Chronic Kidney Disease, a time bomb waiting to explode, cautions Dr. Vindya Gunasekara, urging prevention as the “best” remedy By Kumudini Hettiarachchi  The chat between ‘Podi Malli’, ‘Chuti Malli’ and experts is meant to “catch” them young and promote kidney health through YouTube. The carefully-thought-out video featuring trending actors Gaminda Priyaviraj and Suneth Chithrananda launched [...]

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How to protect your kidneys

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  • Chronic Kidney Disease, a time bomb waiting to explode, cautions Dr. Vindya Gunasekara, urging prevention as the “best” remedy

By Kumudini Hettiarachchi 

The chat between ‘Podi Malli’, ‘Chuti Malli’ and experts is meant to “catch” them young and promote kidney health through YouTube.

Dr. Vindya Gunasekara

The carefully-thought-out video featuring trending actors Gaminda Priyaviraj and Suneth Chithrananda launched on Wednesday (March 12), declared World Kidney Day is meant to be viewed over and over again and not just during the hype of an international day. The whole of March is World Kidney Month.

It is a health education platform which telecasts two short videos on how to safeguard the kidneys.

Roughly the size of a fist each, this pair of bean-shaped organs located below the rib cage flanking the spine, plays the vital role of removing waste products from the body, maintaining balance in the electrolyte levels and regulating blood pressure.

Seated in her small office in the Nephrology Unit of the Lady Ridgeway Hospital (LRH) for Children, Colombo, the President of the Sri Lanka Society of Nephrology, Dr. Vindya Gunasekara speaks with emotion about the children she has to treat.

Chronic Kidney Disease (CKD), generally is a time-bomb waiting to explode, she stresses, as there are no early symptoms of illness until about 70% of the kidneys are damaged. “Some people are alright even with little surviving (only about 7-10%) renal tissue when they are in end-stage kidney disease. They are very ill and the only options to prolong life are dialysis and kidney transplantation.”

The costs are horrendous, according to Dr. Gunasekara. Moderate kidney damage or Stage 3, necessitates routine monitoring to delay the progression and the monthly expenditure for consumables alone to provide bare minimum haemodialysis would be an exorbitant Rs. 80,000 per month. Better dialysis with the addition of services and medications would double this amount (Rs. 160,000 a month) which not just the families but even the government can hardly afford.

This is the reality even in developed countries, it is understood.

She recalls with emotion, a child with congenital kidney disease whom she had treated from birth. This family owned a car, but by the time the treatment was over and the child had a kidney transplant, they could not even afford a bicycle.

The Director-General of Health Services, Dr. Asela Gunawardena, addressing the event on March 12

Assuring that as a low-resource country, Sri Lanka was spending “a lot” to look after the kidney health of its people, she urges prevention as the best “remedy” and way forward.

To prevent the onset of CKD, Dr. Gunasekara strongly advocates that adults “must” eliminate or control the root causes which are diabetes (sustained high blood sugar levels), hypertension (high blood pressure) and ischaemic heart disease.

“These non-communicable diseases (NCDs) may be prevented by eating a healthy diet with less sugar and salt and adequate exercise,” she says, pointing out that if a person has these NCDs, then controlling them through medications is of paramount importance.

Awareness on kidney health

She effectively debunks the misinformation and misconception among Sri Lankans that metformin prescribed in the control of diabetes damages the kidneys. “It is absolutely not so – untreated diabetes, on the contrary, is a major cause of kidney disease.”

Another factor she looks at closely is the popping of painkillers at will and often not under the guidance of a doctor.

To schoolchildren, this is Dr. Gunasekara’s fervent plea: “With ample evidence that NCDs which are mainly adult diseases arise from childhood, take steps to prevent them. Even though such diseases may run in families, not everyone in those families will get them, if lifestyles are changed to ward them off.”

Children listening to why kidney protection is very important.

She puts forth some critical points for children and adolescents:

  • Eat a healthy balanced diet, avoiding foods including instant and processed foods which are heavily salted or sugared. There should be good quantities of vegetables and fruit in meals.
  • Take adequate hydration.
  • Go to the toilet when in school when the need arises – most hold on until they get home which is not good for them.
  • Minimise stress.
  • Don’t smoke.

While telling children and adolescents to avoid the norm of tucking into fast food and also to say “no” to smoking, she points out to parents not to pack fast food even though it may be an easy way out amidst heavy routines. Schools and universities too should think about what is being sold in their canteens.

Dr. Gunasekara advises mothers of babies to be conscious about the food choices they offer them. If infants are fostered on foods which have high sugar and salt contents, they would have a preponderance for such foods as they grow up, in childhood and also adulthood.

On how to identify, kidney disease, she says that doctors would order blood and urine tests for those at risk, after taking a detailed case history.

Meanwhile, with regard to the scourge of Chronic Kidney Disease of unknown aetiology (CKDu) affecting people in certain areas like the Dry Zone, Dr. Gunasekara adds that the specific cause is unknown. Research has pointed towards multifactorial causes including agrochemicals, dehydration, water quality and maybe even genetics.  

(See ‘Podi Malli’, ‘Chuti Malli’ and experts on kidney health: https://youtube.com/@slson-public?si=RF8nU_NoukYFZbhj)

Rising risk of CKD in Sri Lanka – Kandy District study

Looking at data, Dr. Vindya Gunasekara says that globally 1 in 10 have some sort of kidney disease, with some causes progressing to irreversible damage to the kidneys. Worldwide around 850 million and in South Asia, according to research, 10-20% (1 in 10 or 1 in 5), have Chronic Kidney Disease (CKD).

For Sri Lankan data, she cites a study in the Kandy District done by Prof. Rajitha Abeysekera et al from the Centre for Education Research Training in Kidney Disease (CERTKiD), Faculty of Medicine, University of Peradeniya, in 2023.

Using a multi-stage, random-cluster-sampling method, the stratification had been according to age and sector – urban, rural and estate in this district, one of the most populated in the country, having arepresentative population. The sample had included consenting residents of Kandydistrict, aged ≥18 years and had excluded residents with arecent or current history of acute kidney disease. There had been 1,843 participants.

Giving first estimates of CKD prevalence in Sri Lanka from a representative region outside of CKDu endemic areas, it had found:

  • The overall prevalence of CKD in the Kandy District – 14.4%
  • In the ‘Urban’ population – 12.5%
  • In the rural population – 15.4%
  • In the estate population – 7.6%
  • Increasing age, male sex, presence of diabetes and hypertension identified as risk factors for CKD
  • Sri Lanka, with an ageing population and increasing rates of non-communicable diseases such as diabetes andhypertension, is facing a rising burden of CKD

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