Joint National and International Workshop on CKDu to Recommend a CKDu Policy, Research Agenda, and an Action Plan

项目摘要 自1994年以来，斯里兰卡中北部省(NCP)的稻农一直在 经历一场不寻常的慢性肾脏疾病(CKD)流行，这不是由 传统上已知的病因，如糖尿病、高血压或肾小球肾炎。从今天起， CKDu已经杀害了2.35万名农民和他们的家人。另有6.9万人被杀 被诊断出患有这种疾病。类似的CKDU在农业工人中的流行也是 在印度安德拉邦、孟加拉国、墨西哥和中美洲报道。一个 包括世界卫生组织(世卫组织)在内的一些研究小组已经进行了 研究确定斯里兰卡这种独特类型的CKDu的病因。在那里的时候 人们的共识是，这是一种多因素疾病，主要因素包括慢性接触 砷、镉和肾毒性农药。其他风险因素，如饮用水 来自浅井的农药和受污染的三元磷肥的使用 已被确认身份。然而，这些因素如何在特定的水文、地球化学和 社会环境和环境设置还没有得到系统的研究。我们建议采取一项 从美国到斯里兰卡的多学科科学家团队到NCP和斯里兰卡进行实地考察 举办两个研讨会。团队成员将被选为代表以下领域的成员 专长：医学和肾病学、公共卫生、环境科学和工程学， 地表和地下水文学、土壤科学、地球化学、行为科学和 环境心理学和地理信息系统。这些车间有两个 主要目标：(1)从两个领域都活跃的斯里兰卡科学家那里收集信息 和实验室研究，以及(2)综合收集的知识和确定关键 通过讨论和分析发现知识差距。这些研讨会的最终成果将是 开发一个框架，将我们对不同因素的理解整合在一起 到CKDu的风险。一份立场文件、研究议程和行动计划，可能会导致 将制定斯里兰卡的国家CKDu政策。我们期望这一框架 计划将成为制定短期和长期战略的基础 不仅斯里兰卡和美国科学家之间的跨学科合作研究努力， 但也将来自其他国家，在那里CKDu已经成为一种健康危机，需要科学家 对导致CKDU的主要危险因素进行研究，同时勾画出相似之处 以及两个地理区域的差异。

Project Summary Since 1994, the rice paddy farmers in Northern Central Province (NCP) of Sri Lanka have been experiencing an unusual epidemic of Chronic Kidney Disease (CKD) that is not caused by traditionally known causes such as diabetes, hypertension or glomerular nephritis. As of today, CKDu has already killed 23,500 farmers and their family members. Another 69,000 have been diagnosed with the disease. Similar epidemics of CKDu among agricultural workers have been reported in Andra Pradesh in India, in Bangladesh and in Mexico and Central America. A number of research groups including the World Health Organization (WHO) have conducted research studies to determine the etiology of this unique type of CKDu in Sri Lanka. While there is the consensus that this is a multi-factorial disease, main factors include chronic exposure to Arsenic, Cadmium and nephrotoxic pesticides. Additional risk factors such as drinking water from shallow wells and the use of pesticides and contaminated triple phosphate fertilizer have been identified. However, how these factors interact in the specific hydrologic, geochemical and social environment al settings has not been systematically studied. We propose to take a multidisciplinary team of scientist from the US to Sri Lanka for a site field visit to NCP and conduct two workshops. The team members will be selected to represent the following areas of expertise: medicine and nephrology, public health, environmental sciences and engineering, surface and subsurface hydrology, soil science, geochemistry, behavioral sciences and environmental psychology, and geographic information systems. The workshops have two primary goals: (1) to gather information from Sri Lankan scientists who are active both in field and laboratory studies, and (2) to synthesize the gathered knowledge and identify key knowledge gaps through discussions and analysis. The final product of these workshops will be to develop a framework that integrates our understanding of the different factors that contribute to CKDu risk. A position paper, research agenda, and an action plan that could lead to a national CKDu policy in Sri Lanka will be developed. It is our expectation that this framework and plan will become the basis to develop strategies for both short and long-term interdisciplinary collaborative research efforts between not only Sri Lankan and US scientists, but will also from other countries where CKDu has become a health crisis that needs scientists to conduct research on the main risk factors leading to CKDu while delineating the similarities and the differences in the two geographical regions.