Chronic Kidney Disease Prevalence of Mysterious Origins in Sri Lanka
- Saranya Anandakumar
- Mar 9
- 4 min read
Updated: Mar 10
Since the 1990s, there has been a “mysterious” increased rate of chronic kidney disease in rural parts of Sri Lanka, which has economically impacted individuals and the country as a whole. This chronic kidney disease (CKD) occurs when kidneys gradually lose function over time, which can lead to kidney failure. But why has CKD spiked in certain parts of Sri Lanka, and why does it have such a devastating impact?
One consideration is ethnic-based genetic predisposition. The uptick in CKD prevalence in rural Sri Lanka is part of a larger context of relatively high CKD occurrence in South Asia, where CKD prevalence ranges from 10.6% to 22.9% among adults. Studies in the United Kingdom have investigated the difference in CKD prevalence between those identifying with White versus South Asian backgrounds. Findings demonstrate that there is no significant difference in CKD mortality rates between the two groups. Similar studies vary in whether or not they found an increased rate of CKD incidence in South Asians compared to Whites. Thus, it is hard to determine if there are ethnic-related risk factors that put South Asian or Sri Lankan individuals at risk for CKD.
In Sri Lanka specifically, the districts where this phenomenon is observed are Anuradhapura, Polonnaruwa, and Badulla. They are rural agricultural districts, each with 15.1-22.9% prevalence. These districts practice a certain kind of farming known as ‘chena’ cultivation, where a farmer cuts down the trees of a small area of land in the jungle, sets fire to the area, and cultivates the land, moving on the next year to fresh land. However, similar practices are used in other international regions without such incidence in CKD.
According to experts, there are suspected “epistemological” causes that explain the phenomenon of the increased prevalence of CKD in these regions. A study on the topic in 2016 was unable to find the specific cause, though it suggests it is likely related to agriculture or the environment. It is also associated with agricultural irrigation water sources according to geographic mapping. Overall, it is likely agrochemical or pesticide-related inhalation of water pollution is a contributing factor, but it is unknown what the environmental root cause is.
The CKD in these rural areas is a great national burden for Sri Lanka since victims are often young and in productive farming ages. This unusual age distribution of CKD victims is part of what makes the CKD phenomenon in Sri Lanka different from typical CKD cases, where it manifests with old age. In early stages, it is asymptomatic, and symptoms appear later when individuals already have advanced kidney disease. It also typically affects men, those who are most exposed to ecological and agricultural environmental contaminants through labor. This also means that the financial effects on families are even more significant. Without primary laborers, sons or fathers, families are without a source of income.
All of this is without discussing the severe effects of CKD. My own grandma, my Ammamma, as it is said in Tamil, grew up in Sri Lanka, and two months ago she passed away after being in the hospital for months due to complications related to kidney failure. She had dialysis daily and was in constant pain. I don’t think her diagnosis was related to the same environmental phenomenon that is affecting those I have written about prior, but it exemplifies the hardship those experiencing CKD can have. My ammamma suffered so much, even with the wealth, technology, transportation, and other privileges my family here in the US held.
Part of the struggle for individuals in Sri Lanka like Sunil Thennakoon is the distance from centralized healthcare and hospitals. When he needs to make a trip to the hospital, he has to travel 30 km and hire workers to tend to the farm while he is away. There is Sirani Silva, who found out she had 10% kidney function remaining when her CKD was discovered two years ago. She is still on the waitlist for a kidney transplant.
There are significant barriers of time, distance, money, and access to transportation for those in rural Sri Lanka struggling with CKD. Nationally, 10-15% of Sri Lankans experience CKD. It was identified as the 8th leading in-hospital cause of death in Sri Lanka and is the 12th leading cause of death in the world because of the lack of access to affordable care, especially dialysis in the late stages of kidney failure. High cost of kidney treatment ranging from emergency operations to dialysis.
One recommendation is for individuals to switch from drinking groundwater to filtered water, as the former is known to contain many minerals that may exacerbate instances of CKD.
This is difficult considering simple boiling or adding chlorine will not remove hazardous materials like it kills bacteria, and large portions of the community are experiencing poverty and food scarcity as is. Other recommendations include reducing agrochemical usage, limiting time in the sun, and preventing dehydration, but it is unusual that specifically, Sri Lanka is experiencing such a significant increase in CKD as these same factors affect agricultural workers globally. It is also a band-aid, not a real solution for those being exposed and affiliated.
Given the scope of this problem and the countless lives lost due to the lack of access to care in these rural regions, more government resources and funding should go into the establishment of healthcare entities in these areas or into determining the cause of CKD in these areas. There too should be efforts in researching the extent of this in historically Tamil communities, who also saw spikes in CKD prevalence but were given much less attention due to their marginalized identities and limited records from hospitals. At present, more than 20,000 people in Sri Lanka are experiencing end-stage kidney failure, and the government cannot stand by as this number grows.
Sources
Rajapakse S, Shivanthan MC, Selvarajah M. 2016. Chronic kidney disease of unknown etiology in Sri Lanka. Int J Occup Environ Health 22(3):259-264. doi: 10.1080/10773525.2016.1203097. https://pmc.ncbi.nlm.nih.gov/articles/PMC5102238/
Ling S, Xu G, Zaccardi F, Khunti K, Brunskill NJ. Kidney Function and Long-Term Risk of End-Stage Kidney Disease and Mortality in a Multiethnic Population. 2023. Kidney Int Rep. 8(9):1761-1771. doi: 10.1016/j.ekir.2023.06.014. https://pmc.ncbi.nlm.nih.gov/articles/PMC10496088/
Hasan M, Sutradhar I, Gupta RD, Sarker M. 2018. Prevalence of chronic kidney disease in South Asia: a systematic review. BMC Nephrol 19(1):291. doi: 10.1186/s12882-018-1072-5. https://pubmed.ncbi.nlm.nih.gov/30352554/
Cheng, Kang-Chun. The inexplicable rise of kidney disease in Sri Lanka's farming communities. 2024. Al Jazeera,
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