertension, bone mineral disease etc. and void use of nephrotoxic agents would be helpful in prevention of CKDu.
Dr. Nishantha Nanayakkara mentioned that CKDu Sri Lanka is result of atoxic insult or recurrent episodic insults, rather than chronic ongoing exposure. Further, he indicated the importance of finding a good biomarker to identify CKDu. Dr. Dhammika Magana-Arachchi listed eleven factors that could be related to the CKDu. Among them, well water source for drinking was notable. Her research team has identified the presence of cyanotoxins in most of the water sources in Girandurukotte, Anuradhapura and Kurunegala Districts. Additionally they have identified the presence of cyanotoxin (cylindrospermopsin and nodularin) producing cyanobacteria in CKDu patients’ well water samples. Currently her group is researching on Gene expression profiling/Whole transcriptome analysis using microarrays to discover biomarkers which will be useful in diagnosing CKDu.
Prof. Rohana Chandrajith, Head/Dept. of Geology, University of Peradeniya delivered a perceptive presentation on the chemistry of water in the CKDu endemic areas. His data clearly showed that the water in CKDu areas is very low (less than the world acceptable guideline values)for heavy metals/metalloids (such as As, Cd etc) however, the fluoride and dissolved salts are considerably high. Furthermore, he indicated that it is a must to use standard protocols and practice Quality Assurance and Quality Control (QA/QC) throughout sampling, pre-treatment, analysis etc.
Dr. Herath Manthrithilake from the International Water Management Institute (IWMI) stated that although the agrochemical usage is considered as one of the main reasons, the data showed that agrochemical application in the endemic region is less than in Kalpitiya (1350 kg/ season/ac & Jaffna – about 2000 kg/season/ac and Hill country – major user of agrochemicals and ‘Glyphosate’). However the people Kalpitiya and Jaffna areas do not suffer from CKDu indicates the involvement of some other factors for its presence. He demonstrated strong data on the hydrological and groundwater dynamic involvement of high dissolved solids in drinking water for CKDu using examples from two villages (only 1 km apart). One village is free of CKDu, the public drinks water from the river Mahaweli and high prevalence of CKDu was observed in the village where the general public use shallow dug wells which recharges from nearby ridges. Dr. Manthrithilake indicated lack of replenishing and the static water conditions in the wells cause stratification of dissolved salt concentration may induce CKDu.
Mr. Viraj Edirisinghe, Isotope Hydrology Section, Sri Lanka Atomic Energy Board exhibited the identified distinct isotope signature in water at CKDu endemic and non-endemic regions. Furthermore he confirmed high electrolyte content but low nitrate concentrations in wells where CKDu is present. His data indicated that the depth to water table is relatively high in the wells in CKDu endemic regions.
Finally the Mini Symposium on Outlook on Chronic Kidney Disease of unknown etiology (CKDu) held at NIFS, Kandy raised the important of developing a framework that integrates the understanding of different factors that contribute and aggravate conditions to CKDu risk including the influence of limited access to portable water, poor nutrition and economic status, low immunity, genetic susceptibility and hesitation for medical screening. The mini symposium was valuable in providing a clear view for ground status and insight to CKDu not only for the outside expert group as well as to the local science community. About 50 scientists participated the event and the co-organizers appreciate the support given by Prof. S.H.P.P Karunaratne, the Director, NIFS for his guidance and support given.