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

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Abstract

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.

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References

  • 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.

  • Adachi, K., Dote, T., Dote, E., Mitsui, G., & Kono, K. (2007). Strong acute toxicity, severe hepatic damage, renal injury and abnormal serum electrolytes after intravenous administration of cadmium fluoride in rats. Journal of Occupational Health-English Edition, 49, 235–241.

    Article  CAS  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 

  • Bandara, J. M. R. S., Wijewardena, H. V. P., Liyanege, J., Upul, M. A., & Bandara, J. M. U. A. (2010). Chronic renal failure in Sri Lanka caused by elevated dietary cadmium: Trojan horse of the green revolution. Toxicology Letters, 198(1), 33–39.

    Article  CAS  Google Scholar 

  • Barbier, O., Jacquillet, G., Tauc, M., Cougnon, M., & Poujeol, P. (2005). Effect of heavy metals on, and handling by, the kidney. Nephron Physiology, 99(4), 105–110.

    Article  CAS  Google Scholar 

  • Cerdas, M. (2005). Chronic kidney disease in Costa Rica. Kidney International, 97, S31–S33.

    Article  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.

    Article  CAS  Google 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.

    Article  CAS  Google Scholar 

  • Codreanu, I., Perico, N., Sharma, S. K., Schieppati, A., & Remuzzi, G. (2006). Prevention programmes of progressive renal disease in developing nations. Nephrology, 11(4), 321–328.

    Article  Google Scholar 

  • Dalrymple, L. S., Katz, R., Kestenbaum, B., Shlipak, M. G., Sarnak, M. J., Stehman-Breen, C., et al. (2011). Chronic kidney disease and the risk of end-stage renal disease versus death. Journal of General Internal Medicine, 26(4), 379–385.

    Article  Google Scholar 

  • Debelle, F. D., Vanherweghem, J. L., & Nortier, J. L. (2008). Aristolochic, acid nephropathy: A worldwide problem. Kidney International, 74(2), 158–169.

    Article  CAS  Google 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, C. B., & Chandrajith, R. (2007). Medical geology in tropical countries with special reference to Sri Lanka. Environmental Geochemistry and Health, 29(2), 155–162.

    Article  CAS  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.

  • 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.

  • El Nahas, A. M., & Belle, A. K. (2005). Chronic kidney disease: The global challenge. Lancet, 365(9456), 331–340.

    Article  Google Scholar 

  • Ferraro, P. M., Costanzi, S., Naticchia, A., Sturniolo, A., & Gambaro, G. (2010). Low level exposure to cadmium increases the risk of chronic kidney disease: Analysis of the NHANES 1999–2006. BMC Public Health, 10, 304. doi:10.1186/1471-2458-10-304.

    Article  CAS  Google Scholar 

  • Gamvroula, D., Alexakia, D., & Stamatis, G. (2013). Diagnosis of groundwater quality and assessment Megara basin (Attica. Greece). Arabian Journal of Geosciences, 6(7), 2367–2381.

    Article  CAS  Google Scholar 

  • Gooneratne, I. K., Ranaweera, A. K. P., Liyanarachchi, N. P., Gunawardane, N., & Lanerolle, R. D. (2008). Epidemiology of chronic kidney disease in a Sri Lankan population. International Journal of Diabetes in Developing Countries, 28(2), 60–64.

    Article  CAS  Google Scholar 

  • 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 

  • Hassen, W., Abid, S., Achour, A., Creppy, E., & Bacha, H. (2004). Ochratoxin A and beta2-microglobulinuria in healthy individuals and in chronic interstitial nephropathy patients in the centre of Tunisia: A hot spot of ochratoxin a exposure. Toxicology, 199(2–3), 185–193.

    Article  CAS  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.

    Article  CAS  Google 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.

    CAS  Google Scholar 

  • Järup, L., Hellström, L., Alfvén, T., Carlsson, M. D., Grubb, A., Persson, B., et al. (2000). Low level exposure to cadmium and early kidney damage: The OSCAR study. Occupational and Environmental Medicine, 57(10), 668–672.

    Article  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/

  • Jayatilake, N., Mendis, S., Maheepala, P., & Mehta, F. R. (2013). Chronic kidney disease of uncertain aetiology: Prevalence and causative factors in a developing country. BMC Nephrology, 2013(14), 180. doi:10.1186/1471-2369-14-180.

    Article  Google Scholar 

  • 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.

    Article  CAS  Google 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.

    CAS  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.

    Article  Google Scholar 

  • Soderland, P., Lovekar, S., Weiner, D. E., Brooks, D. R., & Kaufman, J. S. (2010). Chronic kidney disease associated with environmental toxins and exposures. Advances in Chronic Kidney Disease, 17(3), 254–264.

    Article  Google Scholar 

  • Stamatis, G., Alexakia, D., Gamvroula, D., & Migiros, G. (2011). Groundwater quality assessment in Oropos–Kalamos basin. Environmental Earth Sciences, 64(4), 973–988.

    Article  CAS  Google Scholar 

  • Thijssen, S., Maringwa, J., Faes, C., Lambrichts, I., & Van Kerkhove, E. (2007). Chronic exposure of mice to environmentally relevant, low doses of cadmium leads to early renal damage, not predicted by blood or urine cadmium levels. Toxicology, 229(1–2), 145–156.

    Article  CAS  Google Scholar 

  • Varner, J. A., Jensen, K. F., Horvath, W., & Isaacson, R. L. (1998). Chronic administration of aluminum–fluoride or sodium–fluoride to rats in drinking water: Alterations in neuronal and cerebrovascular integrity. Brain Research, 784, 284–298.

    Article  CAS  Google Scholar 

  • Wanigasuriya, K. P., Peiris-John, R. J., & Wickremasinghe, R. (2011). Chronic kidney disease of unknown etiology in Sri Lanka: Is cadmium a likely cause? BMC Nephrology, 12, 32. doi:10.1186/1471-2369-12-32.

    Article  Google Scholar 

  • Warnakulasuriya, K. A. A. S., Balasuriya, S., Perera, P. A. J., & Peiris, L. C. L. (1992). Determining optimal levels of fluoride in drinking water hot dry climates-A case study in Sri Lanka. Community Dental Oral Epidermiology, 20(6), 364–367.

    Article  CAS  Google 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.

  • Xiong, X., Liu, J., He, W., Xia, T., He, P., Chen, X., et al. (2007). Dose-effect relationship between drinking water fluoride levels and damage to liver and kidney functions in children. Environmental Research, 3(1), 112–116.

    Article  CAS  Google Scholar 

  • Zhu, Y. N., Zhang, X. H., Xie, Q. L., Wang, D. Q., & Cheng, G. W. (2006). Solubility and stability of calcium arsenates at 25 °C. Water, Air, and Soil pollution, 169(1–4), 221–238.

    Article  CAS  Google Scholar 

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Acknowledgments

Support from A. Jegenathan, K. Wejerathne, D. Perera, U.W. Pradeep and P. Chandrasekera to collect samples is highly appreciated.

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Authors and Affiliations

  1. Institute of Fundamental Studies, Hantana Road, Kandy, 20000, CP, Sri Lanka

    Hewa M. S. Wasana, Dharshani Aluthpatabendi & Jayasundera Bandara

  2. Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka

    W. M. T. D. Kularatne & Pushpa Wijekoon

  3. Department of Soil Science, Faculty of Agriculture, University of Peradeniya, Peradeniya, Sri Lanka

    Rohan Weerasooriya

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  1. Hewa M. S. Wasana
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  2. Dharshani Aluthpatabendi
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Correspondence to Jayasundera Bandara.

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Wasana, H.M.S., Aluthpatabendi, D., Kularatne, W.M.T.D. et al. Drinking water quality and chronic kidney disease of unknown etiology (CKDu): synergic effects of fluoride, cadmium and hardness of water. Environ Geochem Health 38, 157–168 (2016). https://doi.org/10.1007/s10653-015-9699-7

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