By Annahl Anbini Hoole –
Chronic Kidney Disease (CKD) is a non-communicable disease that affects 10% of the global population to some degree, but goes undiagnosed till the later, more dangerous stages when symptoms appear. Numbers are rising disproportionately in Sri Lanka, especially of CKD of unknown etiology (CKDu – meaning no one knows the cause).
The Sri Lankan Government therefore set up a Presidential Task Force on CKDu in 2014. Although it was thought to affect mostly older, male agricultural workers who are chronically exposed to pesticides and other chemicals, there is now an increase in cases among children and females. With more than 15% of the population in the North Central and Uva Provinces affected, CKDu is now spreading to the Northern, Eastern, North Western, Central, and Southern Provinces.
To prepare the people in the Northern Province, the Lions’ Club has come forward to raise awareness and has begun a fund to help people. They also organized this public health awareness seminar on CKD at the District Secretariat Auditorium in Nallur on March 15, 2017.
Lion R. Rakini, Lions’ Club Nallur President delivered the welcome address and Lion Dr. V. Thiyagarajah, the 306 B1 Centennial District Governor, gave the keynote address and distributed informational leaflets.
We all have two kidneys that are about the size of your fist and lie in the middle of your back on either side of your spine. The kidneys’ main jobs are to filter our blood by removing waste products and extra water through urine. They help control blood pressure, make red blood cells, and maintain healthy bones. They also filter out waste products from our food, drink, medicines, and breakdowns from muscular activity.
Chronic Kidney Disease (CKD):
In CKD, the kidneys are damaged and cannot complete their job. It happens over the course of 5 stages, with symptoms not showing until later stages. As the stages progress your blood pressure might increase, you might have low red blood cells (anemia), weak bones, a change in urine and its output, swelling feet, fatigue, and back pain. These can eventually lead to kidney failure and death. There has been a 134% increase in deaths resulting from CKD worldwide, with incidence of end stage renal disease more than doubled at the Teaching Hospital, Jaffna in 2012-2015. Dr. V.G. Rajeev (Regional Epidemiologist), standing in for Dr. Nanthakumar, Regional Director of Health Services, pointed out that deaths caused by non-communicable diseases (like heart disease, diabetes, and kidney disease) now surpass those by other non-communicable diseases (like dengue and malaria).
From left to right: Dr. R. Surenthirakumaran, Dr. T. Saththiyamoorthy, Mr. Alvapillai Siri, Dr. V. Thiyagarajah, Mr. V.Niranjan, Dr. V. Rajeev, Dr. Ranga Weerakkody
Dr. T. Peranantharajah, Consultant Physician for the Teaching Hospital gave a folksy, entertaining talk on prevention. Along with regular checkups with your doctor, a healthy lifestyle can prevent you from getting kidney diseases, manage your risk factors, and slow down the progression of kidney disease. He talked about the importance of managing what you put into your body. Poor eating habits, smoking, drinking alcohol, and obesity are all associated with kidney disease. Dr. Peranantharajah recommended a whole-grain (preferably vegetarian) diet, with lots of non-chemically treated fruits, nuts, legumes, and vegetables and less sodium, sugar, and red meats. He condemned white foods except milk. Another important lifestyle change is increasing our physical activity. As he says “Our society is plagued by an addiction to cereals: we start our day with cereals, then come home after work and plunk ourselves in front of our TV set watching mega-serials.”
He recommends walking at least a half an hour every day, as well as making small changes like taking the stairs instead of the elevator, getting down two bus-stops earlier so we have to walk. Cars promote health better than motorbikes because you cannot park at the entrance and need to walk. It is not enough; however, to saunter from one house to the next house, stopping at each gate to pick up on the latest news as seems the customary Jaffna “exercise”. By exercise, he means varying your pace and walking fast enough to increase your heart rate. “Even if there is no god, it’s good to believe in god so we can walk to the temple,” he says. To re-activate our muscles, traditional kitchens with ammis, urals and kappis are better than grinders, mortars, and pumps, respectively, he advises.
Lose weight if you must; keep your body mass index within a healthy range. For obesity check, a rough calculation by him is height in cm minus 100 should be our weight in kg. Stop smoking if you are a smoker, and limit how much alcohol you drink. Another important point he brought up was to not take more medication (i.e. NSAIDs like aspirin, ibuprofen, and naproxen) than recommended by your doctor, as filtering these is a burden on your kidneys.
Dr. Peranantharajah also urged everyone to drink more water, not colored drinks or soda, just clean, pure water. Many avoid drinking water so we don’t have to go to use a public bathroom. However, holding your urine and not drinking enough water can cause urinary tract infections, which if recurrent and untreated can lead to kidney damage. By drinking enough water, your kidneys can use that water to filter out waste products through your urine.
Dr. R. Surenthirakumar, head of Community and Family Medicine at University of Jaffna, presented his research done with students at the Teaching Hospital. It showed that diabetes and hypertension are the biggest risk factors among newly diagnosed CKD patients in 2014, followed by an unknown cause (CKDu), renal calculi, and recurrent urinary tract infections. CKDu is not associated with common risk factors like diabetes or hypertension. He also found that Jaffna (specifically in Nallur, Karainagar, and Delft) has the most newly diagnosed patients, followed by Kilinochchi and Mullaitheevu, and then Mannar. Keep in mind that this study only takes into account patients at the Jaffna Teaching Hospital and excludes data from other clinics/hospitals. Among the newly diagnosed CKD patients 50% were aged 17-49 years, 32% were 50-69, and 18% over 70, with males afflicted more than females.
The WHO found that the typical CKDu patient is a poor male farmer aged 40-70 years, with a family history of kidney disease. Keep in mind that although this is the typical CKDu patient, there are other types of CKD and that in Dr. Surenthirakumar’s sample pool, house-wives were the most affected, followed by farmers, businessmen, and then teachers.
Dr. Surenthirakumar and his team also found that 29% were diagnosed at an early stage, while 70% only at a later stage. This is why regular check-ups are important. Hypertensive patients should get their blood pressure checked by a doctor at least every year (aim for pressure below 140/90) and diabetics should check their Hb A1C at least every 6 months (aim for below 7.0%). Tests to check for kidney disease are a urine test (looking for excessive protein) and a blood test for your glomerular filtration rate (GFR – checks for a waste product called creatinine from muscle tissue).
Treatment plans depend on what stage of kidney disease you have, besides your other health problems. It includes managing your blood pressure, cholesterol, and blood sugar if they are high, protecting kidney function with certain medications, treating any symptoms (e.g. anemia, bone disorder), and tracking your progress. Treatment can help slow down or stop kidney disease, depending on what stage you are in, how carefully you follow your treatment plan, and what caused your kidney disease. If kidney disease gets worse it can lead to kidney failure, which has no cure.
Dr. Ranga Weerakkody, a consultant nephrologist at the Teaching Hospital, Jaffna, discussed treatments that can replace the work of your kidneys.
Evincing a spirit of reconciliation, he sat through two hours of talks in Tamil, which he does not understand. He apologized for speaking in English and noted that for those who have come through the war, tackling CKD is a minor issue; however, he added that CKD is worse than the war. Appreciating his sentiment, however, I respectfully disagree because CKD is preventable and only affects approximately 10-15% of the population, while the war was out of people’s hands and affected everyone.
Dialysis is offered in Jaffna and Vavuniya within the Northern Province, and kidney transplants only in Colombo and Kandy. Dialysis removes wastes and extra water from your body. In hemodialysis, more commonly used in Sri Lanka, a machine pumps blood out of the body, filters any toxins the kidney could not remove, and then returns the filtered blood back to the body. In kidney transplants, a healthy kidney from a matched donor is placed in your body. Certain tests are done to confirm matching to ensure the body does not reject the transplanted organ.
Although early stages of kidney disease are hard to detect, with regular checkups by your physician and routine tests, it can be caught early and treated. Make sure to eat healthful meals, drink lots of water, and exercise. Remember that Kidney Disease can present in anyone, so regardless of your age, weight, class, or gender make sure you check-in with your doctor regularly – a yearly visit can do no harm.
Mr. Alvapillai SIRI (Divisional Secretary, Nallur), Dr. T. Saththiyamorthy (Director of the Teaching Hospital, Jaffna) also spoke. And Lion V. Niranjan coordinated the event and gave a vote of thanks.