1. Prevalence of Chronic Kidney Disease in an Urban Population
ST De Silva1,2, DM Gamage1, WSAA Yasith Udara1
1Department of Medicine, Faculty of Medicine, University of Kelaniya
2University Medical Unit, Colombo North Teaching Hospital, Ragama

2. INTRODUCTION
Prevalence of chronic kidney disease (CKD) is increasing worldwide –
population prevalence is >10%
>50% in high-risk subpopulations*
Median global prevalence is estimated to be –
7.2% in persons aged ≥30 years
23.4% % in persons aged ≥64 years**
Due to increasing incidence of Diabetes Mellitus (DM) and Hypertension (HPT) in aging populations
* Eckardt et al. Evolving importance of kidney disease: from subspecialty to global health burden.
Lancet July:382(9887):
**Zhang et al. Prevalence of chronic kidney disease in population-based studies: Systematic review.
BMC Public Health 2008, 8:117

3. Situation in Sri Lanka DM and HPT affect many Sri Lankan adults
Prevalence of DM in adults is 10.3%*
Prevalence of HPT is 18.8% for men and 19.3% for women (in 4 provinces)**
*Katulanda et al. Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka. Diabetes Medicine Sep;25(9):1062-9
**Wijewardene et al. Prevalence of hypertension, diabetes and obesity: baseline findings of a population based survey in four provinces in Sri Lanka. CMJ 2005 Jun;50(2):62-70.

4. CKD in Sri Lanka
Data on population prevalence of CKD in Sri Lanka is scarce
Published studies have mainly looked at hospital prevalence rates*
*Athuraliya et al. Prevalence of chronic kidney disease in two tertiary care hospitals: high proportion of cases with uncertain aetiology. CMJ 2009 Mar;54(1):23-5
*Gooneratne et al Epidemiology of chronic kidney disease in a Sri Lankan population. International Journal of Diabetes in Developing Countries Apr;28(2):60-4
*Wijewickrama et al. Epidemiology of chronic kidney disease in a Sri Lankan population: experience of a tertiary care center. Saudi Journal of Kidney Disease & Transplantation Nov; 22(6):

5. CKDu
CKD of uncertain aetiology (CKDu) in the some provinces of Sri Lanka receives much attention
High mortality & morbidity

6. CKDu Conflicting reports on CKDu prevalence rates WHO – 15.3%*
Previous estimates ranged from %**
*Investigation & evaluation of chronic kidney disease of uncertain aetiology in Sri Lanka – Final Report WHO 2013
** Athuraliya et at. Uncertain aetiologies of proteinuric chronic kidney disease in rural Sri Lanka. Kidney lnternational 2011;80(11);

7. METHODOLOGY
Ragama Health Study (RHS) - ongoing community based research project of the Ragama MOH area
RHS has 3012 recruited adult participants
Randomly selected subjects from RHS cohort
Informed written consent
Interviewer-administered questionnaire

8. METHODOLOGY Serum creatinine tested*
Estimated glomerular filtration rate (eGFR) calculated using the CKD-EPI formula
CKD defined as eGFR <60ml/min/1.73m2
(≥Stage III in KDIGO/KDOQI classification)**
*JAFFE method – all tests done at same laboratory
**Levey et al. The definition, classification, and prognosis of chronic kidney disease. Kidney International 2011 July; 80(1): 17-28

9. RESULTS
301 subjects
178/301 (59.1%) were female

10. Age Distribution
Mean age years (range years)

11. Distribution of CKD Stages
42/301 (14%) had eGFR <60ml/min/1.73m2
34/42 (81%) were in CKD Stage IIIA

12. Distribution of CKD Stages

13. Comparison of CKD & Non-CKD

14. Subjects with CKD were,
significantly older than 60 years (p<0.000)
more likely to have –
type 2 DM (p<0.012)
HPT (p<0.000)
IHD (p<0.031) hyperlipidaemia (p<0.023)
compared to those without CKD

15. Limitations
Urinary albumin to creatinine ratio (ACR) was not assessed due to cost constraints
Formulae used to calculate eGFR are known to systematically underestimate GFR
CKD-EPI performs better at higher GFR values than MDRD equation, but performance in elderly is uncertain

16. CONCLUSIONS
CKD prevalence in our sample (14%) is similar to the prevalence of CKDu in Rajarata (15.3% WHO 2013)
As expected, DM and HPT were the primary associated co-morbidities

17. CONCLUSIONS
Most subjects with CKD were in stage IIIA- when early recognition and better control of co-morbid factors are known to retard progression
CKD is under-recognized in Sri Lanka –
large population-based studies are needed to better understand the size of the problem and implement preventive strategies  

18. Acknowledgements
This study was carried out with the assistance of a WHO research grant provided to the Faculty of Medicine, University of Kelaniya
Laboratory services were provided at a concessionary rate by Asiri Hospital Laboratory Services