Chronic kidney disease of unknown etiology in Sri Lanka Quest for understanding and global implications

By Myles Elledge, Jennifer Hoponick Redmon, Keith Levine, RJ Wickremasinghe, KP Wanigasariya, RJ Peiris-John

This research brief examines chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. A new and growing public health challenge that has emerged in Sri Lanka, CKDu is epidemic in selected geographic areas of the country, primarily in its central and eastern dry zones. CKDu is not attributed to diabetes, hypertension, or other factors commonly associated with chronic kidney disease. A number of risk factors point to environmental triggers for the onset of CKDu, but evidence so far is insufficient to accurately pinpoint the potential cause or causes. Small studies conducted to date attempt to associate CKDu with agrochemicals, ayurvedic (traditional) medicines, water quality, or other environmental or lifestyle factors. This complex emerging health crisis requires an interdisciplinary approach, following strict field protocols and a rigorous environmental health risk assessment framework. Research and analysis to better understand CKDu are important for Sri Lanka and have global implications for understanding of similar geographic CKDu “hot spots” in Central America, Eastern Europe, and South Asia.


Elledge, M., Redmon, J. H., Levine, K., Wickremasinghe, RJ., Wanigasariya, KP., & Peiris-John, RJ. (2014). Chronic kidney disease of unknown etiology in Sri Lanka: Quest for understanding and global implications. (RTI Press Publication No. RB-0007-1405). Research Triangle Park, NC: RTI Press.

© 2019 RTI International. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


Myles ElledgeMyles F. Elledge, MPIA (Master of Public and International Affairs), is a senior director, Innovation Advisors, at RTI International.  

Jennifer Hoponick Redmon

Keith LevineKeith E. Levine, PhD, is a research analytical chemist in RTI’s Trace Inorganics group.

RJ WickremasingheRajitha J. Wickremasinghe, PhD, is a professor of public health at the University of Kelaniya, Sri Lanka.

KP WanigasariyaKamani P. Wanigasariya, PhD, is a professor in the Department of Medicine at Sri Jayaewardenepara University, Sri Lanka.

RJ Peiris-JohnRoshini J. Peiris-John, PhD, is a research fellow in the Section of Epidemiology and Biostatistics, University of Auckland, New Zealand.

Contact RTI Press

To contact an author, request an exam or review copy, or seek permission to use copyrighted content, contact our editorial team.