Utility of Self-Reported Heat Stress Symptoms and NGAL Biomarker to Screen for Chronic Kidney Disease of Unknown Origin (CKDu) in Sri Lanka

Pavithra N. Kulasooriya, Kithsiri B. Jayasekara, Thilini Nisansala, Sajani Kannangara, Ranawaka Karunarathna, Chaminda Karunarathne, Mahinda Wikramarathne and Steven M. Albert
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Pavithra N. Kulasooriya: University Hospital, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka
Kithsiri B. Jayasekara: Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka
Thilini Nisansala: University Hospital, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka
Sajani Kannangara: Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka
Ranawaka Karunarathna: Provincial Directors’ Office, Anuradhapura 5000, Sri Lanka
Chaminda Karunarathne: Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Colombo 10290, Sri Lanka
Mahinda Wikramarathne: Faculty of Allied Health Sciences, University of Peradeniya, Kandy 20400, Sri Lanka
Steven M. Albert: Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA 15621, USA

IJERPH, 2021, vol. 18, issue 19, 1-11

Abstract: Objective. We examined heat stress symptoms and urine markers of chronic kidney disease (CKDu) in Sri Lanka to assess differences between endemic vs. non-endemic regions and by occupation. Sample and Methods. We assessed a total of 475 villagers. In the endemic region, 293 were agricultural workers and 67 were not working primarily in agriculture. In the non-endemic region, 76 were agricultural workers. Of the residents, 218 were assessed for neutrophil gelatinase-associated lipocalin (NGAL), an early predictor of acute kidney injury, along with urine markers of chronic kidney disease. Results. The mean (sd) age of the sample was 45.2 (12.6), with males comprising 52.7%; 7.2% reported kidney disease ( n = 34), and 5.7% reported diabetes ( n = 27). The heat stress index (mean (sd)) was highest among agricultural workers in the endemic region (8.05 (5.9)), intermediate in non-agricultural workers in the endemic region (4.61 (4.5)), and lowest among agricultural workers in the non-endemic region (3.85 (3.3)); p < 0.0001. Correlations were higher between NGAL and serum microalbumin in the endemic agricultural worker sample than in the other two samples (Spearman’s r = 0.34 vs. 0.15 and 0.20). Conclusions. Both heat stress symptoms and NGAL values were higher among agricultural workers in endemic CKDu regions. Correlations between NGAL and microalbumin suggested a link between acute kidney injury and chronic kidney disease in the more-exposed sample.

Keywords: chronic kidney disease; Sri Lanka; heat stress; agriculture; NGAL (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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