Medicine

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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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    Regional variation in chronic kidney disease and associated factors in hypertensive individuals in rural South Asia: findings from control of blood pressure and risk attenuation-Bangladesh, Pakistan and Sri Lanka.
    (Oxford University Press, 2019) Feng, L.; de Silva, H.A.; Jehan, I.; Naheed, A.; Kasturiratne, A.; Himani, G.; Hasnat, M.A.; Jafar, T.H.; COBRA-BPS Study Group
    BACKGROUND: We aimed to determine the prevalence of chronic kidney disease (CKD) and its cross-country variation among hypertensive individuals in rural Bangladesh, Pakistan and Sri Lanka. We also explored the factors associated with CKD in these populations. METHOD: We studied baseline data from the Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan and Sri Lanka (COBRA-BPS) trial, an ongoing cluster randomized controlled trial on 2643 hypertensive adults ≥40 years of age from 30 randomly selected rural clusters, 10 in each of the three countries. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or a urine albumin:creatinine ratio (UACR)  ≥30 mg/g. Determinants for CKD were assessed using logistic regression analysis. RESULTS: The overall prevalence of CKD was 38.1% (95% confidence interval 36.2-40.1%): 21.5% with eGFR <60 mL/min/1.73 m2 and 24.4% with UACR ≥30 mg/g. CKD prevalence varied across the three countries (58.3% in Sri Lanka, 36.4% Bangladesh and 16.9% Pakistan; P <0.001). The factors independently associated with higher odds of CKD were older age, being unmarried, higher 24-h urinary sodium excretion, presence of diabetes, elevated systolic blood pressure, diuretic use and living in Bangladesh or Sri Lanka (versus Pakistan). CONCLUSIONS: The prevalence of CKD is alarmingly high in community-dwelling hypertensive adults, with significant cross-country variation in South Asia. Our findings underscore the urgency for further research into the etiology of CKD and address associated factors in targeted public health strategies with hypertension care outreach services in rural South Asia.
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    Protein energy malnutrition in patients with chronic kidney disease in Sri Lanka
    (Sri lanka Medical Association, 2015) Dassanayake, R.T.; Gunarathne, R.M.C.L.; Gunasekara, V.C.D.G.; de Silva, S.T.
    INTRODUCTION AND OBJECTIVES: Worldwide, there is a higher prevalence of protein energy malnutrition (PEM) among patients with chronic kidney disease (CKD), compared to the general population. Biomarkers of under nutrition are associated with worse CKD outcomes and mortality. Our objectives were to determine prevalence of PEN/! in CKD patients and to assess the relationship between PEM and age, sex and CKD stage. METHOD: Adult CKD patients attending Kidney Disease Treatment and Research Centre clinics at Teaching Hospital, Anuradhapura, from 1st-31stAugust 2014 were recruited. Patients on dialysis or after renal transplantation, were excluded. CKD was defined using KDIGO guidelines. Body Mass Index (BMl), mid arm circumference (MAC), Triceps Skin-fold thickness (TSFT), most recent eGFR and knowledge about protein intake were assessed. RESULTS: 670 patients were enrolled. Average age was 58.2 years (SD 10.5 years). 634/670 (94.7%) were >40 years. 487/670 (72.7%) were men. 206/670 (30.7%) were in CKD Stage 3, 256/670 (38.2%) in Stage 4 and 153/670 (22.8%) in Stage 5. 165/670 (24.6%) had a BMI<18.5kg/m2; male sex (p<0.043) was significantly associated. 637/670 (95.1%) had a low MAC; male sex (p<0.001), age >40 years (/xO.OOl), and CKD Stage >3 (p<0.001) were significantly associated. 581/670 (86.7%) had a low TSFT; male sex (p<0.049) and CKD Stage >3 (p<0.001) were significantly associated. 359/670 (53.6%) were voluntarily restricting protein intake. 321/670 (47.9%) thought protein harmed their kidneys. CONCLUSION: A majority of CKD patients had PEM. Older men in CKD stage >3 were significantly more likely to have PEM. Since adequate nutrition is protective, assessment of nutrition parameters and correction of PEM whenever possible must be prioritised in CKD management.
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