Drinking water quality and chronic kidney disease of unknown etiology (CKDu): synergic effects of fluoride, cadmium and hardness of water
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High prevalence of chronic kidney disease of unknown etiology (CKDu) in some regions of the world is suspected mainly due to a toxin-mediated renal failure. We examined the incidence of CKDu and potable chemical water quality in a CKDu-affected region. This region has been identified as a high-risk zone for CKDu (location: latitude: 8.3500°–9.0000°, longitude: 80.3833°–81.3000°, North Central Province, NCP, Sri Lanka) by the World Health Organization (WHO). However, within this macro-region, small pockets of CKDu non-prevalence zones do exist; notably, the residents in those pockets consume spring water. Therefore, the drinking water quality of four areas, namely high-CKDu-prevalence areas (zone I), low-CKDu-prevalence area (zone II), the CKDu-free isolated pockets (zone III) and control areas (controls) were examined for F, Al, Cd, and As, and hardness and the statistical analysis were carried out to probe possible correlations among these parameters. The fluoride and hardness concentrations of water in zone III and control areas are much lower compared to zones I and II, and the water hardness is ~61 mg/L CaCO3. In zones I and II, the harness of drinking water is ~121–180 mg/L CaCO3; however, Al, Cd and As concentrations are almost comparable and below WHO recommendations. In most of the locations in zones I and II, the F concentration in drinking water is higher than the WHO recommendations. The peculiar distribution patterns of CKDu point to a synergic effect of trace elements in water for etiology of the disease.
KeywordsChronic kidney disease Fluoride toxicity AlFx complex Metal toxicity CKDu Synergistic effect
Support from A. Jegenathan, K. Wejerathne, D. Perera, U.W. Pradeep and P. Chandrasekera to collect samples is highly appreciated.
- Abeysekara, D. T. D. J., (2006). Clinical presentation of patients. In Proceedings of mini-symposium on chronic kidney disease of uncertain aetiology in Sri Lanka, (pp. 10–11). Erlangen: Germany.Google Scholar
- Aturaliya, T. N. C., Abeysekera, D. T. D. J., Amerasinghe, P. H., Kumarasiri, P. V. R., & Dissanayake, V. (2009). Prevalence of chronic kidney disease in two tertiary care hospitals: High proportion of cases with uncertain aetiology. Ceylon Journal of Medical Science, 54(1), 23–25.Google Scholar
- Chandrajith, R., Dissanayake, C. B., Ariyarathna, T., Herath, H. M. J. M. K., & Padmasiri, J. P. (2011a). Dose-dependent Na and Ca in fluoride-rich drinking water -Another major cause of chronic renal failure in tropical arid regions. Science of the Total Environment, 409(4), 671–675.CrossRefGoogle Scholar
- Chandrajith, R., Nanayakkara, S., Itai, K., Aturaliya, T. N., Dissanayake, C. B., Abeysekera, T., et al. (2011b). Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: Geographic distribution and environmental implications. Environmental Geochemistry and Health, 33(3), 267–278.CrossRefGoogle Scholar
- Dissanayake, C. B. (2005). Water quality in the dry zone of Sri Lanka—some interesting health aspect. Journal of the National Science Foundation of Sri Lanka, 33(3), 161–168.Google Scholar
- Dissanayake, D. M., Jayasekera, J. M. K. B., Ratnayake, P., Wickramasinghe, W., & Radella, Y. A. (2011). The short term effect cyanobacterial toxin extracts on mice kidney, In Proceedings of the Peradeniya University Research Sessions, Sri Lanka, Vol 16.Google Scholar
- Dissanayake, D. M., Jayasekera, J. M. K. B., Ratnayake, P., Wickramasinghe, W., Radella, Y. A., & Palugaswewa, W. B. (2012). Effect of concentrated water from reservoirs of high prevalence area for chronic kidney disease of unknown origin in Sri Lanka on mice. In Symposium proceedings, international symposium on water quality and human health: Challenges ahead, 22–23 March 2012, PGIS, Peradeniya, Sri Lanka proceedings. 12. http://www.pgis.lk/watersym/docs/proceedings_2012.pdf. Accessed at December 2012. Postgraduate Institute of Science, Sri Lanka, 2012.
- Greenberg, A. E., Clesceri, L. S., & Eaton, A. D. (2005). Standard methods for the examination of water and wastewater (18th ed.). Washington, DC: American Public Health Association, American Water Works Association and Water Environment Federation.Google Scholar
- Ileperuma, O. A., Dharmagunawardhane, H. A., & Herath, K. P. R. P. (2009). Dissolution of aluminium from sub-standard utensils under high fluoride stress: A possible risk factor for chronic renal failure in the North-Central Province. Journal of the National Science Foundation of Sri Lanka, 37(3), 219–222.CrossRefGoogle Scholar
- Inkielewicz, I., & Krechniaka, J. (2003). Fluoride content in soft tissues and urine of rats exposed to sodium fluoride in drinking water. Fluoride, 36(4), 263–266.Google Scholar
- Jayasumana, M.A.C.S., Paranagama, P.A., Amarasinghe, M., Fonseka, S. I., & Wijekoon, D. V. K. Presence of arsenic in pesticides used in Sri Lanka. http://www.lankaweb.com/news/items/2011/10/03/presence-of-arsenic-in-pesticides-used-in-sri-lanka/
- Jin, X., Qian, Z., Lu, B., Yang, W., & Bi, S. (2011). Density functional theory study on aqueous aluminum − fluoride complexes: Exploration of the intrinsic relationship between water-exchange rate constants and structural parameters for monomer aluminum complexes. Environmental Science and Technology, 45(1), 288–293.CrossRefGoogle Scholar
- Johnson, S, Misra, S. S., Sahu, R., & Saxena, P (2012). Environmental contamination and its association with Chronic Kidney Disease of Unknown Etiology in North Central Region of Sri Lanka, Centre for Science and Environment Report. CSE/PML/PR‐42/2012. http://www.cseindia.org/userfiles/sri_lanka_final_report.pdf
- Lubkowska, A., Zyluk, B., Chlubek, D., & Poland, S. (2002). Interactions between fluorine and aluminium. Fluoride, 35(2), 73–77.Google Scholar
- Nanayakkara, S., Senevirathna, S., Abeysekera, T., Chandrajith, R., Ratnatunga, N., Gunarathne, E., et al. (2013). An integrative study of the genetic, social and environmental determinants of chronic kidney disease characterized by tubulointerstitial damages in the North Central Region of Sri Lanka. Journal of Occupational Health, 56, 28–38.CrossRefGoogle Scholar
- Wasana, H.M.S., Aluthpatabendi, A., & Bandara, J. (2012). Drinking water quality assessment towards “Chronic Kidney Disease of unknown etiology in North Central Province of Sri Lanka. In Symposium proceedings, international symposium on water quality and human health: Challenges ahead, 22–23 March 2012, PGIS, Peradeniya, Sri Lanka proceedings. 12. http://www.pgis.lk/watersym/docs/proceedings_2012.pdf. Accessed at, December 2012. Postgraduate Institute of Science, Sri Lanka, 2012.
- Wasana, H. M. S., Perera, G. D. R. K., Gunawardena, P. S. De., & Bandara, J. (2015). The impact of aluminum, fluoride, and aluminum–fluoride complexes in drinking water on chronic kidney disease. Environmental Science and Pollution Research. doi: 10.1007/s11356-015-4324-y.
- WHO. (1994). World Health Organization expert Committee on oral health status and fluoride use: Fluorides and oral health, WHO Technical Report series No 846. Geneva: World Health Organization.Google Scholar
- World Health Organization. (2012) Country office for Sri Lanka, WHO Sri Lanka home page. http://dh-web.org/place.names/posts/WHO-on-CKDU.pdf
- www report 1. http://www.groundwatergovernance.org/fileadmin/user_upload/groundwatergovernance/docs/Thematic_papers/GWG_Thematic_Paper_1.pdf. Accessed 17 August 2014.
- www report 2. http://cran.r-project.org/web/packages/vegan/index.html. Accessed 17 August 2014.
- www report 3. http://water.epa.gov/action/advisories/drinking/fluoride_index.cfm. Accessed 17 August 2014.
- www report 4. http://pubs.usgs.gov/wri/wri024094/pdf/mainbodyofreport-3.pdf. Accessed 17 August 2014.