@phdthesis{oai:niigata-u.repo.nii.ac.jp:02000206,
 author = {Abeywickrama, Madushika Hansani},
 month = {2022-01-07, 2022-01-07},
 note = {For more than two decades, various tropical regions of the world have been experiencing increasing rates of chronic kidney disease (CKD) unrelated to conventional causes such as diabetes, hypertension, and other known etiologies. The etiology of the disease is still unclear; therefore, referred to as CKD of unknown etiology (CKDu). The disease has become a serious health problem in certain parts of Sri Lanka particularly, in North Central, Uva, and North-Western provinces. The aims of the study were to describe and characterize the nutritional status, anthropometry, symptom burden, and health-related quality of life (HRQOL) of CKDu patients in order to examine the association of nutritional status in the development of CKDu, to study the longitudinal changes in anthropometry in CKDu, and to assess the sarcopenia prevalence, symptom burden, HRQOL, and associated factors of CKDu patients. This was a prospective, longitudinal study that included a cohort of newlyidentified CKDu patients and an individually age- and the sex-matched control group who live in the same area. A total of 120 patients with CKDu stages II-V participated in the study and followed-up for a period of one year. Demographic and health-related characteristics data were collected from all the participants, and laboratory, symptom burden, and HRQOL data of CKDu patients were also collected. Each participant underwent anthropometric and body composition measurements at each 2-month interval. The mean age of the case and control group was 62 (SD-11), and 83 (69.2%) were men. A significantly higher proportion of CKDu patients were engaged in farming (93.3% vs. 82.5%) and had no or primary education (97.5% vs. 78.3%) compared to the control group. Study I: All basic anthropometric measures and indices except body muscle% (BM%) were higher in the control group than the case group; however, the actual magnitude of these differences was small or non-significant. The discriminative ability of anthropometric parameters was low (area under the ROC curve ≤0.6). Study II: The proportion of CKDu patients with low muscle mass, muscle strength, and physical performance was 77.5%, 70.8%, and 35.0%, respectively. The prevalence of sarcopenia was 66.7%, while 15% had severe sarcopenia. Only 5% of the CKDu patients had none of the indicators of sarcopenia. Men were more likely to be sarcopenic than women (OR-7.735; p=0.009). The likelihood of having sarcopenia was increased by 7.9 times with central obesity (p=0.041) and reduced by 6.12% with each unit increase in body mass index (BMI). Study III: There was a significant gain in body fat% and decline in BM% among elderly male CKDu patients over time with no significant effect on weight and BMI, which is referred to as masked obesity. Female CKDu patients demonstrated a significant gain in waist and hip circumferences; however, the effect on weight and BMI was significant only among young women. Study IV: The majority of patients (95%) reported experiencing at least one symptom, and 55.8% of them reported having 5 or more symptoms. Bone/joint pain was the most experienced symptom. The mean symptom burden, physical component summary, mental component summary, and kidney-disease-specific component scores were 12.71 (SD-10.45), 68.63 (SD-19.58), 78.53 (SD-18.78), and 81.57 (SD-5.86), respectively. Age was a significant predictor of HRQOL, while hemoglobin level and being a farmer were significant predictors of symptom burden. A number of important conclusions can be drawn from these results. First, this study unable to find any constructive evidence linking nutritional status to the development of CKDu. Second, evidence of a higher prevalence of sarcopenia among CKDu patients was found, even during the early stages of the disease. Third, elderly male CKDu patients demonstrated masked obesity with time, and therefore the integration of body composition measurements in addition to conventional BMI screening is recommended. Finally, CKDu patients in all stages experience symptom burden affecting all aspects of HRQOL warranting measures to relieve symptoms and improve the wellbeing of patients., 新大院博(保)甲第41号},
 school = {新潟大学, Niigata University},
 title = {Nutritional status, anthropometry, symptom burden, and health-related quality of life of chronic kidney disease of unknown etiology (CKDu) patients in Sri Lanka},
 year = {}
}