• Diabetes, heart disease and high blood pressure are main causes of CKD
• Over 200,000 CKD patients, many linked to diabetes
• 15-22% of the North Central Province and Badulla have CKDu
• ‘Are your kidneys safe?’ – an awareness campaign for World Kidney Day 2025 by NINDT

Sri Lanka’s long-standing health problem with kidney health is no trivial matter, with nearly one in ten Sri Lankans battling one form or the other of the life threatening illness. With World Kidney Day 2025 (WKD2025) around the bend, The Daily Morning sat down with three experts at the National Institute for Nephrology Dialysis and Transplantation (NINDT) in Colombo, to discuss the current status quo of Chronic Kidney Disease (CKD) and the institute’s plans for WKD2025 which is to be held under the theme of ‘Are Your Kidneys OK? – Detect early, protect kidney health.’

We got Consultant Nephrologist Dr. Anupama De Silva, Medical Officer in Anesthesia and Intensive care Dr. Rajeev Menon Gengatharan and Consultant Vascular and Transplant Surgeon Dr. Malaka Amarasinghe from the NINDT to discuss CKD, CKDu, its treatment, new trends and the institution's plans to mark the WKD2025. 

Following are experts from the interview:

What is being planned for World Kidney Day and why is it important for Sri Lanka?

The World Kidney Day was founded in 2006 by the International Society for Nephrology to address issues related to kidney diseases. It is marked in the second week of March, and as such it will be held on 13 March. The Day is a global movement to create awareness amongst the public and healthcare professionals, on identifying and treating issues around kidney health. Since Sri Lanka has a significant kidney health issue, which has been ongoing for some time, we use the World Kidney Day (WKD 2025) to build awareness in Sri Lanka about the related issues.

What has the National Institute for Nephrology Dialysis and Transplantation (NINDT) planned in lieu of WKD 2025?

The NINDT is in line with the international theme ‘Are your Kidneys OK?’, we have planned a series of events. The programme is structured on three principles, the first is to empower and give knowledge to the healthcare staff. The second to make the public more aware of the risks and treatments. Third was to facilitate the organ donors of Sri Lanka, who we are thankful for giving the gift of life to others. The felicitation ceremony, the first of its kind, will be held on 14 March. There will also be a kidney awareness walk, which will be held on 9 March and will be centered around NINDT and the locality.

As such, we have planned to hold workshops for our doctors, nurses and the para-medical staff during this period. We have planned a few events to build team spirit amongst our staff. The NINDT has also organised a public awareness campaign, which plans to use all forms of media. In the pipeline, there are several awareness building videos which will include advice from specialists on how to keep your kidneys healthy and safe. They will also address how to plan your treatment with medical advice, for those who are already suffering from kidney issues.

NINDT plans to launch in the first week of March, a publication on the issue authored by Consultant Nephrologist Dr. Anupama De Silva for kidney patients which will be published in all three languages.

Can you explain the magnitude of the impact Chronic Kidney Disease (CKD) has on Sri Lanka?

CKD in Sri Lanka has a big disease burden. The numbers vary from district to district due to additional burden from so called ‘CKDu’. The main cause of CKD is diabetes, we call it diabetes kidney disease. High blood pressure and heart disease also contribute to CKD. Overall, in Sri Lanka about 10% of the population has CKD. Therefore, we have over 200,000 patients with CKD, of which most cases have diabetes mellitus. I must emphasise that having diabetes per se will not cause CKD, especially if the diabetes is well managed and treated. If you look after your diabetes well, you reduce the risk of CKD.

In the North Central part of Sri Lanka ; Anuradhapura, Polonnaruwa and Badulla Districts, in addition to CKD, there is a disease called CKDu (Chronic Kidney Disease of Uncertain origin). CKDu has impacted almost 15–22% of the population in those areas. Overall, the kidney burden in these areas is high.  

Do the issues related to the quality of groundwater remain a factor for CKDu?

Yes, groundwater quality has been a contributory factor. This is because in those areas the groundwater is found to contain heavy metals. It is suspected that most of the heavy metals originated from the unregulated use of certain types of agro chemicals, weedicides and pesticides. The groundwater has been contaminated with Cadmium, Arsenic etc.  

What advice would you give the public to prevent CKD?

I think the public needs to be cautious. Especially those above 40 years old. We encourage them to get screened. This is important if you have diabetes, hyper-tension, heart disease, the history of leptospirosis, kidney stones etc. Screening is a simple process and is worthwhile for early detection. In the case of kidney stones, a growth or an enlarged prostate we normally recommend an ultrasound scan.

Once diagnosed, how does treatment work?

Mainly, we can treat the stage of CKD and or treat the causes of CKD. For example, if CKD was caused by diabetes, we treat that and control it. We also control conditions such as blood pressure and control protein leaks. This is to prevent further growth of CKD. There are five stages of CKD. We treat the relevant ailments of that particular stage. The complication of each state needs to be managed while the main cause is addressed. This way, we can manage the situation and improve it without allowing the situation to deteriorate to the level where dialysis or kidney transplantation is needed.

Sometimes, depending on the cause, some cases can be 100% treatable. CKD can also be managed to a great extent, without letting it progress to the end stage.

Despite all these measures, if a patient reaches stage five; the end stage renal disease, there are options to manage the situation. In such cases, there are occasions where we can go for a preemptive kidney transplant, without going for the dialysis stage. This is because in some cases, kidney transplants are the best option for the patient. Where dialysis is needed, there are two types of it. One is hemodialysis where the patient goes to a center where his or her blood is filtered and cleaned via machine. The other form, peritoneal dialysis where a cleansing fluid is passed through a catheter tube into part of the abdomen known as the peritoneal cavity. The fluid absorbs waste products from blood vessels in the lining of the abdomen, called the peritoneum. It uses the lining of your abdomen, or belly, to filter your blood inside your body. There are other options of dialysis as well.

How can renal replacement therapy help in treating renal failure?

Kidneys are vital organs, they filter waste from your body, balance your fluids and regulate your blood pressure. So, most of the time CKD can be managed with medication. But sometimes when the situation reaches end stage renal failure, drugs and diet alone cannot help. The patient in this category needs support to remove waste from his blood and out of his body. We measure kidney function by measuring creatinine level. Once we confirm a patient is at end stage renal failure, we decide the treatment options.

The best way is to have a kidney transplant. However, most patients will likely not be able to go through that, primarily because of lack of donor organs. For those patients, we recommend dialysis.  

Can you explain how kidney transplantation works?

Getting a kidney transplant is a complex process. In Sri Lanka we have two types of organ donation, live donation and a deceased donation, where organs are donated from someone who has passed away.

Since we have two kidneys, some people donate one to those in need. The other form of donation, if a parent or families of a brain dead donor is agreeable to it, the deceased kidney can be donated.

To receive a kidney donation, a patient has to be prepared to receive it. Since the body will view the new kidney as a foreign entity, the blood groups and relevant HLA protein markers and PRA markers need to be properly matched to the donor organ, to ensure success, and prevent organ rejection by the host body.

Once you get a proper match from a donor, the surgery is rather a simple procedure. There are three specific tubes which need to be properly linked. Most of the time, while doing the surgery, we see the kidney in operation and urine being formed, which is indicative of successful surgery.

When receiving a kidney from a deceased donor what is the process?

There is a legal process when we use a live donation, where no financial benefit to the donor is allowed. There is a process of ethics and a committee at the hospital and the Ministry of Health oversee the process to ensure that it is done properly. At the same time, for donations from a deceased donor, again the relatives and close family members must be happy to do so and give consent. Only with consent, the organs can be harvested.  This is carried out by a specialised team at each hospital. The team is led by an anesthetist. Internationally, there is a declaration on organ trafficking and we in Sri Lanka adhere to the same guidelines.

What are the causes of CKD and CKDu that have raised concerns amongst you?

Other than the main causes of CKD, when it comes to CKDu it was mainly identified amongst the farming population at first. But we have found that the Chronic Interstitial Nephritis, which is a nonspecific diagnosis of a pattern of kidney injury, is increasing. It has been observed to be prevalent amongst the younger demography. This has no area specific spikes. It is suspected that younger people who use a lot of unregulated cosmetics and whitening products, certain weight-gain and weight-loss products, may be susceptible to such a condition. We were at an international conference recently where we heard similar concerns being echoed from countries like Thailand. This indicates that untested and unregulated products may have a risk factor which needs to be studied and regulated. We would like to warn the public to be aware of such risks and avoid them. So, this is no longer limited to a certain area in Sri Lanka. Beware of heavy metals in products, and even high levels of proteins, aluminum etc. 

PHOTOS Ishan Sanjeewa