Chronic kidney disease of unknown aetiology: a review of literature on the socio-economic aspects

Abstract

Introduction

The global burden of Chronic Kidney Disease (CKD) continues to increase not only because of its higher prevalence of traditional causes, such as diabetes and hypertension, but also CKD resulting from infections and unknown aetiology. Endemic occurrence of Chronic Kidney Disease of unknown etiology (CKDu) is reported in Sri Lanka, Bangladesh, India, Nicaragua and El Salvador. It has been a prevalent environment-related national health issue for two decades in Sri Lanka. As the term CKD in Agricultural Communities (CINAC) reveals, a close relationship is drawn between agriculture and the particular socio economic status of the farmer and CKDu. It is the eighth factor for mortality in Sri Lanka and reportedly was the cause of 13.8 % of mortality in 2017.

Research in this area claims tentative causes for CKDu which include high fluoride contents in groundwater, presence of toxins produced by cyanobacteria in surface waters, particularly in freshwater reservoirs, excessive use of agrochemicals, consumption of contaminated (heavy metal pollutants from agro-chemicals) and consumption of water-based plants such as nelum and kohila, and Tank fish. Some studies have hypothesized that high concentrations of Cadmium, Arsenic, smoking tobacco, excessive dehydration in the work environment of farmers, and genetic predisposition are factors contributing to the prevalence of Chronic Kidney Disease of unknown aetiology. Numerous studies have been conducted by a range of institutions and researchers in relation to the problem. However, there is yet to be more research done in relation to this area, more specifically, the lack of identifying definite causes hampers its diagnosis. Moreover much research is to be conducted in exploring the terrain of the socio-economic aspects of the disease. This paper aims at reviewing existing literature in this area.