Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka; Postgraduate Institute of Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
Instrument Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
Environ Res. 2022 Jan;203:111779. doi: 10.1016/j.envres.2021.111779. Epub 2021 Jul 30.
The epidemic of chronic kidney disease of unknown etiology (CKDu) that contributes significantly to morbidity and mortality rates among dry-zonal farming communities has become a public health priority in Sri Lanka. Though a large number of hypotheses were introduced as causative factors, none of them have been confirmed so far. As drinking water quality is among the most suspected causative factors for the emergence of CKDu, a detailed hydro-geochemical investigation was carried out concurrently with the population screening in the Monaragala district of Sri Lanka where high incidences of CKDu are reported. A population screening was performed selecting 46,754 people using both dipstick proteinuria test and Albumin-Creatinine Ratio (ACR). The results revealed that the disease prevalence is about 6.7 % in the district. A total of 60 groundwater samples, 30 each, were collected from CKDu-prevalent locations and control locations where there are no CKDu cases reported. The samples were analyzed to identify any possible linkage between water quality and disease prevalence. Concentrations of hardness, F, Na and Mg in groundwater revealed a statistically significant difference between CKDu and control wells at a confident level of p = 0.05. The study revealed that alkali (Na+K) and alkaline earth cations (Mg, Ca, Sr, Ba) were relatively higher in drinking water sources used by CKDu patients, compared to the well waters used by healthy individuals. Nearly 87 % of the wells used by CKDu cases showed higher fluoride levels that exceed the threshold level (1.0 mg L). Contents of nephrotoxic trace elements such as As, Cd, and Pb were found to be comparable in both types of wells and were well below the WHO permissible levels, thus negating their prime influence on the CKDu prevalence. It is obtrusive that the elevated fluoride levels together with water hardness associated with higher Mg levels have a possible relation with CKDu and may influence the disease progression.
在斯里兰卡，病因不明的慢性肾病（CKDu）流行对干地区农业社区的发病率和死亡率有重大影响，已成为公共卫生的重点。尽管提出了大量假说作为致病因素，但到目前为止，没有一个得到证实。由于饮用水质量是导致 CKDu 出现的最可疑因素之一，因此在 CKDu 高发的斯里兰卡 Monaragala 区同时进行了详细的水文地球化学调查和人群筛查。人群筛查选择了 46754 人，使用尿蛋白试纸和白蛋白-肌酐比（ACR）进行检测。结果显示，该地区的疾病患病率约为 6.7%。从 CKDu 流行地区和没有 CKDu 病例报告的对照地区共采集了 60 个地下水样本，每个地区采集 30 个。对样本进行了分析，以确定水质与疾病患病率之间是否存在任何可能的联系。地下水的硬度、F、Na 和 Mg 浓度在 CKDu 和对照井之间存在统计学显著差异，置信水平为 p=0.05。研究表明，与健康个体使用的井水相比，CKDu 患者使用的饮用水源中的碱（Na+K）和碱性土阳离子（Mg、Ca、Sr、Ba）相对较高。近 87%的 CKDu 病例使用的水井中氟化物含量较高，超过了阈值（1.0mg/L）。两种类型的水井中，肾毒性微量元素如 As、Cd 和 Pb 的含量相当，均远低于世界卫生组织允许的水平，因此可以排除它们对 CKDu 患病率的主要影响。引人注目的是，升高的氟化物水平与与较高 Mg 水平相关的水硬度可能与 CKDu 有关，并可能影响疾病的进展。
