Evaluating the occupational and lifestyle risk factors among Chronic Kidney Disease of unknown etiology (CKDu) patients in the North Central Province of Sri Lanka Open Access

Seneviratne, Tanya (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/z029p4779?locale=en


Purpose Chronic Kidney Disease of unknown etiology (CKDu) was first reported in the early 1990s in the North Central Province of Sri Lanka, and has now escalated to an epidemic level.  This study attempts to further characterize the occupational exposures and daily practices of people in the disease endemic region that puts them at an increased risk of disease. 

Methods A case-control study was conducted at the Medawachchiya renal clinic in the Anuradhapura district of the North Central Province. Cases (N=200) were selected from patients diagnosed with stage 3 or 4 CKDu from the clinic registry, and controls (N=200) were selected by asking each case to bring a spouse, relative, or neighbor who was confirmed to be disease-free. A survey questionnaire was administered to collect demographic information, disease history, and lifestyle habits regarding water consumption and occupational exposure to agrochemicals. Missing occupation data (31.5%) were imputed, and logistic regression modeling was performed to characterize disease risk using covariates sex, age, education, occupation, pesticide use, drinking from an abandoned well.

Results Among the diagnosed cases, the majority were male (N=117, 58.5%) and had up to a primary, or grade 5, education (N=107, 53.5%). The mean age for male and female cases was not statistically significant, but there was a 15.5 year age difference between cases and controls.  Of the male CKDu patients in the non-imputed data, 74.36% worked as farmers, compared to 53.01% in female patients. Non-imputation or complete data modeling showed sex (OR=1.79, 95% CI 1.04-3.06), age (OR=1.12, CI 1.08-1.15), low education (OR=2.73, CI 1.44-5.15), pesticide use (OR=1.72, CI 1.01-2.92), and drinking water from an abandoned well (OR=2.82, CI 1.19-6.65) to be statistically significant predictors.  Modeling with imputed data (c-statistic=0.855) showed sex (OR=2.01, CI 1.14-3.53), age (OR=1.11, CI 1.08-1.15), and drinking from an abandoned well (OR=2.69, CI 1.16-6.26) to increase risk of CKDu.

Conclusion This study supports previous findings that sex, age, and low education are important risk factors of disease.  Both imputation and non-imputation modeling demonstrate that in this study population, being a farmer may not be the best predictor of CKDu, but rather the use of pesticides and drinking water from abandoned wells that may be contaminated with heavy metals and agrochemicals.

Table of Contents

Introduction                                                                            1

Background and Significance                                                   1

Additional Regions with CKDu Prevalence                             3

Characteristics and History of the North Central Province      4

Major Hypothesized Etiologies                                               6

Methods                                                                                 10

Study Participants                                                                   10

Ethical Consideration                                                             11

Data Collection                                                                      11

Non-imputed (Complete) Data Analysis                                 11

Imputed Data Analysis                                                           12

Results                                                                                    14

Demographic Information                                                      14

Non-imputed Logistic Modeling (Complete Data)                  17

Imputation and Logistic Modeling                                          20

Discussion                                                                              25

Conclusions                                                                            29

References                                                                              30

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