Health Project "0 deaths for acute kidney injury by 2025"

Beneficiaries: Suffering from acute kidney injury (AKI) 

Cities / Region involved: Sri Lanka 

Period: 2013 - to date

Project Status: ongoing

In collaboration with the International Society of Nephrology Analysis of the territory of SriLanka to evaluate the possibility of carrying out the project based on the use of peritoneal dialysis for the treatment of acute kidney injury ( AKI ) in Developing Countries , in collaboration with Prof. Giuseppe Remuzzi ( Mario Negri Institute ) , President of the International Society of Nephrology (ISN ) - 2013 For the World Health Organization (WHO) SriLanka is a "category A" country for infectious and parasitic diseases that can be complicated by Acute Renal Failure. Haemorrhagic fever trasmitted by the dengue mosquito is the leading cause of death among children. Most affected areas are the west coast of the island and also those with higher urbanization such as the capital . During the first three months of 2013, 7,962 cases of dengue fever have been reported by the Ministry of Health. Leptospirosis is endemic in the north-east coast and reaches 7000 cases diagnosed per year. Of importance is snake poisoning with 33 000 cases per year reported in the most south-eastern coast . The risk of malaria, especially in the benign form caused by Pl.Vivax persists throughout the year and throughout the country , except in the District of Colombo , Kalutara and Nuwara Eliya. There is a high Pl. falciparum resistance to chloroquine . In any case, in the absence of a registry or otherwise of centralized data there are no clear statistics on cases of acute renal failure in the areas of higher incidence correspondinge to infections mentioned above. All data are obtained from individual health care districts. The incidence of kidney disease in Sri Lanka has increased dramatically and hemodialysis treatment is inadequate to the needs of the territory. Renal failure in both the acute and chronic form is often of unknown nature ( CKDu ). A recent study of 2012 shows that the progressive increase in kidney disease is correlated with the use of pesticides, fertilizers and toxic pesticides imported from neighboring China . Especially in the center and northeast of the country 15% of the population, mostly rice farmers, is suffering from chronic renal insufficiency without the presence of risk factors (diabetes, immunological disorders , cardiovascular problems ). High concentrations of cadmium and arsenic, elements contained in the illegal chemical compounds used in agriculture have been found in blood sample. Project Proposal of collaboration with the Medical Institution of SriLanka : The area of Batticaloa where @uxilia has increased project activity is also the one most relevant to the ISN staff training and treatment of patients with Acute Renal Failure by peritoneal dialysis project. This is because the hospital in Batticaloa has the adequate characteristics to sustain a process of training and learning, has excellent staff skills, a good level of infrastructure and management of the patient. In addition, it is the reference center on a large territory on the east coast corresponding to a population of about 1.5 million people involved in the epidemiological risks described above. Currently the treatment of End Stage Renal Failure is accomplished with two B Braun hemodialysis machines without specialist' nephrologists. The treatment of chronic patients is suspended according to the need of treatment of acute patients. The real need for dialysis is far superior to the availability of these 2 dialysis machines. During the mission in SriLanka Auxilia has contacted most iof the principal managers in health care and nephrology. There was some discussion on the feasibility of the project and the following authorities expressed high availability and collaboration: Dr. Palitha Mahipala, Director General of Health Service; Dr. Rustom Mehta responsible Firdosi WHO Srilanka; Prof Mohamed Hussain Rezvi Sheriff Professor of nephrology PGIM University of Colombo; Dr. K. Muruganandam, Director of Batticaloa Teaching Hospital; Prof. Rajiva Wijesinha, Adviser on Reconciliation to the President, and finally the Italian Ambassador Fabrizio Arpea. Considering government policies in this oligarchic form of government, friendship and confidence with the Italian ambassador and adviser to the President are harbingers of good result. In summary, the various meetings have highlighted the absence of peritoneal dialysis in the whole island, the possibility of hemodialysis almost exclusively in the capital, where there is the only center with nephrologists, Hemodialysis in the remaining territory is limited to the presence of 2/4 type B Braun hemodialysis machines located in the major town hospitals of the country which are accessible to the population in a time ranging from 30 minutes to 4 hours by car.