The evolving impact of Chronic Kidney Disease in a crisis-hit Sri Lanka By Dr. Malith Atapattu

Chronic kidney disease (CKD) is quickly becoming a major public health concern,
attracting increased global attention because of the disease’s rapid rate of incidence
and its grave impact on patients and their quality of life. In Sri Lanka alone, there are
over 164,000 identified CKD patients today, with another staggering 11,000 annually
diagnosed with the condition, and 10,500 eventually succumbing to the complications
caused by it.
So what is CKD and how does it come about? Essentially, CKD is the slow, progressive
and irreversible loss of kidney function over several years, to a point that brings about
kidney failure. Over time, the condition damages the routine functionalities of a kidney,
obstructing its ability to filter waste and fluid, and allowing harmful waste to build up to
such an extent that it harms a person’s health and wellbeing. It is usually caused by
other secondary conditions that put a strain on the kidneys, and is often the result of a
combination of different problems such as high blood pressure, diabetes, high
cholesterol, kidney infections, polycystic kidney disease, kidney stones, and even the
long-term use of certain medicines.
In CKD stages one to three, which are mild to moderate stages of the condition, patients
are generally unlikely to feel unwell or present symptoms. However, even at this point,
CKD can be diagnosed by an estimated glomerular filtration rate (eGFR) before any
symptoms develop.
Once a patient is diagnosed, the psychosocial toll it creates amplifies due to the
physical discomfort of the illness as well as treatment modalities such as oral
medications, hemodialysis, renal transplantation, dietary, and fluid restrictions.
Depending on the stage a patient is in, other stressors may include financial burden of
dialysis, high time commitment for dialysis, a feeling of worthlessness and a burden to
loved ones, a fear of pain through treatment, low sleep cycles, eating restrictions, and
the constant worry of how all this impacts their families. In fact, these mental stressors
are not limited to the patient, their immediate communities and loved ones are also
affected by the massive commitment of frequent treatment that CKD creates.
Symptoms start to present strongly when the kidney damage starts becoming more
fierce – stage 4 or worse. If kidney function continues to gradually decline then various
other problems may develop – for example, anaemia and an imbalance of calcium,
phosphate and other chemicals in the bloodstream. These can cause various
symptoms, such as tiredness due to anaemia, and bone thinning or fractures due to
calcium and phosphate imbalance. Eventually, end-stage kidney failure, stage 5, can
prove to be fatal unless treated quickly and efficiently.
While the incidence of CKD elevates with age, the incidence of Chronic Kidney Disease
of Uknown Origin (CKDu) depends on a multitude of environmental factors. CKDu tends
to affect rural populations with limited access to safe drinking water and affects men
more than women. In many patients, CKDu will progress to end-stage renal disease,
which might be catastrophic for individuals in poor areas and communities where
access to renal replacement therapy is limited or not affordable.
While there is no cure for chronic kidney disease, treatment can slow or halt the
progression of the disease and can prevent other serious conditions from developing
because of it. To survive end-stage kidney disease, the individual may need to have
artificial kidney treatment, either through dialysis or with a kidney transplant to maintain
their quality of life and health, with both procedures placing an intense level of financial
burden on Sri Lankan patients and their loved ones.
Dialysis is one of the primary methods of treating CKD. It is a procedure to remove
waste products and excess fluid from the blood when the kidneys stop working properly,
and often involves diverting blood to a machine to be cleaned. In Sri Lanka, only 74
dialysis centers are currently available to cater to the frequent, island-wide demand of
164,000 patients, through just 482 machines.
With catastrophic numbers such as these, the national healthcare system often finds it
difficult to cater to the full requirement of all patients requiring dialysis, affecting their
health and wellbeing to a large degree. Further, in Sri Lanka where the worsening
macroeconomic conditions have put a gigantic strain on the healthcare supply chain, an
increasing number of CKD patients continue to be impacted negatively, with strain on
both their health and the wellbeing of their loved ones and communities.
In such a dire context, it has then become critical for the private healthcare sector to
step up to the plate to elevate their support to ensure that all CKD patients in Sri Lanka
have a fair and equal chance at a good life with access to the treatments and
medication they need to survive and thrive.

Dr. Malith Atapattu, Head of Medical Services – Hemas Hospitals

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