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

2. 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.

3. 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

4. Dr. Ananda Gunewardena4 Affects  Approximately 300-600 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

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

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

7. 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

8. 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

9. Dr. Ananda Gunewardena9 Hemodialysis Units in Sri-Lanka

10. 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

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

12. Dr. Ananda Gunewardena12 Statistics - 2007 Successfully Treated Deaths Snake bites 101606 Leptospirosis 15105 Total 116711

13. 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.

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

15. 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

16. 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. 33.5 million building (CECB estimate)

17. 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)