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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Causes, complications and short-term outcome of acute Kidney injury in a resource-limited setting(SAGE-Hindawi Access to Research, 2024-12) Herath, N.; De Silva, S.; Liyanage, P.; Kumara, S.; Devi, S.; Abeysekara, V.; Mallawarachi, R.; Perera, S.; Karunathilaka, I.; Samarasinghe, S.; Weerakoon, K.AIMS The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90-day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. METHODS Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. RESULTS Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212-45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow-up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p=0.017). More severe AKI was associated with type 2 diabetes (p=0.0042), hypertension (p < 0.0001) and multiple comorbidities (p=0.0014). Persons with no comorbidities had less severe AKI (p=0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35-0.99 and p=0.047). CONCLUSIONS AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka.Item Anaemia due to chronic kidney disease: A cross-sectional analysis from a tertiary referral centre in Sri Lanka(Ceylon College of Physicians, 2023) Lakmini, S.; Dilhani, N.; Luke, W. A. N. V.; de Silva, S.INTRODUCTION: Anaemia is a common complication of chronic kidney disease (CKD) that adversely affects cardiovascular health and quality of life. Data on anaemia in Sri Lankan CKD patients is scarce. OBJECTIVES: This study was conducted to assess the prevalence, associations, and treatment response of anaemia in a cohort of patients with CKD. METHODOLOGY: A descriptive cross-sectional study was conducted among consecutive, consenting adult patients with stable CKD attending clinics and wards of the University Medical Unit, Colombo North Teaching Hospital, Ragama. RESULTS: Of 149 patients with CKD (males 57.7%), 70.5% had diabetes, 83.9% had hypertension and 37.6% had ischemic heart disease. Anaemia was present in 90.6% of females and 93% of males. The severity of anaemia was significantly (p=<.05) associated with female gender, advancing CKD stage, diabetes, chronic liver cell disease, being on dialysis, and increasing degree of proteinuria. Of 91 patients investigated for the cause of anaemia, 60.4% had iron deficiency with anaemia of chronic disease, while 27.5% had anaemia of chronic disease based on the blood picture. Of 88 patients with haemoglobin <10g/dl, only 45.4% were on erythropoietin and 56.8% had received blood transfusions. 76.1% of the anaemic patients had hemoglobin below 10g/dL at follow-up despite treatment. CONCLUSIONS: Anaemia was highly prevalent in the CKD cohort with a significant number requiring transfusions. Patients continued to have anaemia despite being treated with nutritional supplements and erythropoietin.Item Desidustat in anemia due to Non-Dialysis-Dependent Chronic Kidney Disease: A phase 3 study (DREAM-ND)(Karger,New York, 2022) Agrawal, D.; Varade, D.; Shah, H.; Nazar, A.; Krishnan, J.; Shukla, V.; Ramakrishna, C.; Bandara, G.M.C.; Mavani, S.B.; Rajanna, S.; Jikki, P.; de Silva, S.; Ruhela, V.; Koradia, P.; Kansagra, K.; Kanani, P.; Sharma, N.; Zala, K.; Parmar, D.Background: Desidustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, is being developed to treat anemia in patients with chronic kidney disease (CKD) without dialysis dependency.Methods: In total, 588 patients with a clinical diagnosis of anemia due to CKD without dialysis need and with baseline hemoglobin of 7.0-10.0 g/dL (inclusive) were randomized in a 1:1 ratio to receive either desidustat 100 mg oral tablets thrice a week for 24 weeks or biosimilar darbepoetin subcutaneous injection 0.75 μg/kg once in 2 weeks for 24 weeks. The primary outcome was the change from baseline in hemoglobin to evaluation period of Weeks 16-24. Key secondary outcomes included the number of patients with hemoglobin response, changes in the hepcidin levels, changes in the vascular endothelial growth factor (VEGF) levels, and changes in the lipid and lipoprotein profiles.Results: Hemoglobin change from baseline to Weeks 16-24 was 1.95 g/dL in the desidustat group and 1.83 g/dL in the darbepoetin group (difference: 0.11 g/dL; 95% CI: -0.12, 0.34), which met prespecified non-inferiority margin (-0.75 g/dL). The hemoglobin responders were significantly higher (p = 0.0181) in the desidustat group (196 [77.78%]) compared to the darbepoetin group (176 [68.48%]). The difference of change in hepcidin from baseline to Week 12 and Week 24 (p = 0.0032 at Week 12, p = 0.0016 at Week 24) and the difference of change in low-density lipoprotein from baseline to Week 24 (p value = 0.0269) between the two groups was statistically significant. The difference of change from baseline in VEGF to Weeks 12 and 24 between the two groups was not statistically significant.Conclusion: Desidustat is non-inferior to darbepoetin in the treatment of anemia due to non-dialysis dependent CKD and it is well-tolerated.Item Epidemiology of chronic kidney disease in two tertiary referral centres in Sri Lanka(Journal of the Ceylon College of Physicians, 2019) Herath, H.M.N.J.; Perera, H.S.S; Karunathilaka, M.A.I.B.B.; Perera, U.M.S.; Bandara, D.M.P.; Samarasinghe, S.M.S.N.; de Silva, S.T.INTRODUCTION AND OBJECTIVES: Chronic kidney disease (CKD) has become a major public health problem in Sri Lanka. The worldwide leading underlying causes for CKD are diabetes, hypertension and glomerulonephritis. There is regional variation in CKD prevalence in Sri Lanka due to the presence of a CKD of uncertain aetiology (CKDu). The objectives of our study were to identify aetiology, clinical stage and associated co-morbid diseases in patients with CKD referred to the Nephrology Service. METHODOLOGY: This cross-sectional descriptive study was carried out over one-year at Colombo North Teaching Hospital (CNTH), Ragama and District General Hospital, Negombo, from May 2018. All data was obtained from CNTH Renal Registry. RESULTS: Data of 1147 patients were studied. Mean age was 61.8 (SD 13.6) years, 683 (59.8%) were male and the majority [969 (84.5%)] were from Gampaha District. The primary renal disease was diabetes in 645 (56.2%), hypertension in 251 (22%) and glomerulonephritis in 40 (3.5%). There were only 16 (1.4%) patients with CKD-u and none were from Gampaha district. 539 (47%) were in CKD stage III, 329 (28.7%) in stage IV and 147 (12.8%) in stage V; there was no significant difference in the mean age of patients in each CKD stage. The commonest co-morbidity was hypertension, present in 180 (15.7%) patients. CONCLUSION: The commonest causes of CKD in Gampaha district were diabetes and hypertension, with no cases of CKDu. Screening patients with diabetes and hypertension for CKD is mandatory. More research is needed in to CKD due to identifiable causes in the non-CKDu regions of the country, since this appears to be an emerging and under-appreciated problem.Item Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka-lessons learned from the WHO CKDu population prevalence study(BioMed Central, 2014) Redmon, J.H.; Elledge, M.F.; Womack, D.S.; Wickremasinghe, R.; Wanigasuriya, K.P.; Peiris-John, R.J.; Lunyera, J.; Smith, K.; Raymer, J.H.; Levine, K.E.The recent emergence of an apparently new form of chronic kidney disease of unknown aetiology (CKDu) has become a serious public health crisis in Sri Lanka. CKDu is slowly progressive, irreversible, and asymptomatic until late stages, and is not attributable to hypertension, diabetes, or other known aetiologies. In response to the scope and severity of the emerging CKDu health crisis, the Sri Lanka Ministry of Health and the World Health Organization initiated a collaborative research project from 2009 through 2012 to investigate CKDu prevalence and aetiology. The objective of this paper is to discuss the recently published findings of this investigation and present additional considerations and recommendations that may enhance subsequent investigations designed to identify and understand CKDu risk factors in Sri Lanka or other countries.