Decreasing incidence of hospital diagnosed CKD/CKDu in North Central Province of Sri Lanka: is it related to provision of drinking water reverse osmosis plants?

BACKGROUND: We assessed the possible impact of provision of reverse osmosis (RO) water on the incidence of hospital diagnosed CKD/CKDu in North Central Province (NCP) of Sri Lanka. METHODS: An ecological study was conducted on data from 2010-2020 on the incidence of hospital diagnosed CKD/CKDu, CKD/CKDu screening and provision of drinking water RO plants in NCP. Analysis was conducted using descriptive statistics, ANOVA and chi-square test. RESULTS: The annual incidence of hospital diagnosed CKD/CKDu (per 100 000 population) in 2010-2013, 2014-2016 and 2017-2020 periods in Anuradhapura district were 129.07, 331.06 and 185.57 (p = 0.002) while in Polonnaruwa district these were 149.29, 326.12 and 296.73 (p = 0.04) respectively. In NCP provision of RO plants commenced after 2011 and the decline in the incidence of hospital diagnosed CKD/CKDu was seen in 25 of the 29 Divisional Secretary Divisions when more than 20% of the families received access to drinking RO water projects. CONCLUSIONS: The annual incidence of hospital diagnosed CKD/CKDu increased in NCP from 2010 to 2016 and continuously decreased thereafter. Continuous declining of CKD/CKDu incidence was seen after more than 20% of the families received access to drinking water RO plants.

The incidence, prevalence and trends of Chronic Kidney Disease and Chronic Kidney Disease of uncertain aetiology (CKDu) in the North Central Province of Sri Lanka: an analysis of 30,566 patients.

BACKGROUND: Chronic Kidney Disease (CKD) of uncertain origin (CKDu) has affected North Central Province (Anuradhapura and Polonnaruwa districts) of Sri Lanka. The cause is still unknown. The objective of this study was to describe the incidence, prevalence and trend of CKD/CKDu in North Central Province of Sri Lanka. METHODS: A cross sectional survey conducted in North Central Province with GPS mapping in CKDu highly affected areas. The diagnosis of CKD and staging were made according to the Kidney Disease: Improving Global Outcomes paper. Descriptive statistics used with chi-square test for evaluating dichotomous variables. Log rank test was used to compare survival rates. The population data was obtained from the 2011 Census. RESULTS: There were 30,566 CKD/CKDu patients in the North Central Province. Incidence of 0.10 in 2009, 0.39 in 2016 in Anuradhapura district, decreased slightly to 0.29 in 2017. Incidence of 0.09 in 2009, 0.46 in 2016 in Polonnaruwa district, decreased slightly to 0.41 in 2017. The point prevalence in high incidence areas ranged from 2.44-4.35. The 5 year survival rate was 71.2 (Anuradhapura 72.4 and Polonnaruwa 68.3, p = 0.0212). More than 70, 40 and 33% of patients were over 50, 60 and 70 years of age respectively. A male preponderance was seen in all the divisional areas (ranging from 1.3:1 to 2.6:1) and in all the age groups. Farmers were the most affected (70.6% Anuradhapura district and 65.1% Polonnaruwa district). Majority in CKD stage I (4943, 69.6%). There were 1685 deaths (17.5% of total CKD/CKDu patients, 67.6% of total deaths in CKD/CKDu patients) occurring within the first 3 years of diagnosis. GPS mapping shows that there is a clustering of households with CKD/CKDu. CONCLUSIONS: The incidence of CKD/CKDu increased up to 2016 with a slight decrease in 2017. The most vulnerable age group was 40 to 60 years. There is a male preponderance. Farmers at a higher risk. Majority were in CKD stage 1. More than two thirds of the deaths of CKD/CKDu patients occurred within three years of diagnosis with disparities in 5 year survival rate among the two districts. There is clustering of cases.