Browsing by Author "Dassanayake, R.T."

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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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    Zinc supplementation in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study. (ZisCKDu-P)
    (Ceylon College of Physicians, 2020) Abeysundara, P.K.; Nishad, N.; de Silva, S.T.; Dassanayake, R.T.; Galabada, D.P.; Jayawardane, U.G.W.; Premawardana, N.P.; Kumara, G.M.S.S.; Dilani, P.M.; Herath, H.M.T.D.; Wijesinghe, P.S.
    INTRODUCTION: It was hypothesized that the antioxidant properties of zinc retard the progression of chronic kidney disease of unknown etiology in the North Central Province of Sri Lanka. METHODS: The pilot study was a randomized, placebo-controlled, single blinded, parallel group, single-center clinical trial with two arms (Z and P) and a 1:1 allocation ratio. Participants in group Z (n=20) received 60 mg of elemental zinc daily, in the form of zinc sulfate, and group P (n=21) received a starch tablet per day. Clinical, hematological parameters and kidney function were measured at the baseline and following three months of the intervention. RESULTS: A total of 86 CKDu patients were screened; only 35 males and 6 females were selected. Mean age and estimated glomerular filtration rate of the study population were 51.2±6.2 years and 38.9±8.8 mL/min/1.73 m2 respectively. At the end of three months there was non-significant increase in urine protein creatinine ratio (Z arm: 65±54 vs. 82± 86 mg/mmol; P=0.46, P arm: 72.4±113 vs. 120± 209 mg/mmol; P=0.36) and non-significant decline in estimated glomerular filtration rate (Z arm: 40.9±10.4 vs. 39.7±9.2 mL/min/1.73 m2; P=0.31, P arm: 37.1±6.8 vs. 36.4±10 mL/min/1.73m2; P=0.31) in both groups. Body mass index was significantly reduced (23±4 vs. 22.7± 3.9 kg/m2; P=0.01) and diastolic blood pressure was significantly increased (78±6 vs. 86±10 mmHg; P=0.001) in the placebo arm. Haemoglobin levelshowed a decline in the study group; 0.33±1 g/dl, while there was an increase in the placebo group, 0.34±0.7 g/dl, (P=0.02). There were no major side effects. CONCLUSIONS: The change of urine protein: creatinine ratio and estimated glomerular filtration rate did not show a significant difference between the two groups. A future trial should test effectiveness of same dose of zinc for a similar duration of time in a larger sample. Extended follow-up of the study subjects for one year after the intervention would be useful to assess the long-term effects of zinc on kidney function and side effects.