This project is an interdisciplinary effort between The University of Peradeniya (Sri Lanka), The University of Connecticut and Stanford University (USA).
Chronic kidney disease of unknown etiology is currently the world’s most common tubulointerstitial kidney disease. A distinct profile of patients are affected young-to-middle aged, predominantly men, working strenuously at high temperatures, applying pesticides without protection and drinking water from nearest available field sources. We are observing high rates of death that are completely out of the expected range given the demographics, and obesity and diabetes rates in the affected communities. Three regional epidemics of kidney disease have occurred in the 20th century, all due to singular environmental exposures and all manifesting as a primary tubulointerstitial kidney disease.
Aim 1: To test whether consumption of candidate agrochemicals via well water increases risk for incident CKDu.
Aim 1a. To test the association of contaminated well water consumption and candidate well water agrochemicals with likelihood of incident case status, accounting for work intensity and heat stress.
Aim 1b. To compare the bioburden of persistent agrochemicals identified in well water from our preliminary work (diazinon, p,p’-DDE, endosulfan II, and propanil) in cases versus controls.
Aim 2: To determine gene expression patterns in patients with early-stage CKDu in order to precisely classify CKDu as a primarily tubular injury versus autoimmune or infectious disease
Manuscripts to date:
- Shipley et al. (2022) Agrochemical exposure in Sri Lankan inland water systems https://www.sciencedirect.com/science/article/pii/S2666765721001216
- Vlahos et al. (2021) Water sources and kidney function: investigating chronic kidney disease of unknown etiology in a prospective study https://www.nature.com/articles/s41545-021-00141-2.pdf?proof=t+target%3D
- Anand et al. (2020) Using GIS Mapping to Track Hot Spots of Kidney Disease in California https://www.nejm.org/doi/full/10.1056/NEJMc2001023
- Vlahos et al. (2018) Kidney progression project (KiPP): Protocol for a longitudinal cohort study of progression in chronic kidney disease of unknown etiology in Sri Lanka https://www.tandfonline.com/doi/full/10.1080/17441692.2018.1508480