Prevalence of chronic kidney disease and anemia in Hirakud Command Area, Odisha, India: unveiling the role of environmental toxicants.

BACKGROUND

The present community-based study assessed the prevalence of chronic kidney disease (CKD)/chronic kidney disease of unknown origin (CKDu) as well as anemia in some intense agricultural zones under Hirakud Command Area and evaluated their association with pesticides and heavy metal exposure.

METHODS

Random cluster sampling method was used to assess the prevalence of CKD and anemia. Hematological analysis was carried out using autoanalyzer. Pesticide residues in soil, water, rice grains, blood and urine samples were analyzed using LCMSMS and GCMS, while heavy metal levels were assessed using ICP-MS. Risks associated with exposure to pesticides and to heavy metals through dietary and non-dietary sources were assessed using the United States Environmental Protection Agency (USEPA) method.

RESULTS

CKDu was predominant among the farming community in "blocks" i.e. administrative units in rural governance, functioning as subdivisions of districts in India with intense agricultural activities. Blocks reporting higher prevalence of CKDu showed greater concentrations of nephrotoxic pesticide residues in the soil, water and rice grain. Heavy metals in water, such as cadmium, chromium, lead and arsenic, were found to be above permissible limits in all the hotspot blocks. Dietary exposure to pesticide residues was presumed to contribute significantly to non-carcinogenic risk among the exposed population. Analysis of blood and urine samples collected from patients with CKD/CKDu indicated the presence of nephrotoxic pesticide residues and heavy metals among the directly exposed group. Anemia was found to be prevalent among CKDu patients.

CONCLUSION

The present study indicated a strong association between environmental toxicants, like pesticides and heavy metals, and the onset and progression of CKD, as well as anemia in a high intensity agricultural zone. Dietary exposure to pesticides and heavy metals may pose high risks for kidney diseases.