Identifying Contributing Factors to the Progression of Chronic Kidney Disease of Unknown Etiology in Sri Lanka

摘要 在过去的二十年里，病因不明的慢性肾脏疾病迅速增加。 在许多国家的农村、干旱、农业低地地区已经出现了(CKDu)。这些地区 报告称，30岁至60岁的男性和女性的患病率为15%至20%。CKDu是一种 除非透析或肾脏，否则会导致肾功能衰竭和死亡的进行性不可逆转的疾病 可以进行移植。到目前为止，主要的努力集中在确定病因上。 这导致了CKDU，但密集的调查结果却令人沮丧地没有定论 公共卫生官员和农业工人几乎没有得到预防疾病的指导。在 缺乏预防方法，这项拟议的研究将侧重于确定因素 与延缓斯里兰卡疾病进展有关，斯里兰卡是受疫情影响最严重的国家之一 CKDu流行。该项目将在斯里兰卡的一个农村流行地区进行，并呼吁 跨学科研究的重点是确定环境、行为和卫生保健因素 与CKDu从中度进展到更严重的CKDu的速度有关。该项目 是美国康涅狄格大学和斯里兰卡佩拉迪亚大学的合作项目 这两个机构的环境、社会和医学科学家参加了会议。300个样本 以血肌酐水平衡量中度CKDU的男性和女性农民将被 由卫生部在研究地区进行的筛查产生，在启动 项目后每季度进行一次血清肌酐检测，以确定该项目的发展轨迹 研究样本中个体的进展情况。该项目的目标是确定 与更快或更慢相关的环境、行为和医疗保健领域 CKD进展。这一拟议项目的具体目标是：(1)评估和监测农用化学品 CKDU个体在水和土壤中的微环境；(2)识别与 农业，包括农业中的水合作用、杀虫剂和农用化学品的使用，以及非农业行为 包括心理状态、耻辱、酒精和烟草的使用；(3)检查卫生保健的使用情况 CKDU患者包括使用对抗疗法与非对抗疗法(例如，阿育吠陀、治疗师、灵媒) 护理、服药依从性和并存；以及(4)。提高师生的能力 对斯里兰卡的CKDu和其他机构进行跨学科研究 地方病流行国家。这项拟议中的研究将是斯里兰卡第一个关注疾病进展的研究 对这些受影响的社区具有潜在的变革性。该项目还提供了 跨学科、跨国家交流的机会，可以产生解决问题的模式 斯里兰卡和其他国家的非传染性疾病。

Abstract Over the last two decades there has been a rapid increase in chronic kidney disease of unknown etiology (CKDu) that has emerged in rural, arid, agricultural lowland regions in multiple countries. These regions report 15 to 20% prevalence among men and women between the ages of 30 to 60. CKDu is a progressive and irreversible disease resulting in renal failure and death unless dialysis or a kidney transplant is available. The primary effort to date has focused on identification of the etiological factors that cause CKDu, but the result of intensive investigation have been frustratingly inconclusive leaving public health officials and agricultural workers with little guidance for preventing the disease. In the absence of an approach to prevention, this proposed research will focus on identifying factors associated with delaying progression of the disease in Sri Lanka, one of the countries hardest hit by the CKDu epidemic. The project will be conducted in a rural endemic area of Sri Lanka and calls for an interdisciplinary study focused on identifying the environmental, behavioral and health care factors that are associated with the rate of progression of CKDu from moderate to more advanced CKDu. The project is a collaboration between the University of Connecticut in the US and the University of Peradeniya in Sri Lanka and involves environmental, social and medical scientists from both institutions. A sample of 300 male and female farmers with moderate CKDu as measured by their serum creatinine level will be generated from a Ministry of Health screening in the study area conducted prior to the initiation of the project and followed by quarterly serum creatinine testing by the project to determine trajectory of progression for the individuals in the study sample. The project objective is to identify the factors in the domains of the environment, behavior and health care that are associated with more rapid or slower CKD progression. The specific aims of this proposed project are to: (1) Assess and monitor agrochemicals in water and soil of the microenvironments of individuals with CKDu; (2) Identify behaviors related to farming including hydration, pesticide and agrochemical use during farming, and non-farming behavior including psychological states, stigma, alcohol and tobacco use; (3) Examine the use of health care by individuals with CKDu including use of allopathic v. non-allopathic (e.g. ayurvedic, healer, spiritualist) care, medication adherence, and co-morbidities; and (4). Increase the capacity of faculty and students from both institutions to conduct interdisciplinary research with regard to CKDu in Sri Lanka and other endemic countries. The proposed study would be the first in Sri Lanka to focus on disease progression and potentially transformative for these affected communities. The project also provides the opportunity for cross-disciplinary, cross-national exchange that can be generate a model for addressing NCDs in Sri Lanka and other countries.