CKD of Unknown Etiology (CKDu) in Sri Lanka: A Multilevel Clinical Case Definition for Surveillance and Epidemiological Studies

Emergence of a new form of chronic kidney disease (CKD) of unknown etiology (CKDu) during the last 2 decades has resulted in considerable morbidity and mortality among the agricultural community residing in the north central region of Sri Lanka. A 3-level epidemiological case definition to identify CKDu in Sri Lanka was developed and published by the Ministry of Health in November 2016. The Sri Lanka Society of Nephrology (SLSON) refined the definition through a consensus of experts using a systematic approach in August 2017. An initial consultative meeting with the participation of 31 experts, including nephrology specialists, experts on primary care and epidemiology, and policy and university academics with long-standing experience in CKDu research, was held to identify the gaps in the existing definition. Following the meeting, a facilitator conducted 2 rounds of remote consultations using the Delphi method to obtain consensus of the participants on suggestions to improve the existing case definition. The process was initiated in August 2017 and was completed in April 2018 and resulted in the participants agreeing to a refined multilevel clinical case definition for CKDu to be used in surveillance and epidemiological studies. This article describes the process used and development of this new case definition for CKDu in Sri Lanka.