Pesticide exposures and chronic kidney disease of unknown etiology: an epidemiologic review

Abstract

The main causes of chronic kidney disease (CKD) globally are diabetes and hypertension but epidemics of chronic kidney disease of unknown etiology (CKDu) occur in Central America, Sri Lanka, India and beyond. Althoug also being observed in women, CKDu concentrates among men in agricultural sectors. Therefore, suspicions fell initially on pesticide exposure, but currently chronic heat stress and dehydration are considered key etiologic factors. Responding to persistent community and scientific concerns about the role of pesticides, we performed a systematic review of epidemiologic studies that addressed associations between any indicator of pesticide exposure and any outcome measure of CKD. Of the 21 analytical studies we identified, seven were categorized as with low, ten with medium and four with relatively high explanation value. Thirteen (62%) studies reported one or more positive associations, but four had a low explanation value and three presented equivocal results. The main limitations of both positive and negative studies were unspecific and unquantified exposure measurement (‘pesticides’), the cross-sectional nature of most studies, confounding and selection bias. The four studies with stronger designs and better exposure assessment (from Sri Lanka, India and USA) all showed exposure-responses or clear associations, but for different pesticides in each study, and three of these studies were conducted in areas without CKDu epidemics. No study investigated interactions between pesticides and other concommittant exposures in agricultural occupations, in particular heat stress and dehydration. In conclusion, existing studies provide scarce evidence for an association between pesticides and regional CKDu epidemics but, given the poor pesticide exposure assessment in the majority, a role of nephrotoxic agrochemicals cannot be conclusively discarded. Future research should procure assessment of lifetime exposures to relevant specific pesticides and enough power to look into interactions with other major risk factors, in particular heat stress.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-017-0254-0) contains supplementary material, which is available to authorized users.

Serum Creatinine Level and Its Relation to Backache in Chronic Kidney Disease with Unknown Aetiology (CKDu) Patients in North Central Province, Sri Lanka

“…Use of pesticides is another factor that causes increased minerals presented in water which is consumed in NCP, this causes increased phosphate production that leads to acute kidney injury most commonly which can develop into chronic with time (Valcke et al, 2017). 1naphthol and 2-naphthol are the most commonly presented molecules in the pesticides.…”

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

“…While there is limited evidence of the effect of trace elements, pesticides and chemical preservatives on kidney health, a planet-friendly approach to nutritional issues should consider not only increasing the quantity of plantbased food, but also controlling its quality, avoiding processed food and favouring seasonal products [22,[117][118][119][120]. In this regard, nutritional management can be considered the basis for comprehensive management of CKD patients [121].…”

A Pilot Case-Control Study Using a One Health Approach to Evaluate Behavioral, Environmental, and Occupational Risk Factors for Chronic Kidney Disease of Unknown Etiology in Sri Lanka

“…The driving hypothesis for this study is that alcohol consumption and/or pesticide exposure are associated with CKDu as a health outcome. In addition, it is recognized that relationships between key demographic, cultural, and occupational variables may play a role in CKDu health outcomes [27][28][29][30][31].…”