Impact of water quality on Chronic Kidney Disease of unknown etiology (CKDu) in Thunukkai Division in Mullaitivu District, Sri Lanka

Abstract

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% were suffered with diabetes and hypertension, respectively. Physicochemical characteristics of more than 50% of the water samples recorded higher electric conductivity, salinity, total dissolved solids, total hardness and Na levels compared to drinking water standards in Sri Lanka. Conclusions The association between serum creatine excreted by CKDu patients and water quality parameters were determined by using regression model, revealing a significant negative relationship with phosphate and positive relationship with Total Dissolved Solid and arsenic content of the drinking water. Thus, the study suggests, total dissolved solid and arsenic in drinking water have a positive correlation with CKDu in Thunukkai region in the Mullaitivu District.

The position of geochemical variables as causal co-factors of diseases of unknown aetiology

“…Chronic Kidney Disease of Unknown Aetiology Chronic Kidney Disease of unknown aetiology (CKDu) has, as its predominant feature, tubular atrophy and interstitial fibrosis (thickening and scarring of the tiny air sacs and interstitial tissues in the lungs) Reported in many parts of the world, especially among rural farming communities. High incidence in low- and middle-income countries over last two decades—[ 98 , 99 ]; “In 2017, the global prevalence of Chronic Kidney Disease (CKD) was 9·1% (95% uncertainty interval [UI] 8·5 to 9·8), which is roughly 700 million cases”—[ 100 ] Synergistic reaction between Cd and diabetic-related hyperglycaemia—[ 101 ]; Consumption of (polluted) well water suggested; need for investigating role of Cd—[ 102 ]; Too high Ca intake?—[ 103 ]; “Geographical mapping showed that villages with a high prevalence of CKDu are often related to irrigation water sources and/or located below the level of the water table” [ 104 ]; Toxins/heavy elements -[ 105 ]; Groundwater geochemistry (high levels of F − , Cd, As)—[ 106 ]; Exposure to low levels of Cd—[ 107 ]; High ionicity of drinking water due to fertiliser runoff -[ 108 , 109 ]; Toxic metal exposure; water pollution—[ 110 ]; Synergistic reaction between fluoride and water hardness—[ 111 – 113 ]; Chemical species such as Ca, phosphate, oxalate, and F − form intra-renal nanomineral particles initiating the CKD of multifactorial origin (CKDmfo)—[ 114 ]; Total dissolved solids and As in drinking water have a positive correlation with CKDu—[ 115 ] Altitude—[ 116 ]; Heat stress nephropathy due to global warming—[ 117 – 119 ]; Climatic patterns—[ 114 ]; A quintessential climate-sensitive disease—[ 120 ] Salas et al, 2019 In 2017 Gifford et al [ 121 ] noted that of the several epidemics of CKDu that have occurred worldwide, some, like Itai-Itai disease in Japan and Balkans nephropathy have been explained, whereas the aetiology of others remains unknown There is the absence of common risk factors or underlying conditions that lead to CKD, such as diabetes, immune-mediated glomerulonephritis, or structural renal disease—Caplin et al—[ 122 ] 8. Endomyocardial fibrosis Endom...…”