The nearest tertiary care hospital, Kandy Teaching Hospital, hosts nephrologists-who do visit this rural clinic once a month-but is 100 km away. It has an affiliated hospital but no regular specialist care. This clinic is run by internal medicine-trained medical officers and nurses.
In 2006, a new renal care and research unit was opened in Girandurukotte. Girandurukotte clinic in dry zone, Uva Province, close to Kandy Teaching Hospital. Since 2003, ongoing reports of a deadly kidney disease from this region, as well as in the Northern and Central provinces, have led to research projects attempting to understand its extent and etiology. 2 After the government built reservoirs in the 1970s, people moved into the area to begin rice paddy farming. Girandurukotte, and its catchment area, is located in Sri Lanka’s Uva province, one of the “dry-zone” epicenters of CKDu ( Figure 1).
2 We believe that a focus on the provision of continuous ambulatory peritoneal dialysis (CAPD) with collaboration between local providers (nephrology and nonnephrology trained) and support from international peritoneal dialysis experts can create a viable model for delivery of effective renal replacement therapy in this particular setting, but also in others where similar resource constraints exist. 1 A majority of patients are middle-age male rice paddy farm workers living in rural areas with little to no specialist care. More than 20,000 deaths in Sri Lanka have been ascribed to patients with this disease over the past decade. Although investigations into its etiology are underway, patients afflicted with the disease urgently need care. The problem of chronic kidney disease of unknown etiology (CKDu) affecting farm workers in Sri Lanka (and potentially in other regions of the world including Mesoamerica) has brought intense and acute attention to this disparity. Thus the disparity in care for end-stage renal disease is even larger for those living in rural areas in low- and middle-income countries. Hemodialysis is the default predominant therapy even in these low-resource settings its availability is chiefly limited to major metropolitans where the necessary specialists and water treatment facilities are available. Recent analyses have shown that in low- and middle-income countries, fewer than a quarter of patients reaching end-stage renal disease initiate dialysis.
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