CKD due to a cocktail of factors - doctor

By Don Asoka Wijewardena

North Central Province Chronic Kidney Disease Control Unit head Dr. Asanga Ranasinghe said last week that a majority of kidney patients detected in the province had suffered 30 to 40 per cent kidney damage by the time treatment began. The kidney disease had now spread to other provinces, he added.

To date no specific cause of CKD in Sri Lanka had been identified, but a multitude of potential toxic pollutants had been suggested, including heavy metals, fluoride and hard water, ionic -concentration of water, chemical fertilisers and toxic agro-chemicals, but the cause of CKD was not clear, Dr. Ranasinghe said at a media conference held at Export Development Board Auditorium on May 23.

Dr. Ranasinghe said that the development of CKD was insidious; by the time it manifested clinically, advanced pathological and irreversible damage had occurred in kidneys. Once the damage was done, it was difficult or impossible to reverse. Dialysis only slowed the deterioration and postponed death. Meanwhile, other non communicable diseases, including diabetes, hypertension and depression might co-exist with CKD. Because the causes of CKD were multiple, "single- cause hypothesis" or research programmes on such was unlikely to generate meaningful data or provide useful evidence to curb CKD, he argued.

CKD was most likely due to a combination of factors and when the right adverse conditions existed, kidney failure occurred. Nevertheless, there were other serious but preventable potential sources prevailing in the regions that had not been addressed to date. Those included the overuse of non-steroidal anti-inflammatory analgesic agents, consumption of illegal drugs and alcohol, smoking locally grown tobacco that contained higher amounts of heavy metals, leptospirosis, excessive exposure to petro-chemicals, exposure to harsh climatic conditions in the field, chronic dehydration and continually drinking concentrated polluted water at times from the paddy fields. It was most likely that a combination of some of the above-mentioned components were precipitating the CKD, he said.

Dr. Ranasinghe said that CKD was found in Ampara, Moneragala and even in Jaffna, while it was spreading fast in the NCP. Water contamination was not new to Sri Lanka. Deforestation of hill country, industrialization and colonization of former forest areas in the NCP for settlements, further contributed to the environmental stress. Without adequate planning for potable water, drainage, and sanitation, those human settlements would exert tremendous pressure on the environment and continued to have adverse impacts on freshwater systems and thus on human health. Uncoordinated planning had led to surface and ground water contamination with nutrients (nitrate/nitrites/ phosphates and organic matter, toxic chemicals and other unhealthy substances. Unfortunately this had worsened due to haphazard and overuse of agro-chemicals and other pollutants by farmers.

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