Dr. Ananda Gunewardena1 Help Treat Chronic Renal Failure in Sri-Lanka An Appeal by Sri-Lankan Physicians

Dr. Ananda Gunewardena2 Chronic Renal Failure  An endemic form of chronic renal failure emerged in epidemic proportions in North Central, North Western, Eastern and Uva provinces in Sri Lanka  Unknown etiology. Ongoing clinically investigation with the financial support from the WHO.

Dr. Ananda Gunewardena3 Chronic Renal Failure - 2  2 – 3% Prevalence in all affected provinces  Very high prevalence (10%) in some areas Padaviya (NCP) Madavachchiya (NCP) Polpethigama (NWP)  Approximately 2000 patients are being added annually to the disease burden

Dr. Ananda Gunewardena4 Affects  Approximately deaths occur in hospitals due to CKD Annually  Mortality rate could be higher because home deaths are not included in death registries.  Approximately 1400 deaths occur nation wide  50 to 60 deaths in Kurunegala

Dr. Ananda Gunewardena5 Socioeconomic Impact  Young people are predominantly affected.  Common among patients residing in paddy cultivating areas  Male to female ratio = 4: 1

Dr. Ananda Gunewardena6 Etiology  Unknown Primary cause  Possible causes: Chronic exposure to heavy metals such  Cadmium  Fluoride

Dr. Ananda Gunewardena7 Diagnosis and Treatment  Diagnosis Urine Albumin test Blood Creatinine test US scanning of kidney  Treatment Kidney replacement treated by using dialysis Medical management of metabolic abnormalities

Dr. Ananda Gunewardena8 Financial Needs  Chronic kidney disease clinics for identification and management of patients  (approximately 3000 patients are being treated)  Pharmaceuticals  Maintenance dialysis for end stage renal disease  Kidney transplantation for eligible patients

Dr. Ananda Gunewardena9 Hemodialysis Units in Sri-Lanka

Dr. Ananda Gunewardena10 Special Burdens  High disease burden in Kurunegala and Anuradhapura districts  Being in the most affected provinces, these hospitals have to care for more patients  Results in high cost of care and shortage of resources

Dr. Ananda Gunewardena11 Related Issues  Acute renal failure is prevalent in this region mainly due to Snake bites Leptospirosis etc.

Dr. Ananda Gunewardena12 Statistics Successfully Treated Deaths Snake bites Leptospirosis Total

Dr. Ananda Gunewardena13 Current Status  Dialysis unit Three Hemodialysis machines and A peritoneal dialysis section.  Current dialysis unit serves only a small proportion of patients Grossly inadequate to meet the demand.

Dr. Ananda Gunewardena14 Estimated Needs  Hemodialysis unit with 25 dialysis machines and chairs.  Ten-bed Peritoneal dialysis section  Male and female wards

Dr. Ananda Gunewardena15 Existing Facilities  Twenty five peritoneal dialysis section  16-bed male and female wards  Water purification plant for hemodialysis  Consultant MOO, nurse manager and clinic nurses with nursing station  Restrooms for MOO, nurses and non-medical staff  Supply, storage, linen and sterilization areas  Academic areas

Dr. Ananda Gunewardena16 Costs  Machine costs Rs. 30 million / 15 hemodialyis machines Rs. 5 million for a water purification plant  Cost of consumables Hemodialysis: RS. 2.4 million Peritoneal dialysis : Rs. 1.5 million Intensive care hemodialysis: Rs. 0.6 million  Rs million building (CECB estimate)

Dr. Ananda Gunewardena17 Wish List  Dialysis machines of following brands Dialog, B’Braun, Fresenius, Gambro  Consumables Diacaps Blood line set Concentrate can (bicarbonate & acetate) Transducer protector (two per dialysis)