Abstract
Chronic kidney disease of uncertain etiology (CKDu) is a common health issue among farming communities in the dry zone of Sri Lanka where groundwater fluoride is known to be higher than recommended levels. Excessive environmental ingestion of fluoride is widely considered as a possible factor for the onset of CKDu. This study was carried out to evaluate the serum and urine fluoride levels in biopsy-proven, non-dialysis CKDu patients. Control subjects were selected from the same area without any deteriorated kidney functions. Serum and urine fluoride levels were determined by ion-selective electrode method. Higher content of serum and urine fluoride levels were observed in patients with chronic renal failures. In CKDu cases, the serum fluoride concentrations ranged between 0.47 and 9.58 mg/L (mean 1.39 ± 1.1 mg/L), while urine levels were varied between 0.45 and 6.92 mg/L (mean 1.53 ± 0.8 mg/L). In patients, urine fluoride levels showed a significant difference with the CKDu stage; however, no difference was obtained between genders and age. In endemic controls, serum and urine fluoride levels ranged between 0.51 and 1.92 mg/L (mean = 1.07 ± 0.3 mg/L) and 0.36 and 3.80 mg/L (mean = 1.26 ± 0.6 mg/L), respectively. Significantly higher fluoride in serum and urine was noted in CKDu patients compared to endemic control groups. Higher fluoride exposure via drinking water is possibly the reason for higher fluoride in serum, while excessive urinary excretion would be due to deterioration of the kidney, suggesting a possible nephrotoxic role of environmental fluoride exposure.
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This study was supported by the National Research Council (NRC) Target Orient research grant (TO 14-05).
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The study was carried out with the approval of the Ethical Review Board of the Faculty of Medicine, University of Peradeniya, Sri Lanka. Written consents were obtained from all subjects before collecting samples.
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Fernando, W.B.N.T., Nanayakkara, N., Gunarathne, L. et al. Serum and urine fluoride levels in populations of high environmental fluoride exposure with endemic CKDu: a case–control study from Sri Lanka. Environ Geochem Health 42, 1497–1504 (2020). https://doi.org/10.1007/s10653-019-00444-x
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DOI: https://doi.org/10.1007/s10653-019-00444-x