Fluoridation of drinking water and chronic kidney disease: absence of evidence is not evidence of absence

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.

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The impact of aluminum, fluoride, and aluminum–fluoride complexes in drinking water on chronic kidney disease

Environmental Science and Pollution Research ◽

10.1007/s11356-015-4324-y ◽

2015 ◽

Vol 22 (14) ◽

pp. 11001-11009 ◽

Cited By ~ 20

Author(s):

Hewa M. S. Wasana ◽

Gamage D. R. K. Perera ◽

Panduka S. De Gunawardena ◽

Jayasundera Bandara

Keyword(s):

Chronic Kidney Disease ◽

Drinking Water ◽

Kidney Disease ◽

Aluminum Fluoride ◽

Fluoride Complexes ◽

The Impact

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Geochemistry of Groundwater in the Uva Province, Sri Lanka—Implications for Chronic Kidney Disease of Uncertain Origin

Frontiers in Water ◽

10.3389/frwa.2021.771501 ◽

2021 ◽

Vol 3 ◽

Author(s):

I. D. U. H. Piyathilake ◽

W. A. C. Udeshani ◽

H. A. C. S. Hapuarachchi ◽

L. V. Ranaweera ◽

E. P. N. Udayakumara ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Drinking Water ◽

Sri Lanka ◽

Kidney Disease ◽

Causative Factor ◽

Quality Parameters ◽

Binary Logistic Regression Model ◽

The Government ◽

Geochemical Risk

The prevalence of chronic kidney disease of uncertain etiology (CKDu) in the Uva Province (UP) of Sri Lanka has received much attention over the past two decades. Many scientists assumed that prolonged consumption of drinking water with high levels of contaminants may be the causative factor. Thus, the prime objective of this study is to develop a binary logistic regression model based on water quality parameters and the prevalence of CKDu to find out the geochemical risk factors that affect the CKDu. For this, 260 groundwater samples were collected following a stratified random sampling method and analyzed for its major cations, anions, and selected trace element contents. In the model, the dichotomous dependent variable defines the availability of CKDu patients, and explanatory variables define groundwater quality parameters. According to the best-fit model, F− and PO43- levels of the groundwater were found to be the geochemical risk factors that were significantly associated with the progression of CKDu in the study area. Furthermore, it was shown that geochemical processes such as dissolution of bedrocks are the causative phenomenon of the enhancement of F− levels in the groundwater sources. It has also been observed that the PO43- concentrations of the groundwater possibly increase because of the intensive application of agrochemicals in addition to geogenic sources. The results of this study can be used by the government authorities in groundwater management and the management of the prevalence of CKDu disease in the study area. Furthermore, the findings of this study will contribute to the policy-makers in Sri Lanka for providing safe drinking water to meet the sustainable development goals (SDGs).

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Drinking Water Quality on Chronic Kidney Disease of Unknown Aetiology (CKDu) in Ulagalla Cascade, Sri Lanka

Sabaragamuwa University Journal ◽

10.4038/suslj.v16i1.7714 ◽

2018 ◽

Vol 16 (1) ◽

pp. 17 ◽

Cited By ~ 1

Author(s):

W. C. S. Wanasinghe ◽

M. H. J. P. Gunarathna ◽

H. M. P. I. K. Herath ◽

G. Y. Jayasinghe

Keyword(s):

Water Quality ◽

Chronic Kidney Disease ◽

Drinking Water ◽

Sri Lanka ◽

Kidney Disease ◽

Drinking Water Quality ◽

Unknown Aetiology

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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/v2 ◽

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.

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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.

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