Role of drinking water with high Silica and Strontium in Chronic Kidney Disease: An Exploratory Community-based Study in an Indian Village (original) (raw)
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InBackground: Ground water is the ultimate and inevitable source of drinking water in rural India. Seepage of earth’s crust elements into drinking water sources may lead to adverse health effects. Media reported unusually high kidney related disorders among the population in Uchapally village of Nellore district, Andhra Pradesh, India. Objective: The objective of the present study was to assess the role of drinking water in chronic kidney disease (CKD). Methods: A community based cross-sectional study was carried out among the population residing in two villages namely Uchapally with reported cases of renal diseases (Village-A; n=52) and Pedarajupalem with no reported cases of renal diseases (Village-B; n=50) from Nellore district, Andhra Pradesh, India. Blood and urine samples were collected to estimate the renal parameters. Glomerular Filtration Rate (GFR) as calculated by Modification of Diet in Renal Disease (MDRD) equation was used to assess the staging of CKD. Results: Majorit...
Journal of Trace Elements in Medicine and Biology, 2019
Chronic kidney disease of uncertain etiology (CKDu) in areas in and around Sri Lanka's North Central Province has been identified as a major non-communicable disease due to its high prevalence and the burden on the public health system. Controversial evidence relating to the etiology and risk factors of CKDu has been reported. The most debated is the role of trace elements such as Cd and As in the pathogenesis of CKDu. Urine and hair samples collected from CKDu patients and healthy controls were measured for the concentration of different elements including Cd and As. To assess the possible environmental exposures, drinking water and rice samples collected from the affected areas as well as unaffected areas in the country were analyzed. Transmission electronic microscopic analysis of renal biopsies from CKDu patients was also performed. Analysis of drinking water and rice samples indicated that the levels of all minerals and trace elements analyzed including Cd and As were within the levels recommended by World Health Organization and Sri Lanka drinking water guidelines and did not suggest any form of contamination. Analysis of biological samples, including urine, hair and renal tissue, did not provide evidence to support Cd or As toxicity in CKDu patients. Overall, the observations of this integrated, comprehensive study, which included biological, environmental and pathological investigations, strongly support our previous reports on the absence of Cd and As toxicity in areas with high prevalence of CKDu. Further, these observations do not provide evidence on the involvement of Cd and As in pathogenesis of CKDu in Sri Lanka.
Environmental Science and Pollution Research, 2022
Chronic kidney disease of unknown etiology [CKDu] is a condition characterized by decline in kidney function and is not associated with diabetic nephropathy or hypertensive nephropathy. In this review, we have done a detailed literature analysis on CKDu in India, and then had a comparison with that of Mesoamerica and Sri Lanka. In India, CKDu became the second most common type of CKD after diabetic nephropathy. Silica was seen in the groundwater of both India and Sri Lanka, whereas in Mesoamerica silica exposure through particulate matter was seen among CKDu communities. DDE is a common agrochemical seen in both India and Sri Lanka. The risk factors vary from region to region and it is important to categorize CKDu population based on the risk factors to avoid misinterpretation of the condition as non-CKDu category and to evade further complications. More studies have to be conducted to reveal the detailed pathophysiological mechanisms and its relation with irrational exploitation of...
Chronic Kidney Disease due to unknown etiology (CKDu) is a deadly disease of which the prevalence have been identified in several countries in North Central America, India and Sri Lanka. Several studies have showed that, the usual factors as long-standing diabetes and hypertension are not the leading causes for the majority of CKD patients from the dry zone of Sri Lanka. Many researchers suggest that the etiology for CKDu may be a combination of several environmental factors. Some suggest that even though no single geochemical parameter could be clearly and directly related to the CKD etiology, it is very likely that the unique hydro-geochemistry of the drinking water is closely associated with the incidence of the disease. Hence this research was aimed to identify the CKDu prevalence in Sri Lanka and the similarities with the reported cases in the world, and to evaluate the suggested etiologies for the CKDu in Sri Lanka with more focus to the strong etiology suggestions. Initially a thorough literature review was conducted to identify the existing hypothesis and analyzed published and unpublished data to define strong hypothesis related to groundwater quality, socio-economic and environmental facts. Also, a field groundwater quality investigation was conducted in several endemic and non-endemic regions. The results showed that some of the risk factors in Sri Lanka are similar to other country cases, and mainly the excess fluoride and hardness levels seems to have a direct impact on the prevalence of CKDu in Sri Lanka. However, no any heavy metal has proven for direct correlation with the CKDu prevalence.
2014
Chronic Kidney Disease due to unknown etiology (CKDu) is a deadly disease of which the prevalence have been identified in several countries in North Central America, India and Sri Lanka. Several studies have showed that, the usual factors as long-standing diabetes and hypertension are not the leading causes for the majority of CKD patients from the dry zone of Sri Lanka. Many researchers suggest that the etiology for CKDu may be a combination of several environmental factors. Some suggest that even though no single geochemical parameter could be clearly and directly related to the CKD etiology, it is very likely that the unique hydro-geochemistry of the drinking water is closely associated with the incidence of the disease. Hence this research was aimed to identify the CKDu prevalence in Sri Lanka and the similarities with the reported cases in the world, and to evaluate the suggested etiologies for the CKDu in Sri Lanka with more focus to the strong etiology suggestions. Initially a thorough literature review was conducted to identify the existing hypothesis and analyzed published and unpublished data to define strong hypothesis related to groundwater quality, socioeconomic and environmental facts. Also, a field groundwater quality investigation was conducted in several endemic and non-endemic regions. The results showed that some of the risk factors in Sri Lanka are similar to other country cases, and mainly the excess fluoride and hardness levels seems to have a direct impact on the prevalence of CKDu in Sri Lanka. However, no any heavy metal has proven for direct correlation with the CKDu prevalence.
Chronic Kidney Disease due to unknown etiology (CKDu) is a deadly disease of which the prevalence have been identified in several countries in North Central America, India and Sri Lanka. Several studies have showed that, the usual factors as long-standing diabetes and hypertension are not the leading causes for the majority of CKD patients from the dry zone of Sri Lanka. Many researchers suggest that the etiology for CKDu may be a combination of several environmental factors. Some suggest that even though no single geochemical parameter could be clearly and directly related to the CKD etiology, it is very likely that the unique hydro-geochemistry of the drinking water is closely associated with the incidence of the disease. Hence this research was aimed to identify the CKDu prevalence in Sri Lanka and the similarities with the reported cases in the world, and to evaluate the suggested etiologies for the CKDu in Sri Lanka with more focus to the strong etiology suggestions. Initially a thorough literature review was conducted to identify the existing hypothesis and analyzed published and unpublished data to define strong hypothesis related to groundwater quality, socio-economic and environmental facts. Also, a field groundwater quality investigation was conducted in several endemic and non-endemic regions. The results showed that some of the risk factors in Sri Lanka are similar to other country cases, and mainly the excess fluoride and hardness levels seems to have a direct impact on the prevalence of CKDu in Sri Lanka. However, no any heavy metal has proven for direct correlation with the CKDu prevalence.
Water quality parameters in relation to chronic kidney disease in Sri Lanka
2012
In Sri Lanka, high concentrations of certain water quality parameters in drinking water are assumed to be causing Chronic Kidney Disease (CKD). Nmih Central Province (NCP) in Sri Lanka repotis the highest number of CKD patients and mmiality rates. The repmied research herein concentrates on re-examining diverse causative factors identified by previous researchers on CKD and analysis of water quality in samples from shallow wells supplying drinking water to CKD patients and non-patients in NCP. The samples were tested for a number of parameters such as anions, cations, and heavy metals. These include Cd, Na, Ca, F and Cl which previous researchers have suggested as causative factors for CKD. The preliminmy analyses of data indicated majority of water quality parameters collected from the study area did not exceed the WHO drinking water quality standards. The critical water quality parameters that could cause the CKD were investigated using Factor Analysis techniques. From the water s...
Background Increase in the number of cases in Chronic Kidney Disease of Unknown etiology (CKDu) in Sri Lanka has become an environmental health issue of national concern. Even though, Northern Province is not identified as a high risk province, there is an increasing trend of CKDu after the end of civil war in the Northern territory. Methods The present study was conducted in Thunukkai Division in Mullaitivu District to investigate the socio demographic and clinical pattern of CKDu patients and to evaluate the quality of their water sources. The samples were selected by using stratified purposive random sampling method which represented 29% of total CKDu patients in Thunukkai Division. Pretested structured questionnaire was administrated to collect the data from CKDu patients. Results Among the patients, 80% of them were male with an age range of 30-80, majority (88%) involved in farming. 26% and 20% of people were engaged in smoking and taking alcohol, respectively. 17% and 43% wer...
Environmental Geochemistry and Health, 2011
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 highprevalent 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.
npj Clean Water
Poor drinking water quality in household wells is hypothesised as being a potential contributor to the high prevalence of chronic kidney disease of uncertain aetiology (CKDu) among the farming communities of the Medawachchiya area, Anuradhapura, Sri Lanka. One of the natural processes that can affect water quality is the dissolution of minerals contained within an aquifer by water–rock interactions (WRIs). Here we present a comprehensive assessment of WRIs and their influence on the water chemistry in household wells and spring waters in the Medawachchiya area by combining measurements of environmental isotopes, such as strontium, lithium and stable carbon isotopes and inorganic chemistry parameters, and modelling geochemical mass balance reactions between rainfall and groundwater samples. Our results reveal the presence of strontium, dissolved from both silicate and carbonate minerals, with high isotopic (87Sr/86Sr) ratios of up to 0.7316. Geochemical mass balance modelling and pri...