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Published on October 1, 2026

A paper co-authored by DI Faculty Fellow Dr. Firdosi Mehta reached 500 Citations in September 2026 on Research Gate. Articles that reach this milestone after 10 years represent a steady, highly respected, and enduring contribution to the field, averaging around 30 to 40 citations a year.

This 2013 study by Jayatilake and colleagues (including Dr Firdosi Mehta) investigated the prevalence and possible causes of chronic kidney disease of uncertain aetiology (CKDu) in agricultural communities in North Central Sri Lanka. CKDu is characterized by progressive kidney damage that cannot be explained by diabetes, hypertension, or other recognized causes. The study was undertaken as part of a national research project supported by the Sri Lankan Ministry of Health and WHO.

A cross-sectional population study was conducted in three CKDu-endemic districts between 2010 and 2012. Among 6,698 invited adults aged 15–70 years, 4,957 participated and 733 met the study's CKDu definition, based primarily on persistent albuminuria and exclusion of recognized kidney diseases. Researchers compared CKDu cases with controls from both endemic and non-endemic areas and analysed urine, blood, hair, nails, food, water, soil, fertilizers and pesticides for potentially nephrotoxic substances.

The age-standardized prevalence was substantial—16.9% among females and 12.9% among males. Prevalence increased with age, while more advanced disease was disproportionately observed among men. Being older than 39 years and working as a farmer, particularly in chena cultivation, were associated with increased risk.

The strongest environmental finding concerned cadmium exposure. Urinary cadmium concentrations were significantly higher in CKDu patients than in controls, and increasing urinary cadmium was associated with more advanced CKDu stages. Cadmium was also elevated in some locally produced foods, particularly certain vegetables and lotus products, while soil in endemic areas contained higher cadmium concentrations.

The study also identified multiple potential contributing exposures. Arsenic concentrations were elevated to levels associated with kidney injury, 63% of CKDu patients had serum selenium below 90 μg/L, and pesticide residues above reference levels were detected in 31.6% of cases. However, drinking-water samples generally did not show consistently elevated cadmium, arsenic or lead.

The authors therefore concluded that CKDu is probably multifactorial, with chronic low-level cadmium exposure through the food chain and pesticide exposure potentially playing important roles. Low selenium and genetic susceptibility may increase vulnerability. The study did not establish a single definitive cause, and the authors acknowledged limitations including the cross-sectional design, limitations of the CKDu case definition, and lack of biopsy confirmation.

Find the full study here:

Jayatilake, N., Mendis, S., Maheepala, P., & Mehta, Firdosi R. (2013). Chronic kidney disease of uncertain aetiology: prevalence and causative factors in a developing country. BMC Nephrology, 14(1), 180.

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