Biswas Pralaya, Sahu Ashish Kumar, Sahoo Sawan Kumar, Ahmed Syed Nikhat, Shristi Sourav, Naik Pradeep Kumar, Baitharu Iswar
Laboratory of Renal Toxicopathology & Medicine, P.G. Department of Environmental Sciences, Sambalpur University, Burla, Odisha, 768019, India.
School of Life Sciences, Sambalpur University, Burla, Odisha, 768019, India.
J Nephrol. 2025 Mar;38(2):563-577. doi: 10.1007/s40620-024-02169-2. Epub 2025 Jan 12.
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.
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.
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.
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.
本项基于社区的研究评估了希拉库德指挥区一些集约化农业区慢性肾脏病（CKD）/不明原因慢性肾脏病（CKDu）的患病率以及贫血情况，并评估了它们与接触农药和重金属之间的关联。
采用随机整群抽样法评估CKD和贫血的患病率。使用自动分析仪进行血液学分析。采用液相色谱 - 串联质谱法（LCMSMS）和气相色谱 - 质谱法（GCMS）分析土壤、水、稻谷、血液和尿液样本中的农药残留，同时采用电感耦合等离子体质谱法（ICP - MS）评估重金属含量。使用美国环境保护局（USEPA）的方法评估通过饮食和非饮食来源接触农药和重金属所带来的风险。
在“街区”（即印度农村治理中的行政单位，作为农业活动密集的地区分区）的农业社区中，CKDu占主导地位。报告CKDu患病率较高的街区，土壤、水和稻谷中肾毒性农药残留浓度更高。发现所有热点街区水中的镉、铬、铅和砷等重金属含量均超过允许限值。饮食接触农药残留被认为是导致暴露人群非致癌风险的重要因素。对CKD/CKDu患者采集的血液和尿液样本分析表明，直接暴露组中存在肾毒性农药残留和重金属。发现CKDu患者中贫血普遍存在。
本研究表明，在高强度农业区，农药和重金属等环境毒物与CKD的发生发展以及贫血之间存在密切关联。饮食接触农药和重金属可能对肾脏疾病构成高风险。
