Significance of Mg-hardness and fluoride in drinking water on chronic kidney disease of unknown etiology in Monaragala, Sri Lanka

Abstract BackgroundIncrease 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.MethodsThe 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.ResultsAmong 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.ConclusionsThe 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.

Download Full-text

Exploring the Root Cause for Chronic Kidney Disease of Unknown Etiology (CKDu) via Analysis of Metal Ion and Counterion Contaminants in Drinking Water: A Study in Sri Lanka

Journal of Chemistry ◽

10.1155/2020/8670974 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

W. P. R. T. Perera ◽

M. D. N. R. Dayananda ◽

J. A. Liyanage

Keyword(s):

Chronic Kidney Disease ◽

Drinking Water ◽

Sri Lanka ◽

Kidney Disease ◽

Water Samples ◽

Unknown Etiology ◽

Reference Area ◽

Permissible Limits ◽

Dug Wells ◽

Endemic Areas

The introduction of elevated amounts of foreign ions into the blood may lead to impairment of the filtration membrane of kidneys and chronic kidney damage. In order to assess the risk of consumption of drinking water (dug well water) in chronic kidney disease of unknown etiology (CKDu), affected areas in Sri Lanka, trace metals, and other counterions in water samples obtained from dug wells were analyzed and compared with a reference area. Drinking water could be the major source that is responsible for entering nephrotoxic ion contaminants into the human body. To achieve the objective, drinking water samples were collected from dug wells in two CKDu endemic areas and a reference area where no CKDu patients were found in a dry season. In the Wewelketiya area (one of the endemic areas), Cd concentrations in 60% of water samples and Pb concentrations in 40% of water samples have exceeded the maximum limit given by Sri Lanka water quality standards. Fluoride concentrations also have exceeded the permissible limits of more than 80% of collected water samples in both CKDu endemic areas. However, none of the water samples in reference areas has reported that Cd, Pb, and fluoride are beyond their maximum permissible limits. Hence, people in the particular CKDu endemic areas are at risk of kidney tissue damage due to long-term exposure to drinking water with elevated levels of some metal ions and counterions.

Download Full-text

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

10.21203/rs.3.rs-19873/v1 ◽

2020 ◽

Author(s):

Kalaivani Gobalarajah ◽

Subramaniam Prabagar ◽

Uthpala Jayawardena ◽

Rasiah Gobalarajah ◽

Subramaniam Rajendra ◽

...

Keyword(s):

Water Quality ◽

Chronic Kidney Disease ◽

Drinking Water ◽

Sri Lanka ◽

Kidney Disease ◽

Negative Relationship ◽

Total Hardness ◽

Unknown Etiology ◽

Arsenic Content ◽

Total Dissolved Solid

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.

Download Full-text

Chemical Speciation Comparison of Drinking Water in North Central Province: An Affected Area of Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka

Proceedings of International Forestry and Environment Symposium ◽

10.31357/fesympo.v22i0.3339 ◽

2018 ◽

Vol 22 (0) ◽

Cited By ~ 1

Author(s):

K.A.D.H. Perera ◽

J.A. Liyanage

Keyword(s):

Chronic Kidney Disease ◽

Drinking Water ◽

Sri Lanka ◽

Kidney Disease ◽

Chemical Speciation ◽

Unknown Etiology ◽

Central Province ◽

North Central ◽

Affected Area ◽

North Central Province

Download Full-text

Risk Assessment of Trace Element Contamination in Drinking Water and Agricultural Soil: A Study in Selected Chronic Kidney Disease of Unknown Etiology (CKDu) Endemic Areas in Sri Lanka

Journal of Chemistry ◽

10.1155/2021/6627254 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

W. P. R. T. Perera ◽

M. D. N. R. Dayananda ◽

D. M. U. C. Dissanayake ◽

R. A. S. D. Rathnasekara ◽

W. S. M. Botheju ◽

...

Keyword(s):

Heavy Metals ◽

Chronic Kidney Disease ◽

Drinking Water ◽

Sri Lanka ◽

Kidney Disease ◽

Toxic Metals ◽

Paddy Soil ◽

Agricultural Soil ◽

Unknown Etiology ◽

Endemic Areas

Unexplained or unclear etiology of chronic kidney disease (CKDu) has been reported in Sri Lanka’s North Central Province (NCP) for more than two decades. Meanwhile, high exposure to heavy metals/metalloids and their accumulation are recognized as the origin of many acute and chronic diseases in certain vulnerable human tissues including kidneys. This study evaluates the contamination status of heavy metals/metalloids of the drinking water and agricultural soil in two CKDu endemic areas compared with a reference area in Sri Lanka based on common indexes and attribute of the commonly used fertilizers evaluated to identify the basic sources of toxic metals in the agricultural soil. Mean concentrations of heavy metals/metalloids such as Mn, Co, As, Cd, Pb, Cu, Zn, and Fe in drinking water of CKDu endemic areas were far below Sri Lankan water quality standards (permissible limits). In addition, all sampling locations dropped below the medium range of the heavy metal pollution index of water (HPI 15–40). Geoaccumulation indexes (Igeo) of soil reveal that paddy soil in CKDu endemic areas is being moderately polluted with toxic metals/metalloids such as As, Pb, Cu, Ni, Cr, Zn, and Cd. On the other hand, the application of fertilizers, which contained a high dose of toxic metals, could be the driving force for agricultural soil pollution, and limitless application of low-quality fertilizer would lead to more soil contamination with heavy metals. Hence, hazardous metals can be incorporated into the food chains via contaminated paddy soil.

Download Full-text

An Air Operated Domestic Brackish Water Reverse Osmosis Plant: Economically Sustainable Solution for Safe Drinking Water Supply for Chronic Kidney Disease of Unknown Etiology Affected Areas in Sri Lanka

Journal of Water Resource and Protection ◽

10.4236/jwarp.2020.1211053 ◽

2020 ◽

Vol 12 (11) ◽

pp. 911-920

Author(s):

Mudiyanselage C. P. Dissanayake

Keyword(s):

Chronic Kidney Disease ◽

Drinking Water ◽

Sri Lanka ◽

Kidney Disease ◽

Water Supply ◽

Reverse Osmosis ◽

Brackish Water ◽

Unknown Etiology ◽

Safe Drinking Water ◽

Reverse Osmosis Plant

Download Full-text

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

BMC Nephrology ◽

10.1186/s12882-020-02157-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Kalaivani Gobalarajah ◽

Prabagar Subramaniam ◽

Uthpala Apekshani Jayawardena ◽

Gobalarajah Rasiah ◽

Sittampalam Rajendra ◽

...

Keyword(s):

Water Quality ◽

Chronic Kidney Disease ◽

Drinking Water ◽

Sri Lanka ◽

Kidney Disease ◽

Serum Creatinine ◽

Total Dissolved Solids ◽

Unknown Etiology ◽

Northern Province ◽

Dissolved Solids

Abstract Background Increase in the number of cases in Chronic Kidney Disease of Unknown etiology (CKDu) in Sri Lanka has become a 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 Province. 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 administered to collect the data from the CKDu patients. The association between serum creatinine excreted by CKDu patients and the water quality parameters were determined by using linear regression model. Results Among the patients, 80% were male with over 68% falling in the age range of 50–70. Majority (90%) were involved in agriculture related occupation. Smoking and alcohol consumption were detected as common habits among 40% of the patients. Secondarily developed, hypertension (60%) and diabetes (34%) were reported as common diseases in the area. Dug wells served as the commonest source of drinking water in the area (90% households) together with few tube wells. Physicochemistry of more than 50% of the water samples revealed higher electric conductivity, salinity, total dissolved solids, total hardness and Na levels compared to drinking water standards in Sri Lanka. Conclusions Serum creatinine levels of the CKDu patients were significantly and negatively correlated with phosphate while positively correlated with total dissolved solids (TDS) and arsenic content of the drinking water. Geospatial mapping of TDS and arsenic in drinking water with the occurrence of higher serum creatinine levels confirmed the same trend. Thus, the total dissolved solids and arsenic in drinking water may have positive correlation with the occurrence of CKDu in Thunukkai region in the Mullaitivu District of Sri Lanka.

Download Full-text

The water chemistry and microbiome of household wells in Medawachchiya, Sri Lanka, an area with high prevalence of chronic kidney disease of unknown origin (CKDu)

Scientific Reports ◽

10.1038/s41598-020-75336-7 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Liza K. McDonough ◽

Karina T. Meredith ◽

Chandima Nikagolla ◽

Ryan J. Middleton ◽

Jian K. Tan ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Drinking Water ◽

Chemical Composition ◽

Sri Lanka ◽

Kidney Disease ◽

Water Chemistry ◽

Gut Microbiome ◽

Unknown Etiology ◽

Well Water ◽

Human Gut

Abstract Chronic kidney disease (CKD) of unknown etiology (CKDu) mostly affects agricultural communities in Central America, South Asia, Africa, but likely also in North America and Australia. One such area with increased CKDu prevalence is the Medawachchiya District Secretariat Division of the Anuradhapura District in the North Central Province of Sri Lanka. Recent research has focused on the presence of various microbial pathogens in drinking water as potential causal or contributing factors to CKDu, yet no study to date has performed a more comprehensive microbial and water chemistry assessment of household wells used for domestic water supply in areas of high CKDu prevalence. In this study, we describe the chemical composition and total microbial content in 30 domestic household wells in the Medawachchiya District Secretariat Division. While the chemical composition in the tested wells mostly lies within standard drinking water limits, except for high levels of fluoride (F), magnesium (Mg), sodium (Na), chloride (Cl) and calcium (Ca) in some samples, we find a frequent presence of cyanotoxin-producing Microcystis, confirming earlier studies in Sri Lanka. Since the total microbial content of drinking water also directly influences the composition of the human gut microbiome, it can be considered an important determinant of health. Several bacterial phyla were previously reported in the gut microbiome of patients with CKD. Using these bacteria phyla to define operational taxonomic units, we found that these bacteria also occur in the microbiome of the sampled well water. Based on available environmental data, our study demonstrates associations between the abundances of these bacteria with geographical distribution, well water temperature and likely fertilizer use in the local surface water catchment area of the individual household wells. Our results reinforce the recommendation that household wells with stagnant or infrequently used water should be purged prior to use for drinking water, bathing and irrigation. The latter is suggested because of the reported potential accumulation of bacterial toxins by agricultural crops. The observation that bacteria previously found in chronic kidney disease patients are also present in household wells requires a more detailed systematic study of both the human gut and drinking water microbiomes in CKDu patients, in relation to disease prevalence and progression.

Download Full-text