Kidney progression project (KiPP): Protocol for a longitudinal cohort study of progression in chronic kidney disease of unknown etiology in Sri Lanka

ABSTRACT

Over the last two decades, a global epidemic of chronic kidney disease of unknown etiology (CKDu) has emerged in rural, arid, agricultural, lowland areas. Endemic regions have reported 15 to 20% prevalence among residents aged 30–60 years. CKDu is a progressive and irreversible disease resulting in renal failure and death in the absence of dialysis or a kidney transplant. While much of the research has focused on identifying etiology, this project seeks to ascertain factors associated with the rapidity of kidney disease progression in one of Sri Lanka’s CKDu endemic areas. A sample of 296 male and female residents aged 21 to 65 with moderate CKD, as measured by their serum creatinine level, and a clinical diagnosis of CKDu are followed using quarterly serum testing to track the rate of progression. A baseline survey administered to the entire sample addresses potential risk factors, supplemented by a short survey focusing on changes through time. Concurrently water, soil and air are tested at the local and household levels. The study is the first to foster a multi-disciplinary approach that focuses on disease progression, identifying behavioural and exposure risk factors for rapid kidney function decline, in this progressively fatal disease.

KEYWORDS:

• CKDu
• kidney disease
• progression
• agriculture
• contaminants

Acknowledgements

First and foremost we thank the participants of the study. We are extremely grateful to the dedicated and enthusiastic team of young people H.P.M. Hewavitharane (research coordinator), S.M.R.G. Godavita (RA), H.P.N. Santhushya (RA), D.M.D.A. Dissanayake (RA), W.M.K.G.P. Wijerathne (RA), R.D.M.B. Karunrathne (RA), H.S. Sandaruwan (RA), A.M.C.M. Aththanayake (field assistant), P.N. Hewavitharane (field assistant), working in to collect participant and environmental data. This work was supported by the U.S. NIH Fogarty Institute under Grant R21TW010425. Dr Anand is supported by NIDDK K-23. The investigators would also like to acknowledge the support of the Sri Lankan Ministry of Health for facilitation of the above research.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Penny Vlahos http://orcid.org/0000-0002-0034-6007

Jean J. Schensul http://orcid.org/0000-0003-2786-2340

Additional information

Funding

This work was supported by Fogarty International Center: [grant number R21TW010425]; National Institute of Diabetes and Digestive and Kidney Diseases: [grant number K-23].