Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: geographic distribution and environmental implications
The increase in the number of chronic kidney disease (CKD) patients from the north central region of Sri Lanka has become a environmental health issue of national concern. Unlike in other countries where long-standing diabetes and hypertension are the leading causes of renal diseases, the majority of CKD patients from this part of Sri Lanka do not show any identifiable cause. As the disease is restricted to a remarkably specific geographical terrain, particularly in the north central dry zone of the country, multidisciplinary in-depth research studies are required to identify possible etiologies and risk factors. During this study, population screening in the prevalent region and outside the region, analysis of geoenvironmental and biochemical samples were carried out. Population screening that was carried out using a multistage sampling technique indicated that the point prevalence of CKD with uncertain etiology is about 2–3% among those above 18 years of age. Drinking water collected from high-prevalent and non-endemic regions was analyzed for their trace and ultratrace element contents, including the nephrotoxic heavy metals Cd and U using ICP-MS. The results indicate that the affected regions contain moderate to high levels of fluoride. The Cd contents in drinking water, rice from affected regions and urine from symptomatic and non-symptomatic patients were much lower indicating that Cd is not a contributing factor for CKD with uncertain etiology in Sri Lanka. Although no single geochemical parameter could be clearly and directly related to the CKD etiology on the basis of the elements determined during this study, it is very likely that the unique hydrogeochemistry of the drinking water is closely associated with the incidence of the disease.
KeywordsChronic kidney disease (CKD) Fluoride Cadmium Groundwater Hydrogeochemistry Medical geology Dry zone Sri Lanka
- Abeysekara, D. T. D. J. (2006). Clinical Presentation of Patients. In Proceedings of mini-symposium on chronic kidney disease of uncertain aetiology in Sri Lanka, 10-11 Feb. 2006, Erlangen, Germany.Google Scholar
- APHA. (1998). American public health association-standard method for the examination of water and wastewater (17th ed.). DC: Washington.Google Scholar
- Aturaliya, T. N. C., Abeysekera, D. T. D. J., Amerasinghe, P. H., Kumarasiri, P. V., & Bandara, P. (2006). Towards understanding of Chronic Kidney disease of North Central Province. In Proceedings of annual scientific sessions of Sri Lanka Medical Association 2006.Google Scholar
- Bandara, J. M. R. S., Senevirathna, D. M. A., Dasanayake, D. M. R. S. V., Herath, V., & Bandara, J. M. R. P. (2008). Chronic renal failure in cascade irrigation systems in Sri Lanka associated with elevated dietary cadmium levels, rice and fresh water fish (Thilapia). Environmental Geochemistry and Health, 30, 465–478.CrossRefGoogle Scholar
- Codex. (2005). Report of the 28th session of the CODEX Alimentarius Commission. CODEX Alimentarius Commission, Alinorm 06/29/41. Rome, Italy.Google Scholar
- Dissanayake, C. B. (1996) Water quality and dental health in the Dry Zone of Sri Lanka. In JD Appleton, R Fuge, GJH McCall (Eds.), Environmental geochemistry and health. Geological Society UK, Special Publication, No. 113: pp. 131–114.Google Scholar
- Dissanayake, C. B., & Chandrajith, R. (2009). Phosphate mineral fertilizers, trace metals and human health. Journal of the National Science Foundation, 37(3), 153–165.Google Scholar
- Dissanayake, C. B., Weerasooriya, S. V. R. (1986). The Hydrogeochemical Atlas of Sri Lanka Natural Resources Energy and Science Authority of Sri Lanka Colombo, 103 pp.Google Scholar
- Doul, J., Klassen, C. D., & Amdur, M. O. (1980). Casaret and Doul’s toxicology (2nd ed., pp. 239–245). NY: Macmillan.Google Scholar
- Hussain, T. (1991). Study of environmental pollutants in and around the city of Lahore, Ph.D. thesis, University of Punjab, Pakistan. pp. 255.Google Scholar
- Illeperuma, O. A., Dharmagunawardhane, H. A., & Herarh, K. P. R. P. (2009). Dissolution of aluminium from sub-standard utensils under high fluoride stress: A possible risk factors for chronic renal failures in the North-Central Provice. Journal of the National Science Foundation of Sri Lanka, 37, 219–222.CrossRefGoogle Scholar
- Liu, J. L. T., Yu, Y. Y., Sun, X. Z., Zhu, Q., He, W., Zhang, M., & Wang, A. (2005). The dose-effect relationship of water fluoride levels and renal damage in children, Wei Sheng Yan Jiu. 34(3):287–288. (See: http://tinyurl.com/7gv3h).
- Maher, J. F. (1976). Toxic nephropathy. In B. M. Brenner & F. C. Rector Jr (Eds.), The kidney. Philadelphia: WB Sannders.Google Scholar
- Perera, A. P. G. R. L., Gonawala, J. M. L., & Wijekoon, D. (2008). Groundwater quality in Anuradhapura Districy with special reference to fluoride. Groundwater in Sri Lanka, National Academy of Science, 48–64.Google Scholar
- Rogan, N., Serafimovski, T., Dolenec, M., Tasev, G., & Dolenec, T. (2008). Heavy metal contamination of paddy soils and rice (Oryza sativa L.) from Kočani Field (Macedonia). Environmental Geochemistry and Health DOI 10.1007/s10653-008-9197-2.
- Stefanović, V. (1999). Balkan endemic nephropathy; a reappraisal after forty years, Facta Universitatis- Medicine and Biology. University of Niš, 6(1), 53–58.Google Scholar
- Tennakoon, T. M. M. H. (2004). Dental fluorosis in Anuradhapura District, Sri Lanka. In Proceedings of the 4th international workshop on fluorosis prevention and defluoridation of water, Colombo, Sri Lanka. pp. 19–22.Google Scholar
- WHO. (1992). Cadmium: Environmental health criteria, vol. 134. Geneva: World Health Organization.Google Scholar
- WHO (1994) World Health Organisation expert committee on oral health status and fluoride use: Fluorides and oral health. WHO Technical Report Series No. 846. World Health Organization, Geneva.Google Scholar
- WHO. (2004). Guidelines for Drinking-Water Quality. Vol. 1: Recommendations (3rd ed.). Geneva: World Health Organization.Google Scholar