scholarly journals Water sources and kidney function: investigating chronic kidney disease of unknown etiology in a prospective study

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Penny Vlahos ◽  
Stephen L. Schensul ◽  
Shuchi Anand ◽  
Emma Shipley ◽  
Saranga Diyabalanage ◽  
...  
Keyword(s):  
Water Quality ◽  
Chronic Kidney Disease ◽  
Drinking Water ◽  
Kidney Disease ◽  
Kidney Function ◽  
Water Source ◽  
Unknown Etiology ◽  
Well Water ◽  
Drinking Water Source ◽  
Endemic Region

AbstractA chronic Kidney Disease of unknown etiology (CKDu) has emerged with disproportionately high prevalence across dry lowland agricultural communities globally. Here we present the results of a prospective cohort of 293 patients with CKDu in the endemic region of Wilgamuwa, Sri Lanka, in whom we measured baseline kidney function and undertook quarterly follow up over 2 years. Well water was the primary historic drinking water source in the region, although a majority (68%) of participants reported switching to reverse osmosis water during study follow ups. Participants who reported ever drinking from well water had estimated glomerular filtration rates −6.7 (SD: 2.8) ml/min/1.73 m2 lower than participants who did not drink from well water historically (p = 0.0184) during the study period. Geospatial analysis identifies a cluster within the region where CKDu progression is significantly higher than the surrounding area. Samples of household wells (n = 262) indicated 68% had detectable agrochemical compounds with concentration above global water quality standards. It is expected that the detected contaminants compounds are indicators of poor water quality and that there is likely additional agrochemical exposure including commercial additives that may contribute to CKDu onset and/or progression. Thus, our study finds that well water exposure during a person’s lifetime in this region is associated with kidney function decline and identifies and quantifies putative nephrotoxic agrochemicals above safe drinking water concentrations in these wells.

scholarly journals Rainwater as an alternative drinking water source for the Chronic Kidney Disease Of Uncertain etiology (CKDu) prone areas: a case study for Girandurukotte, Sri Lanka

2020 ◽  
Vol 10 (3) ◽  
pp. 539-548
Author(s):  
V. M. Jayasooriya ◽  
V. M. M. Perera ◽  
S. Muthukumaran
Keyword(s):  
Water Quality ◽  
Chronic Kidney Disease ◽  
Drinking Water ◽  
Surface Water ◽  
Sri Lanka ◽  
Kidney Disease ◽  
Water Source ◽  
Drinking Water Source ◽  
Significant Difference ◽  
Uncertain Etiology

Abstract Chronic Kidney Disease of uncertain etiology (CKDu) is a fatal disease that causes death from kidney failure due to unknown risk factors and has already affected more than 400,000 people in the rural agricultural landscape (dry zone) of Sri Lanka. The major drinking source in Sri Lanka is groundwater and it is suspected that the pollution of groundwater sources due to agricultural means has a major impact on CKDu. The primary objective of this study is to determine whether rainwater can be used as an alternative safe drinking water source in Girandurukotte area, Sri Lanka, which is known to be an area endemic for CKDu. The physical, chemical, and biological analyses were performed to compare the water quality parameters of three water sources (groundwater, surface water, and rainwater) for Girandurukotte area. The most common storage tanks in polyethylene (PE) and ferrocement (FC) were compared to assess the influence of the material of rainwater tank on water quality. The results showed that there is a significant difference in rainwater in terms of water quality compared to groundwater and surface water. Rainwater in FC and PE tanks showed significant differences (p < 0.05) for some parameters however, they were still within accepted potable drinking water standards.

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

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 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.

Drinking water quality and chronic kidney disease of unknown etiology (CKDu): synergic effects of fluoride, cadmium and hardness of water

2015 ◽  
Vol 38 (1) ◽  
pp. 157-168 ◽  
Author(s):  
Hewa M. S. Wasana ◽  
Dharshani Aluthpatabendi ◽  
W. M. T. D. Kularatne ◽  
Pushpa Wijekoon ◽  
Rohan Weerasooriya ◽  
...  
Keyword(s):  
Water Quality ◽  
Chronic Kidney Disease ◽  
Drinking Water ◽  
Kidney Disease ◽  
Drinking Water Quality ◽  
Unknown Etiology

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

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.

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

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.

scholarly journals 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)

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.

scholarly journals The influence of water–rock interactions on household well water in an area of high prevalence chronic kidney disease of unknown aetiology (CKDu)

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Liza K. McDonough ◽  
Karina T. Meredith ◽  
Chandima Nikagolla ◽  
Richard B. Banati
Keyword(s):  
Water Quality ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Water Chemistry ◽  
Mass Balance ◽  
Stable Carbon Isotopes ◽  
Environmental Isotopes ◽  
Well Water ◽  
High Prevalence ◽  
Geochemical Mass Balance

AbstractPoor 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 prior 87Sr/86Sr studies on the Wanni Complex bedrock suggest these strontium values may be the result of biotite dissolution. We also identify lithium and uranium contributed from the dissolution of silicates, albeit at concentrations too low to constitute a known health risk. In contrast, the levels of magnesium and calcium in our samples are high and demonstrate that, despite the felsic bedrock, well water chemistry in the Medawachchiya area is dominated by carbonate dissolution.

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

2021 ◽  
pp. 111779
Author(s):  
D.N.D. Liyanage ◽  
Saranga Diyabalanage ◽  
S.P. Dunuweera ◽  
Sanath Rajapakse ◽  
R.M.G. Rajapakse ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Drinking Water ◽  
Sri Lanka ◽  
Kidney Disease ◽  
Unknown Etiology

scholarly journals A Systems Analysis Approach to Identifying Critical Success Factors in Drinking Water Source Protection Programs

2019 ◽  
Author(s):  
Hew Cameron Merrett ◽  
Wei Tong Chen ◽  
Jao Jia Horng
Keyword(s):  
Water Quality ◽  
Drinking Water ◽  
Critical Success Factors ◽  
Success Factors ◽  
Water Source ◽  
Control Measures ◽  
Catchment Management ◽  
Drinking Water Source ◽  
Principle Components Analysis ◽  
Critical Success

The success of source protection in ensuring safe drinking water is centered around being able to understand the hazards present in the catchment then plan and implement control measures to manage water quality risk to levels which can be controlled through downstream barriers. The programs in place to manage source protection are complex sociotechnical systems involving policy, standards, regulators, technology, human factors and so on. This study uses System Theoretic Process Analysis (STPA) to analyze the operational hazards of a typical drinking water source protection (DWSP) program and identify control measures to ensure safe operations. To validate the results a questionnaire was developed and distributed to specialists in DWSP in Taiwan, Australia and Greece. Using Principle Components Analysis (PCA) of the questionnaire responses, the study identified four critical success factors (CSFs) for DWSP. The four factors identified are ‘Policy and Government Agency Support of Source Protection’, ‘Catchment Risk Monitoring and Information’, ‘Support of Operational Field Activities’ and ‘Response to Water Quality Threats’. The results of this study provide insight into the approach of grouping of source protection measures to identify a series of targeted CSF for operational source protection programs. Using CSF can aide catchment management agencies in ensuring that the risk level in the catchment is managed effectively and that threats to public health from drinking water are managed appropriately.

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