Kidney Disease in the NCR:A scientific mismanagement


Dr. Kamal Gammampila, holds an MPhil in Biophysics from Brunel University, UK and a PhD in Physiology from the Faculty of Medicine, Imperial College, London. He is currently attached to the National Institute for Health Research, Imperial College, London. His current research interests include Pathophysiology of heavy metal exposure in chronic kidney failure and development of renal protection strategies. This week he speaks to the "Health and Society" on the Chronic Kidney Disease (CKD) in the North Central Region (NCR).

Qs. Dr. Gammampila, How do you assess the present CKD situation in Sri Lanka?

Ans. The situation is most serious. It foretells an impending disaster, not only the country, but the world has not witnessed in the modern times. With 28,000 CKD cases (Ministry of Health data: Dec 2015) needing dialysis or transplant, over 400,000 in various stages of Chronic Renal Failure, and the youngest victim at 15 years of age is most frightening. The reason for this tragic situation is ‘mismanagement’ compounded by poor scientific approach.

Qs. There was a large scale study conducted by the WHO. What can you say about this study and its findings?

Ans. This was an epidemiological study which has limitations in their findings. It is most regrettable that the data was not properly analyzed, hence the conclusions were extremely weak. One cannot help but think that there was interference from the authorities in the conclusions of that study.

The study only highlighted the toxic levels in food items which is most inappropriate. What is relevant for toxic exposure is, what is known as the Intake dose: the dietary exposure which is worked from the toxic level in each food item multiplied by the quantity of each food item consumed and adding them all up. My calculations based on the Health Ministry’s publication data (Jayatilake et al. 2013) of the dietary cadmium doses show that about 50 percent of the dosage is from rice, about 40 percent from vegetables and less than 10 percent from water as illustrated below.

Some people in the NCR receive 2-3 times the safe exposure level. Those who have high cadmium soils (paddy and vegetables) are the ones that fall ill. Those with low cadmium soils may take longer or escape being a victim. Urban dwellers purchase food grown in both soil conditions, hence their cadmium dose is ‘averaged’, and just within safe limits that’s why urban CKD prevalence is low.

Qs. Are you satisfied with the present response towards CKD?

Ans. Not in the least. Giving clean water is a good thing, but to claim it would prevent CKD is a total fabrication.

Qs. In your opinion, how should this response improve?

Ans. The President must appoint a new team of medical scientists led by a senior academic with complete freedom to address the issue without any hindrance from the Government, groups or individuals with vested interest. UN body on toxic exposure identifies for long term low level cadmium exposure, the ‘Key Health Effect for Assessment’ as chronic kidney disease. It is inexplicable why not a single study other than by Prof. Sarath Bandara, Dr. Tilak Abeysekera group in 2008 investigated cadmium. Unfortunately, they failed to robustly conclude cadmium as the cause. That was because they only considered rice and fish but not the contribution from vegetables which could be as much as 40 percent. Furthermore, the safe limits are very different today as a result of our current greater understanding of dietary exposure.

Qs. What do you suggest as the most urgently needed things to be done to arrest CKD?

Ans. Safe diet strategy can be done and must be done not only to prevent CKD, but to prevent us from being accused of a gross Human Rights violation.

When a country decides to monitor children young as ten (this is the current plan of the MOH), any human being should realize that there is something drastically wrong with that society when they DO NOT ask for help from organisations such as the UNICEF to protect the children, FAO for Food Aid and WHO and other International agencies such as the ‘Doctors Without Boarders’ and International Health, as well as charities such as Clinton or Gates Foundations for help.

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