1
|
Chen D, Parks CG, Beane Freeman LE, Hofmann JN, Sinha R, Madrigal JM, Ward MH, Sandler DP. Ingested nitrate and nitrite and end-stage renal disease in licensed pesticide applicators and spouses in the Agricultural Health Study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:322-332. [PMID: 38191926 DOI: 10.1038/s41370-023-00625-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Nitrate and nitrite ingestion has been linked to kidney cancer, possibly via the endogenous formation of carcinogenic N-nitroso compounds. These exposures might also contribute to end-stage renal disease (ESRD). OBJECTIVES We investigated associations of drinking water nitrate and dietary nitrate and nitrite intakes (total and by food type) with incident ESRD in the Agricultural Health Study. We also explored modifying effects of vitamin C and heme iron intake, which may affect endogenous nitrosation. METHODS We performed complete case analyses among private pesticide applicators and their spouses. We obtained water nitrate estimates for participants whose primary drinking water source at enrollment (1993-1997) was public water supplies (PWS) or private wells (N = 59,632). Average nitrate concentrations were computed from historical data for PWS users and predicted from random forest models for private well users. Analysis of dietary nitrate and nitrite was restricted to the 30,177 participants who completed the NCI Dietary History Questionnaire during follow-up (1999-2003). Incident ESRD through 2018 was ascertained through linkage with the U.S. Renal Data System. We estimated adjusted hazard ratios (HRs) and 95%CI for associations of tertiles (T) of exposure with ESRD overall and explored effects in strata of vitamin C and heme iron intake. RESULTS We identified 469 incident ESRD cases (206 for dietary analysis). Water nitrate and total dietary nitrate/nitrite were not associated with ESRD, but increased ESRD was associated with nitrate and nitrite from processed meats. We found apparent associations between nitrite and ESRD only among participants with vitamin C SIGNIFICANCE ESRD incidence was associated with dietary nitrate/nitrite from processed meat among all study participants and with total dietary nitrite among participants with lower vitamin C or higher heme iron intake. IMPACT STATEMENT There are few well-established environmental risk factors for end-stage renal disease (ESRD), a worldwide public health challenge. Ingestion of nitrate and nitrite, which may lead to endogenous formation of carcinogenic N-nitroso compounds, has been linked to some cancers and chronic diseases. We investigated these exposures in relation to ESRD in an agricultural cohort. ESRD incidence was associated with dietary nitrate/nitrite from processed meat and with total dietary nitrite among subgroups with lower vitamin C or higher heme iron intake. This study provides preliminary evidence that points to dietary nitrite and possibly dietary nitrate intake as a potential contributor to ESRD.
Collapse
Affiliation(s)
- Dazhe Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Laura E Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA
| | - Jonathan N Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA
| | - Rashmi Sinha
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA
| | - Jessica M Madrigal
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA.
| |
Collapse
|
2
|
Bandara S, Rajapaksha AU, Kandasamy A, Hettithanthri O, Magana-Arachchi D, Wanigatunge R, Jayasinghe C, Vithanage M. Food-mediated exposure of Hofmeister ions in Oryza sativa (Rice) from selected CKDu endemic regions in Sri Lanka. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:8417-8432. [PMID: 37634177 DOI: 10.1007/s10653-023-01730-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
The objectives of this study were to determine selected Hofmeister anions and cations that are important for kidney health, in raw rice samples from selected Chronic Kidney Disease of unknown etiology (CKDu) endemic and non-endemic areas in Sri Lanka and their intake. The anions and cations were analyzed by Ion Chromatography and Microwave Plasma Atomic Emission Spectrometry (MP-AES), respectively, after alkaline and acid digestion in thirty raw rice samples each from CKDu endemic and non-endemic areas, and the dietary intake was estimated. The mean concentrations of fluoride (F-), chloride (Cl-), phosphate (PO43-), sulfate (SO42-), sodium (Na+), magnesium (Mg2+), potassium (K+), and calcium (Ca2+) in raw rice in CKDu endemic areas were 53.317, 1515.3, 2799.6, 2704.9, 30.603, 300.76, 1001.3, and 90.075 mg/kg, respectively. The mean concentration of the anions and cations in raw rice from CKDu non-endemic areas were 22.850, 947.52, 4418.7, 6080.2, 23.862, 364.45, 955.78, and 96.780 mg/kg, respectively. Significantly higher differences (p < 0.05) were reported in the mean concentration of F-, Cl-, and Na+ in raw rice from CKDu endemic areas in comparison with the samples from non-endemic areas. The aggregated estimated daily intake (EDI) and cumulative EDI of F- via consumption of cooked non-traditional samba rice from CKDu endemic areas for adults were the highest (0.155 and 0.172 mg/kg bw/d, respectively), which were higher than the recommended tolerable upper intake value (0.15-0.2 mg/kg bw/d). In contrast, the traditional rice from CKDu non-endemic areas for adolescents, reported the lowest values (0.0210 and 0.0470 mg/kg bw/d, respectively). Adults who consume non-traditional samba rice from CKDu endemic areas were at health risk, while children were the most vulnerable group due to their low body weight. These results indicate that the consumption of rice rich in Hofmeister ions may contribute to the total intake and act as risk factors to negatively affect weak kidneys in CKDu endemic areas. Further research to analyze Hofmeister ions in cooked rice and rice from different countries is recommended.
Collapse
Affiliation(s)
- Sanduni Bandara
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Molecular Microbiology and Human Diseases Project, National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Anushka Upamali Rajapaksha
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
- Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Anokshan Kandasamy
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Department of Food Science and Technology, Faculty of Livestock, Fisheries and Nutrition, Wayamba University of Sri Lanka, Makandura, Gonawila (NWP), Sri Lanka
| | - Oshadi Hettithanthri
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Dhammika Magana-Arachchi
- Molecular Microbiology and Human Diseases Project, National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Rasika Wanigatunge
- Department of Plant and Molecular Biology, Faculty of Science, University of Kelaniya, Dalugama, Kelaniya, Sri Lanka
| | - Chamila Jayasinghe
- Department of Food Science and Technology, Faculty of Livestock, Fisheries and Nutrition, Wayamba University of Sri Lanka, Makandura, Gonawila (NWP), Sri Lanka
| | - Meththika Vithanage
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Molecular Microbiology and Human Diseases Project, National Institute of Fundamental Studies, Kandy, Sri Lanka
- Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| |
Collapse
|
3
|
Wimalawansa SJ, Dissanayake CB. Nanocrystal-induced chronic tubular-nephropathy in tropical countries: diagnosis, mitigation, and eradication. Eur J Med Res 2023; 28:221. [PMID: 37408060 DOI: 10.1186/s40001-023-01162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
In tropical countries, a mysterious tubulo-interstitial chronic renal disease (CKD), unrelated to diabetes, hypertension, and immunological causes, manifested four decades ago. Approximately 25,000 primarily middle-aged male farmers succumb annually to this crystal-tubular nephropathy (CTN). Without any known causative factors, it was identified as CKD of unknown aetiology (CKDu). Because multiple factors contribute to causing it later, was changed to CKD of multi-factorial (CKDmfo). Despite no evidence, it was hypothesised to cause by agrochemicals or heavy metals in food or drinking contaminated water. However, current data suggest that the CKD-CTN is due to natural geogenic water contamination. Consumption of concentrated stagnant groundwater from deep-dug wells and tube wells containing hard water and fluoride, overdecades is necessary for its clinical manifestations. In all affected countries have prolonged annual dry seasons that led to the evopo-concentration of ions and minerals in groundwater, making hard water even more unpalatable, thus, peasants consume lesser amounts of water. They develop chronic dehydration from daily exposure to hot climatic conditions aggravated by regular alcohol intake. These conditions provide a highly conducive environment-a perfect storm for calcium phosphate (CaPO4) crystal formation in renal tissues. Our recent histological and preliminary electron microscopic data reveal deposition of CaPO4 crystals and nano-tubes in kidneys. While CaPO4 nano-minerals are unstable, the presence of fluoride ions stabilises and allows their growth. This new concept paves the path for highly cost-effective, straightforward local solutions to protect farm workers and eliminate the disease, without embarking on expensive medications, interventions, or building hospitals. Chronic dehydration-associated CKD-CTN is preventable by increased consumption of potable water. Increasing clean water consumption reduces CKD-CTN incidence, and associated morbidities and premature deaths. However, the damage becomes irreversible when the disease advances beyond CKD stage IIIB. The incidence of this deadly renal failure can be prevented by its education, lifestyle changes, and increased water consumption, not by treating the renal disease or expanding dialysis centres/hospitals, or transplantation services. Eradication of CKD-CTN cost significantly less than the current approach of treating affected persons and unnecessarily expanding health infrastructure. Since the manifestation of CKD-CTN is due to consuming naturally contaminated drinking water (with calcium containing hard water and fluoride), it is not difficult to remove these to prevent CKD-CTN: thus, international assistance is unwarranted for its eradication. The straightforward approaches described here will prevent CKD-CTN and save thousands of lives in affected farming communities.
Collapse
Affiliation(s)
- Sunil J Wimalawansa
- Cardiometabolic & Endocrine Institute, Department of Medicine, Endocrinology, Nutrition, (formerly UMDNJ/Rutgers University), New Brunswick, NJ, 08902, USA.
- , Moratuwa, Sri Lanka.
| | - Chandra B Dissanayake
- Department of Geology, University of Peradeniya, Peradeniya, Sri Lanka
- Institute of Fundamental Studies, Kandy, Sri Lanka
| |
Collapse
|
4
|
Sandanayake S, Diyabalanage S, Edirisinghe EANV, Guo H, Vithanage M. Hydrogeochemical characterization of groundwater with a focus on Hofmeister ions and water quality status in CKDu endemic and CKDu non‒endemic areas, Sri Lanka. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 328:121596. [PMID: 37037276 DOI: 10.1016/j.envpol.2023.121596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Hydro-geochemistry of drinking water was characterized in chronic kidney disease of unknown etiology (CKDu) endemic areas in Girandurukotte (GK) and Dehiattakandiya (DH) and non-endemic areas in GK, DH, and Sewanagala (SW) in Sri Lanka to comprehend any potential risk factors for CKDu. Groundwater (n = 142) and surface water (n = 08) were sampled during wet and dry seasons and analyzed for major anions, cations and stable isotopes of hydrogen and oxygen (δ2H and δ18O). Besides the typical water quality analysis, the water quality status was determined using the weighted arithmetic water quality index (WQI) and Hofmeister ion exposure levels. The measured average groundwater F- level was higher than the permissible level assigned by regulatory agencies for tropical countries at CKDu locations in GK, DH and non-CKDu locations in DH and SW. Significant differences in the content of total hardness (p = 0.017) and total dissolved solids (p = 0.003) were observed between CKDu and non-CKDu locations whereas the differences were insignificant for F- (p = 0.985) and alkalinity (p = 0.203). Weathering of silicate and carbonate minerals was found to be the main governing factor of groundwater compositions in both CKDu and non-CKDu areas, while recharging of groundwater is mainly determined by the rainfall than the surface water inputs. Higher ionic strength of groundwater in non-CKDu areas suggested that the potential environmental CKDu risk factors might be suppressed from dissolution into groundwater. The WQI calculations revealed that the both CKDu and non-CKDu locations were frequently presented with poor water quality. This study highlights the water quality status of the CKDu and non-CKDu locations and signifies the potential health risks that could arise even in non-CKDu areas due to the consumption of poor quality water. Accordingly, regular monitoring of water quality and assessment of Hofmeister ions exposure from food and beverages are highly warranted.
Collapse
Affiliation(s)
- Sandun Sandanayake
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, 10250, Sri Lanka
| | - Saranga Diyabalanage
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, 10250, Sri Lanka; Instrument Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, 10250, Sri Lanka
| | - E A N V Edirisinghe
- Isotope Hydrology Section, Sri Lanka Atomic Energy Board (SLAEB), Wellampitiya, Sri Lanka
| | - Huaming Guo
- Ministry of Education Key Laboratory of Groundwater Circulation and Environmental Evolution & School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China
| | - Meththika Vithanage
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, 10250, Sri Lanka.
| |
Collapse
|
5
|
Trivedi A, Kumar S. Chronic Kidney Disease of Unknown Origin: Think Beyond Common Etiologies. Cureus 2023; 15:e38939. [PMID: 37309333 PMCID: PMC10257931 DOI: 10.7759/cureus.38939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/12/2023] [Indexed: 06/14/2023] Open
Abstract
Chronic kidney disease has an increased health impact on a global scale, with the most common etiologies being hypertension and diabetes. It is most frequently linked to noncommunicable conditions, including diabetes and hypertension, among high-income nations. However, it has a couple of new potential etiologies in low- and middle-income countries, many of which are yet unknown, including viral infections and environmental toxins. The phrase "CKD of unknown etiology" (CKDu) has been used to refer to CKD that is not caused by a typical risk factor such as diabetes, high blood pressure, or HIV. Environmental variables have been investigated as potential contributors to CKDu, including heavy metal exposure, elevated seasonal temperatures, pesticide use, mycotoxins, contamination of water supplies, and snake bites. Furthermore, the underlying causes have not been definitively established in the majority of areas and identifying serious health consequences across different international contexts and populations may be crucial for comprehending and avoiding CKDu.
Collapse
Affiliation(s)
- Alokita Trivedi
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| |
Collapse
|
6
|
Nayak S, Rehman T, Patel K, Dash P, Alice A, Kanungo S, Palo SK, Pati S. Factors Associated with Chronic Kidney Disease of Unknown Etiology (CKDu): A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11040551. [PMID: 36833085 PMCID: PMC9956943 DOI: 10.3390/healthcare11040551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
(1) Background: Despite ample research, the factors, specific causes, and pathways associated with chronic kidney disease of unknown etiology (CKDu) remain elusive. Therefore, we performed a systematic review to explore the potential etiologies for the development of CKDu globally. (2) Methods: A systematic literature review was conducted using databases CINAHL, Cochrane Library, Embase, Google Scholar, MEDLINE, and PsycINFO on the specific causes and pathophysiology related to CKDu from inception until April 2021. Study selection, data extraction of included articles, and quality appraisal were assessed. The narrative approach was used to summarize and comprehend the findings. (3) Results: Our study included 25 studies, considering 38,351 participants. Twelve studies were case-control, ten were cross-sectional, and three were cohort designs. All articles were from low-and middle-income countries (LMICs). The findings suggest 12 factors are associated with CKDu. Most studies (n = 8) identified farming and water sources as the factors related to CKDu, with heavy metal toxicity coming in second (n = 7). (4) Conclusion: The systematic review reported various factors associated with CKDu, from which most studies reported farming, water sources, and heavy metal poisoning. Considering the findings, the study recommends future strategies and public health initiatives to prevent the epidemiological/environmental factors contributing to CKDu.
Collapse
|
7
|
Hidayangsih PS, Tjandrarini DH, Sukoco NEW, Sitorus N, Dharmayanti I, Ahmadi F. Chronic kidney disease in Indonesia: evidence from a national health survey. Osong Public Health Res Perspect 2023; 14:23-30. [PMID: 36944342 DOI: 10.24171/j.phrp.2022.0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVES Several previous studies have stated that consuming certain foods and beverages might increase the risk of chronic kidney disease (CKD). This study aimed to examine the relationships of food and beverage consumption with other risk factors for CKD. METHODS Data sources included the 2018 Basic Health Research (Riskesdas) and the National Socio-Economic Survey (Susenas), which were analyzed using a cross-sectional design. The study samples were households from 34 provinces in Indonesia, and the analysis was performed with provincial aggregates. Data were analyzed using risk factor analysis followed by linear regression to identify relationships with CKD. RESULTS The prevalence of CKD in Indonesia was 0.38%. The province with the highest prevalence was North Kalimantan (0.64%), while the lowest was found in West Sulawesi (0.18%). Five major groups were formed from 15 identified risk factors using factor analysis. A linear regression model presented 1 significant selected factor (p=0.006, R2 =31%). The final model of risk factors included water quality, consumption of fatty foods, and a history of diabetes. CONCLUSIONS Drinking water quality, fatty food consumption, and diabetes are associated with CKD. There is a need to monitor drinking water, as well as to promote health education and provide comprehensive services for people with diabetes, to prevent CKD.
Collapse
Affiliation(s)
- Puti Sari Hidayangsih
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Dwi Hapsari Tjandrarini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Noor Edi Widya Sukoco
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Nikson Sitorus
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Ika Dharmayanti
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Feri Ahmadi
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| |
Collapse
|
8
|
Aoun M, Chelala D. Where do you live and what do you do? Two questions that might impact your kidney health. FRONTIERS IN NEPHROLOGY 2022; 2:1011964. [PMID: 37675017 PMCID: PMC10479685 DOI: 10.3389/fneph.2022.1011964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 09/08/2023]
Abstract
In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.
Collapse
Affiliation(s)
- Mabel Aoun
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | | |
Collapse
|
9
|
Yang YF, Li WG, Wen PP, Jia PP, Li YZ, Li TY, Pei DS. Exposure to Sri Lanka's local groundwater in a CKDu prevalent area causes kidney damage in zebrafish. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2022; 251:106276. [PMID: 36041360 DOI: 10.1016/j.aquatox.2022.106276] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/04/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
How local groundwater induces chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is still elusive. This study aims to elucidate the impacts of Sri Lanka's local groundwater in a CKDu prevalent area and reveal the possible pathogenic mechanism of CKDu using zebrafish models. The drinking water from the local underground well in Vavuniya was sampled and the water quality parameters including Na+, Mg2+, K+, Ca2+, Cl-, NO3-, SO42-, and F- were analyzed. Then, local groundwater exposure to zebrafish larvae and 293T cells was performed, and water with high hardness and fluoride was prepared as parallel groups. Our result showed that exposure to Sri Lanka's local groundwater caused developmental toxicity, kidney damage, and pronephric duct obstruction as well as abnormal behavior in zebrafish. Similar results were also found after exposure to water with high hardness and fluoride in zebrafish. Further, the expression levels of marker genes related to renal development and functions (foxj1a, dync2h1, pkd2, gata3, and slc20a1) were significantly altered, which is also confirmed in the 293T cells. Taken together, those results indicated that Sri Lanka's local groundwater in a CKDu prevalent area could cause kidney damage, implying that high water hardness and fluorine might be the inducible environmental factors for the etiological cause of CKDu.
Collapse
Affiliation(s)
- Yi-Fan Yang
- College of Life Science, Henan Normal University, Xinxiang 453007, China; School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Wei-Guo Li
- College of Life Science, Henan Normal University, Xinxiang 453007, China
| | - Ping-Ping Wen
- College of Life Science, Henan Normal University, Xinxiang 453007, China; School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Pan-Pan Jia
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Yong-Zhi Li
- Chongqing University, Chongqing 400044, China; Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, Chongqing School, University of Chinese Academy of Sciences, Chongqing 400714, China
| | - Tian-Yun Li
- Chongqing University, Chongqing 400044, China; Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Science, Chongqing School, University of Chinese Academy of Sciences, Chongqing 400714, China
| | - De-Sheng Pei
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China.
| |
Collapse
|
10
|
Davies TC. The position of geochemical variables as causal co-factors of diseases of unknown aetiology. SN APPLIED SCIENCES 2022; 4:236. [PMID: 35909942 PMCID: PMC9326422 DOI: 10.1007/s42452-022-05113-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract The term diseases of unknown aetiology (DUA) or idiopathic diseases is used to describe diseases that are of uncertain or unknown cause or origin. Among plausible geoenvironmental co-factors in causation of DUA, this article focusses on the entry of trace elements, including metals and metalloids into humans, and their involvement in humoral and cellular immune responses, representing potentially toxic agents with implications as co-factors for certain DUA. Several trace elements/metals/metalloids (micronutrients) play vital roles as co-factors for essential enzymes and antioxidant molecules, thus, conferring protection against disease. However, inborn errors of trace element/metal/metalloid metabolisms can occur to produce toxicity, such as when there are basic defects in the element transport mechanism. Ultimately, it is the amount of trace element, metal or metalloid that is taken up, its mode of accumulation in human tissues, and related geomedical attributes such as the chemical form and bioavailability that decisively determine whether the exerted effects are toxic or beneficial. Several case descriptions of DUA that are common worldwide are given to illustrate our knowledge so far of how trace element/metal/metalloid interactions in the immune system may engender its dysregulation and be implicated as causal co-factors of DUA. Article highlights The importance of a proper understanding of geochemical perturbations in human metabolisms is emphasisedIt is proferred that such an understanding would aid greatly in the decipherment of diseases of unknown aetiology (DUA)The thesis presented may pave the way towards better diagnosis and therapy of DUA.
Collapse
Affiliation(s)
- Theophilus C. Davies
- Present Address: Faculty of Natural Sciences, Mangosuthu University of Technology, 511 Mangosuthu Highway, 4031, KwaZulu Natal, South Africa
| |
Collapse
|
11
|
Comprehensive Groundwater Quality Analysis in Chronic Kidney Disease of Unknown Etiology (CKDu) Prevalence Areas of Sri Lanka to Investigate the Responsible Culprit. J CHEM-NY 2022. [DOI: 10.1155/2022/1094427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Chronic kidney disease of unknown etiology (CKDu) is a serious health problem in Sri Lanka especially among agricultural communities in dry zone since 19th century. In the present study, several water quality parameters were studied in well water samples and only four parameters, namely, hardness, cadmium level, fluoride level, and strontium level have shown a relationship with the CKDu prevalence. Higher percentage of well water samples collected from CKDu prevalent area in both pre and postmonsoon seasons have exceeded the WHO recommended levels of hardness. Further, water samples collected in postmonsoon seasons had significantly higher hardness than the well water samples collected in premonsoon season (
). This may be due to the dissolution of calcium carbonate by water recharge. Moreover, cadmium and fluoride contents have exceeded the recommended levels in high-risk area during the premonsoon period. Furthermore, according to principal component analysis (PCA), four clusters were identified depending on the different levels of fluoride, cadmium, hardness, and strontium contents. The control area (Am) fell in to separate cluster with low contents of fluoride, cadmium, hardness, and strontium than in CKDu prevalent area. Since it has been found that the above species are directly involved in renal damage, it can be concluded that a synergetic effect of cadmium, fluoride, hardness, and strontium in well water may be a main cause for CKDu in Sri Lanka.
Collapse
|
12
|
Hettithanthri O, Sandanayake S, Magana-Arachchi D, Wanigatunge R, Rajapaksha AU, Zeng X, Shi Q, Guo H, Vithanage M. Risk factors for endemic chronic kidney disease of unknown etiology in Sri Lanka: Retrospect of water security in the dry zone. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 795:148839. [PMID: 34328928 DOI: 10.1016/j.scitotenv.2021.148839] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
The prevalence of chronic kidney disease of unknown etiology (CKDu) is receiving considerable attention due to the serious threat to human health throughout the world. However, the roles of geo-socio-environmental factors in the prevalence of the CKDu endemic areas are still unknown. Sri Lanka is one of the countries most seriously affected by CKDu, where 10 out of 25 districts have been identified as the areas with the high prevalence of CKDu (10-20%). This review summarizes the geographical distribution of CKDu and its probable geochemical, behavioral, sociological, and environmental risk factors based on research related to hydrogeochemical influences on CKDu in Sri Lanka. More than 98% of CKDu patients have consumed groundwater as their primary water source in daily life, indicating the interactions of geogenic contaminants (such as F-, total dissolved solids, Hofmeister ions) in groundwater is responsible for the disease. Apart from the hydrogeochemical factors, mycotoxins, cyanotoxins, use of some herbal medicines, dehydration, and exposure to agrochemicals were alleged as risk factors. Sociological factors, including poverty, living habits and anthropogenic activities, may also provoke the emergence of CKDu. Therefore, the interaction of geo-socio environmental risk factors should be sociologically and scientifically considered to prevent the prevalence of CKDu. Future in-depth studies are required to reveal the individual role of each of the postulated etiological factors, possibly using machine learning and advanced statistics.
Collapse
Affiliation(s)
- Oshadi Hettithanthri
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sandun Sandanayake
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Dhammika Magana-Arachchi
- Molecular Microbiology and Human Diseases, National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Rasika Wanigatunge
- Department of Plant and Molecular Biology, Faculty of Science, University of Kelaniya, Sri Lanka
| | - Anushka Upamali Rajapaksha
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Xianjiang Zeng
- School of Water Resources and Environment, China University of Geosciences, Beijing, China
| | - Qiutong Shi
- School of Water Resources and Environment, China University of Geosciences, Beijing, China
| | - Huaming Guo
- School of Water Resources and Environment, China University of Geosciences, Beijing, China.
| | - Meththika Vithanage
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| |
Collapse
|
13
|
The Groundwater Geochemistry and the Human Health Risk Assessment of Drinking Water in an Area with a High Prevalence of Chronic Kidney Disease of Unknown Etiology (CKDu), Sri Lanka. J CHEM-NY 2021. [DOI: 10.1155/2021/1755140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease of unknown etiology (CKDu) has become an alarming health issue in Sri Lanka. The disease is more notable among farming communities and people who consume groundwater as their main source of drinking water. To assess the possible links between drinking water chemistry and expansion of CKDu, the study was compared with hydrogeochemical data of drinking water sources in a CKDu prevalent area (Girandurukotte GND, Badulla District) and a reference area (Dambethalawa GND, Ampara District) in Sri Lanka. Based on the results, nephrotoxic heavy metal (Cd, Cr, Pb, and As) concentrations were significantly higher in the CKDu prevalent site than the reference area, compromised the harmful consequences to the people in the CKDu hotspot. Results of the inverse distance weighted (IDW) interpolation tool indicated the nephrotoxic heavy metals contents including Cd, Pb, As, and Cr in CKDu hotspot were changed in the ranges of 9.78–187.25 μg/L, 0.08–0.66 μg/L, 20.76–103.30 μg/L, and 0.03–0.34 μg/L. The random distribution patterns were shown by the result in Moran’s index values. Noteworthy, the results have emphasized a strong association between fluoride and water hardness. The frequency of occurrence above the threshold limit of fluoride was 28% in non-CKDu water samples, while 81% in CKDu prevalent sites. The hardness values in the CKDu prevalent site indicated “moderately hard water,” while the non-CKDu area indicated the “soft water.” Furthermore, this paper quantified overall water quality and heavy metal contamination and assessed the human health risks associated with drinking water. According to the results of the water quality index, 90% of the samples in the CKDu prevalent area were classified as “poor water” and “very poor water” for drinking purposes, while 73.33% of the samples in the non-CKDu area were “good” and “excellent” for drinking usage. Calculated chronic daily intake (CDIoral) and hazard quotient (HQoral) of nephrotoxicants were higher in CKDu hotspot than the non-CKDu site. Besides, the hazard index (HI) values obtained for the CKDu prevalent area exceeding the acceptable limit (HI = 1) indicated potential health risks to the people in those areas. This study suggests that long-term exposure to nephrotoxic heavy metals, water hardness, and fluoride present in drinking water may threaten human health and affect kidney functions. Therefore, regular monitoring and better management of water supplies in CKDu prevalent areas are essential to determine the contamination load and reduce the health impacts due to excessive and long-term exposure to the nephrotoxicants.
Collapse
|