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CKd info & statistics

  • Chronic Kidney Disease (CKD) is now a major health issue in Sri Lanka.

  • Over 150,000 people in Sri Lanka are currently affected by CKD.

  • 3% of Sri Lankans with CKD die each year - thousands.

  • Sri Lanka's CKD prevalence is estimated to be between 8% and 21% of the population. 

CKD rates by district

The display below shows the percentage of households in each district that had at least one family member recently diagnosed with CKD. The survey was taken from 2009 to 2018. The highlighted districts have the 10 highest rates of CKD in Sri Lanka.

Project Lanka operates in the Kurunegala district, which has a 10.1% CKD prevalence rate, and we hope to expand the scope of our work to more of Sri Lanka's 25 districts in the near future.

CKD Cause

The official terminology for Chronic Kidney Disease in Sri Lanka is CKDu, with the "u" denoting that CKD has an unknown etiology - it lacks a definite cause, even though it leads to the kidney failure problem that other countries' CKD leads to. 

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However, researchers speculate that CKDu likely stems from long-term ingestion of metals, such as cadmium [Cd], arsenic [As], and aluminum [Al]. These metals accumulate in a person's kidneys and cause renal damage from long-term exposure, affecting tubular epithelial cells in particular.

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This conclusion is based on several studies that have shown correlations between elevated and abnormal concentrations of nephrotoxic elements (mostly Cd and As) in patients' urinary tracts and CKD.

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To further corroborate this claim, geographical mapping of CKD cases within each district shows that CKD is heavily concentrated around communities in close proximity to agricultural irrigation systems.

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The run-off from these agricultural efforts contains increased levels of heavy metals and minerals. For example, cadmium [Cd], one of the metals linked with CKD, has been used in both fertilizers and weedicides, along with fluoride [F-], sodium [Na], and calcium [Ca].

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Then, this run-off with agrochemicals seeps into local wells, causing villages that obtain drinking water from them to ingest the heavy metals and minerals - which leads to CKD formation. 

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This is the exact problem that students in the Kurunegala district face, as the schools wells are contaminated with pollutants from local agricultural projects.

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The above water report, which is from the Wepathanga Primary School, displays high dissolved solids and water hardness. The dissolved solid statistic reflects the presence of heavy metals in the water, while the total hardness measures the amount of fluoride. In addition, Wepathanga's students described the well water as salty, indicating elevated sodium levels. 

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As such, it can be concluded that Wepathanga's students, along with those studying at the four other schools in our most recent project, are at high risk to develop long-term CKD.

CKD effects and diagnosis

CKD occurs when a person's kidney fails; their nephrons are no longer able to filter out waste products from the bloodstream. 

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As a result, people with CKD tend to develop:

  • Anemia - decreased red blood cell (RBC) counts

  • Diabetes and linked heart complications

  • Fluid buildup in the lungs, leading to shortness of breath

  • Abnormal urine production for waste removal

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However, because a person's kidneys can compensate for decreased function, these symptoms often don't appear until the damage from CKD is irreversible.

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CKD is a long-term disease, only displaying the above signs after 30 - 40 years of consumption of contaminated water. While CKD does flash symptoms in a person's childhood—such as high fatigue, urination issues, and fainting—these symptoms are generic and difficult to tie directly to CKD, so they are left untreated.

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This is the problem that exists in many schools in Kurunegala. Students faint, have urination difficulty, and rust lines their teeth (a sign of metal consumption), yet these schools lack the sufficient resources and funds to treat students' CKD and provide clean drinking water.

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As a result, they are exposed to contaminated water for years, causing their CKD to worsen as they reach adulthood. And, because the treatment for CKD is dialysis, a cost-intensive process, people in Sri Lanka's poorer farming villages where CKD is concentrated are unable to pay for aid. As a result, several thousands of Sri Lankans die from CKD each year.

References

  1. Understanding Chronic Kidney Disease: A Socioeconomic Approach in Sri Lanka. International Water Management Institute. August 2019.

  2. Chronic Kidney Disease of Unknown Etiology in Sri Lanka. International Journal of Occupational and Environmental Health. 2016.

  3. Prevalence of Chronic Kidney Disease in Sri Lanka: A Profile of Affected Districts Reliant on Groundwater. Science of the Total Environment Journal. December 2019.

  4. Chronic Kidney Disease (CKD). National Kidney Education. 2022.

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