Hewavitharana Pasan, Schensul Stephen, Lee Edison, Montez-Rath Maria, Senarathne Sachintha, Liu Sai, Harold Kaitlin, Hewapathiranage Santhushya, Erandika Naduni, Abeysundara Hemalika T K, Yu Xue, Bhalla Vivek, Fire Andrew, Levin Adeera, Anand Shuchi, Vlahos Penny, Chandrajith Rohana, Nanayakkara Nishantha
Center for Research, National Hospital Kandy, Sri Lanka.
Department of Nursing, Faculty of Health Sciences, The Open University of Sri Lanka, Kandy, Sri Lanka.
Kidney Int Rep. 2023 Apr 21;8(7):1430-1438. doi: 10.1016/j.ekir.2023.04.010. eCollection 2023 Jul.
Chronic kidney disease of uncertain etiology (CKDu) is a leading cause of death of adults in Sri Lanka's dry region.
We initiated the Kidney Progression Project (KiPP) to prospectively follow 292 persons with Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rate (eGFR) 20 to 60 ml/min per 1.73 m living in a CKDu endemic area. Using data from 3-year follow-up, we assessed kidney function decline (>30% from baseline eGFR), and the composite outcome of >30% eGFR decline, eGFR <15 ml/min or death, and explored the association of the 2 outcomes with baseline demographic, residential, and clinical parameters accounting for baseline eGFR.
Median eGFR at enrollment was 28 ml/min among 71 women; 30 ml/min among 221 men; 91% to 99% had trace or no proteinuria during follow-up. At enrollment, median serum sodium, uric acid, and potassium were 143 mmol/l, 6.3 mg/dl, 4.5 meq/l, respectively among women; and 143 mmol/l, 6.9 mg/dl, 4.3 meq/l among men. Mean slope of eGFR decline was -0.5 (SD 4.9) ml/min/yr. In exploratory analyses, men with greater years of education and those living in northern region of the study area experienced lower likelihood of disease progression (hazard ratios [HR] 0.87 [0.77-0.98] per additional year and 0.33 [0.12-0.89] for northern versus other subregions, respectively). There was a suggestion that men drinking well water had higher likelihood and men living further away from reservoirs had lower likelihood of >30% decline in eGFR (HR 2.07 [0.95-4.49] for drinking well water versus not, and HR 0.58 [0.32-1.05] per kilometer distance, respectively).
The overall rate of kidney function decline was slow in this CKDu cohort, similar to other nonalbuminuric CKD, and event rates were similar among men and women. Further etiologic investigations could focus on specific residence locale and water use.
病因不明的慢性肾脏病（CKDu）是斯里兰卡干旱地区成年人死亡的主要原因。
我们启动了肾脏进展项目（KiPP），对生活在CKDu流行地区、慢性肾脏病流行病学协作组估算肾小球滤过率（eGFR）为20至60 ml/（min·1.73 m²）的292人进行前瞻性随访。利用3年随访数据，我们评估了肾功能下降情况（较基线eGFR下降>30%），以及eGFR下降>30%、eGFR<15 ml/min或死亡的复合结局，并探讨了这两个结局与基线人口统计学、居住情况和临床参数（考虑基线eGFR）之间的关联。
71名女性入组时的eGFR中位数为28 ml/min；221名男性为30 ml/min；91%至99%的人在随访期间有微量蛋白尿或无蛋白尿。入组时，女性血清钠、尿酸和钾的中位数分别为143 mmol/L、6.3 mg/dl、4.5 meq/L；男性分别为143 mmol/L、6.9 mg/dl、4.3 meq/L。eGFR下降的平均斜率为-0.5（标准差4.9）ml/（min·年）。在探索性分析中，受教育年限较长的男性以及居住在研究区域北部的男性疾病进展的可能性较低（每增加一年的风险比[HR]为0.87[0.77-0.98]，北部与其他子区域相比为0.33[0.12-0.89]）。有迹象表明，饮用井水的男性eGFR下降>30%的可能性较高，而居住在离水库较远的男性可能性较低（饮用井水与未饮用井水的HR为2.07[0.95-4.49]，每公里距离的HR为0.58[0.32-1.05]）。
该CKDu队列中肾功能下降的总体速度较慢，与其他非蛋白尿性慢性肾脏病相似，且男女的事件发生率相似。进一步的病因学调查可侧重于特定的居住地点和用水情况。
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