Comprehensive Groundwater Quality Analysis in Chronic Kidney Disease of Unknown Etiology (CKDu) Prevalence Areas of Sri Lanka to Investigate the Responsible Culprit

Abstract

Chronic kidney disease of unknown etiology (CKDu) is a serious health problem in Sri Lanka especially among agricultural communities in dry zone since 19th century. In the present study, several water quality parameters were studied in well water samples and only four parameters, namely, hardness, cadmium level, fluoride level, and strontium level have shown a relationship with the CKDu prevalence. Higher percentage of well water samples collected from CKDu prevalent area in both pre and postmonsoon seasons have exceeded the WHO recommended levels of hardness. Further, water samples collected in postmonsoon seasons had significantly higher hardness than the well water samples collected in premonsoon season ( P < 0.05 ). This may be due to the dissolution of calcium carbonate by water recharge. Moreover, cadmium and fluoride contents have exceeded the recommended levels in high-risk area during the premonsoon period. Furthermore, according to principal component analysis (PCA), four clusters were identified depending on the different levels of fluoride, cadmium, hardness, and strontium contents. The control area (Am) fell in to separate cluster with low contents of fluoride, cadmium, hardness, and strontium than in CKDu prevalent area. Since it has been found that the above species are directly involved in renal damage, it can be concluded that a synergetic effect of cadmium, fluoride, hardness, and strontium in well water may be a main cause for CKDu in Sri Lanka.

Glyphosate and Fluoride in High-Hardness Drinking Water Are Positively Associated with Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka

“…As previously reported, water hardness in wells from the CKDu-endemic region was higher than that measured in wells from nonendemic areas (Figure D) . Although elevated Ca 2+ or Mg 2+ ion levels in drinking water may not directly affect kidney health, harder waters have been shown to facilitate formation of glyphosate metal complexes, which increase the persistence of glyphosate. − ,, Therefore, we posit that the elevated water hardness observed in CKDu-endemic wells (Table S5) may have contributed to the higher glyphosate concentrations measured in the CKDu-endemic areas.…”

“…21 Although elevated Ca 2+ or Mg 2+ ion levels in drinking water may not directly affect kidney health, harder waters have been shown to facilitate formation of glyphosate metal complexes, which increase the persistence of glyphosate. [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]71,72 Therefore, we posit that the elevated water hardness observed in CKDu-endemic wells (Table S5) may have contributed to the higher glyphosate concentrations measured in the CKDu-endemic areas.…”

“…As articulated previously, it is possible that metals and other contaminants in water may act synergistically, also increasing the persistence of glyphosate to influence the onset and progression of CKDu. , However, no large-scale field studies have examined associations among all of these parameters and CKDu incidence. Here, we have conducted the largest well water monitoring study to date for glyphosate and other water contaminants in Sri Lanka, comparing wells in CKDu-endemic and nonendemic regions.…”

Equilibrium Isotherms, Kinetics, and Thermodynamic Mechanisms of a Novel Polyacrylamide-Strychnos potatorum Seed-Derived Activated Carbon Composite for Aqueous Hardness Removal

“…Field Studies. Several water quality complications were found in well water in the Anuradhapura district [21][22][23]. Among the water quality complications, high hardness content in well water is the most significant [22].…”

“…Several water quality complications were found in well water in the Anuradhapura district [21][22][23]. Among the water quality complications, high hardness content in well water is the most significant [22]. erefore, water samples (n = 6) were randomly collected from dug wells in the Medawachchiya Divisional Secretariat (DS) of Anuradhapura district, Sri Lanka, during the premonsoon season.…”