SHIFTING EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE IN SRI LANKA: RISING BURDEN DESPITE DECLINE IN TRADITIONAL CKDU-ENDEMIC AREAS (2015–2023)

Chronic kidney disease (CKD) is a major global health concern and a leading cause of morbidity, mortality, and healthcare expenditure. In Sri Lanka, the burden of CKD has increased disproportionately over the past decade, reflecting a dual challenge—the growing prevalence of CKD due to diabetes mellitus and hypertension, and the persistence of Chronic Kidney Disease of Unknown Etiology (CKDu) in agricultural communities, particularly in the North Central Province. Understanding the temporal and geographic patterns of CKD is crucial for planning preventive strategies and equitable renal services. This study describes national and provincial trends in CKD hospitalizations in Sri Lanka from 2015 to 2023, highlighting shifts that may reflect changing epidemiology and emerging hotspots.

Data on hospital admissions due to CKD from 2015 to 2023 were obtained from the Electronic Indoor Morbidity and Mortality Data Collection System (eIMMR) maintained by the Medical Statistics Unit of the Ministry of Health, Sri Lanka. The eIMMR is a national digital platform that compiles inpatient morbidity and mortality information from all secondary- and tertiary-level government hospitals. Trained medical record officers enter data electronically at discharge using standardized fields that include patient demographics, diagnosis (coded using ICD-10), procedures, and outcomes. Records with a primary or secondary diagnosis of CKD (ICD-10 code N18 and subcategories) were extracted. Statistical analyses were conducted using SPSS version 27 to examine temporal, provincial, and district-level trends in CKD hospitalizations and related in-hospital mortality.

There was a total of 1,047,612 hospital admissions due to CKD recorded between 2015 and 2023. There was a consistent male predominance (approximately 2:1) throughout the period. The mean age at admission declined from 57.9 ± 16.3 years in 2015 to 54.5 ± 14.8 years in 2023, with the predominant age group shifting from 61–70 years in 2015 to 51–60 years from 2016 onward. Annual CKD admissions increased steadily from 18,629 in 2015 to 213,670 in 2023 (Figure 1). The proportion of CKD admissions among total hospitalizations rose from 0.3% in 2015 to 3.07% in 2023, indicating a tenfold relative increase in the burden of CKD on inpatient services.

Provincial trends showed a similar upward pattern in all regions except the North Central Province, where the proportion of CKD admissions declined from 1.3% in 2015 to 0.55% in 2023. The most marked rise occurred in the Eastern Province, increasing from 0.12% in 2015 to 5.87% in 2023 (Figure 2). The overall in-hospital mortality among CKD admissions declined from 5.2% in 2015 to 0.8% in 2023, remaining below 1% since 2020.

Hospitalizations due to CKD in Sri Lanka increased markedly between 2015 and 2023, with a shift toward younger age groups. Although most provinces showed rising trends, the North Central Province, the traditional CKDu-endemic area, demonstrated a sustained decline in CKD admissions. This may indicate the success of community-level interventions such as improved access to safe water and early detection programs. However, the continued national rise despite this regional reduction suggests an increasing contribution of diabetes and hypertension to the CKD burden and the possible emergence of CKDu beyond its historic hotspots.