Introduction:
Chronic kidney disease(CKD) is on the rise globally and poses an increasing health and socioeconomic burden to all countries. CKD prevalence of 10-20% in the South Asian populations with variability between countries has been described, however Sri Lankan data is not available. CKDu in Sri Lanka which is limited to a specific geographical region has been studied extensively, however, overall CKD prevalence patterns outside of the CKDu region are unknown. This study provides the first accurate estimates of CKD prevalence of Sri Lanka from a representative region outside of CKDu endemic areas.
Methods:
The study was conducted using a multi-stage, random-cluster-sampling method and the stages considered were age and sector (urban, rural, estate). The study was conducted in the district of Kandy, which is one of the most populated districts and consists of a representative population of Sri Lanka. The sample included consenting residents of Kandy district, aged ≥18 years and excluded participants with a recent or current history of acute kidney injury.
Results:
A sample of 1843 participants were included. Majority of 78.2% (n=1442) were from the rural sector, 13.9% (n=257) from the urban sector and 7.8% (n=144) from the estate sector in keeping with proportional allocation of the population. Overall median age of the sample was 56 years (IQR 30 - 81) with majority being in the age groups of 40 -59 years (45.7%) followed by 60-79 years (38.7%). The final sample had more females (n=1078, 58.5%) and of Sinhalese ethnicity (n=1478, 80.3%) and this pattern was seen in all three sectors.
The study identified 6.7% (n=124) participants having an eGFR ≤ 60 ml/min/1.73m2 and 9.9% (n=180) having albuminuria. Overall, the prevalence of CKD was 14.4% (n=265) where the participants had either a low eGFR and/or albuminuria. Prior to the study only 59 participants (3.2%) were known to have kidney disease. CKD prevalence varied between the sectors with 12.5% (n=32) in the urban, 15.4% (n=222) in rural and 7.6% (n=11) in the estate sector. Majority of patients (86.8%, n=230) had early stage 1-3A CKD with only 13.2% (n=35) having advanced stage 3B-5 CKD. 49.2% (n=124) of the patients with CKD had diabetes and 81.3% (n=213) had hypertension indicating the most likely causes of CKD in the community.
Logistic regression analysis identified age category, gender, occupation, diabetes and hypertension to be statistically significantly (p value <0.05) associated with presence of CKD. Presence of CKD significantly increased with age, with 60-79 age category having an odds ratio (OR) of 2.0 (95% CI 1.1-3.6)] and age ≥80 having OR 2.9 (95%CI 1.1-7.2) compared to the reference group aged 18-39 years. Males had higher risk of developing CKD with OR 1.6 (95% CI 0.4-0.8) compared to females. Similarly, presence of diabetes (OR 2.4, 95%CI 1.8-3.3) and presence of hypertension (OR 2.3, 95% CI 1.6-3.2) resulted in higher risk of CKD.
Conclusions:
The study finds a CKD prevalence of 14.4% which is comparable to other countries in South Asia as well as globally. Increasing age, male sex, presence of diabetes and hypertension were identified as risk factors for CKD. Sri Lanka, with an aging population and increasing rates of non-communicable diseases such as diabetes and hypertension, is facing a rising burden of CKD.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.