A review of chronic kidney disease of unknown etiology in Sri Lanka, 2001–2015

An increase in the prevalence of chronic kidney disease of unknown etiology (CKDu) was observed in several countries of the world since the early 2000s. We reviewed the literature to summarize the existing knowledge regarding epidemiology, clinical features, and risk factors for CKDu in Sri Lanka. We reviewed published literature from PubMed and unpublished literature from literature repository of CKDu published by the World Health Organization. We identified 36 articles based on various inclusion/exclusion criteria and reviewed the full text of all selected articles. The prevalence of CKDu was approximately 5% in endemic areas based on the surveillance data. CKDu accounted for 70% of CKD cases in endemic areas. Clustering of cases was observed in select divisions and districts in the dry region of the country. Low body mass index, normal blood pressure, scanty proteinuria, and tubulointerstitial pathology were characteristics of early stages of a disease. Genetic susceptibility, farmer as occupation, heavy metals (cadmium and arsenic), and drinking well water were identified as risk factors. Data were limited on the association with agrochemical use and heat stress/dehydration. Community- and facility-based surveillance needs to be strengthened to document the burden of disease and trends over time.