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Drobac Backović D, Tokodi N. Blue revolution turning green? A global concern of cyanobacteria and cyanotoxins in freshwater aquaculture: A literature review. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2024; 360:121115. [PMID: 38749125 DOI: 10.1016/j.jenvman.2024.121115] [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: 02/27/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
To enhance productivity, aquaculture is intensifying, with high-density fish ponds and increased feed input, contributing to nutrient load and eutrophication. Climate change further exacerbates cyanobacterial blooms and cyanotoxin production that affect aquatic organisms and consumers. A review was conducted to outline this issue from its inception - eutrophication, cyanobacterial blooms, their harmful metabolites and consequential effects (health and economic) in aquacultures. The strength of evidence regarding the relationship between cyanobacteria/cyanotoxins and potential consequences in freshwater aquacultures (fish production) globally were assessed as well, while identifying knowledge gaps and suggesting future research directions. With that aim several online databases were searched through June 2023 (from 2000), and accessible publications conducted in aquacultures with organisms for human consumption, reflecting cyanotoxin exposure, were selected. Data on cyanobacteria/cyanotoxins in aquacultures and its products worldwide were extracted and analyzed. Selected 63 papers from 22 countries were conducted in Asia (48%), Africa (22%), America (22%) and Europe (8%). Microcystis aeruginosa was most frequent, among over 150 cyanobacterial species. Cyanobacterial metabolites (mostly microcystins) were found in aquaculture water and fish from 18 countries (42 and 33 papers respectively). The most affected were small and shallow fish ponds, and omnivorous or carnivorous fish species. Cyanotoxins were detected in various fish organs, including muscles, with levels exceeding the tolerable daily intake in 60% of the studies. The majority of research was done in developing countries, employing less precise detection methods, making the obtained values estimates. To assess the risk of human exposure, the precise levels of all cyanotoxins, not just microcystins are needed, including monitoring their fate in aquatic food chains and during food processing. Epidemiological research on health consequences, setting guideline values, and continuous monitoring are necessary as well. Further efforts should focus on methods for elimination, prevention, and education.
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Affiliation(s)
- Damjana Drobac Backović
- University of Novi Sad, Faculty of Sciences, Department of Biology and Ecology, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia
| | - Nada Tokodi
- University of Novi Sad, Faculty of Sciences, Department of Biology and Ecology, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia; Jagiellonian University, Faculty of Biochemistry, Biophysics and Biotechnology, Laboratory of Metabolomics, Gronostajowa 7, Krakow, 30387, Poland.
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Jia PP, Li Y, Zhang LC, Wu MF, Li TY, Pei DS. Metabolome evidence of CKDu risks after chronic exposure to simulated Sri Lanka drinking water in zebrafish. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 273:116149. [PMID: 38412632 DOI: 10.1016/j.ecoenv.2024.116149] [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: 12/28/2023] [Revised: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 02/29/2024]
Abstract
It is still a serious public health issue that chronic kidney disease of uncertain etiology (CKDu) in Sri Lanka poses challenges in identification, prevention, and treatment. What environmental factors in drinking water cause kidney damage remains unclear. This study aimed to investigate the risks of various environmental factors that may induce CKDu, including water hardness, fluoride (HF), heavy metals (HM), microcystin-LR (MC-LR), and their combined exposure (HFMM). The research focused on comprehensive metabolome analysis, and correlation with transcriptomic and gut microbiota changes. Results revealed that chronic exposure led to kidney damage and pancreatic toxicity in adult zebrafish. Metabolomics profiling showed significant alterations in biochemical processes, with enriched metabolic pathways of oxidative phosphorylation, folate biosynthesis, arachidonic acid metabolism, FoxO signaling pathway, lysosome, pyruvate metabolism, and purine metabolism. The network analysis revealed significant changes in metabolites associated with renal function and diseases, including 20-Hydroxy-LTE4, PS(18:0/22:2(13Z,16Z)), Neuromedin N, 20-Oxo-Leukotriene E4, and phenol sulfate, which are involved in the fatty acyls and glycerophospholipids class. These metabolites were closely associated with the disrupted gut bacteria of g_ZOR0006, g_Pseudomonas, g_Tsukamurella, g_Cetobacterium, g_Flavobacterium, which belonged to dominant phyla of Firmicutes and Proteobacteria, etc., and differentially expressed genes (DEGs) such as egln3, ca2, jun, slc2a1b, and gls2b in zebrafish. Exploratory omics analyses revealed the shared significantly changed pathways in transcriptome and metabolome like calcium signaling and necroptosis, suggesting potential biomarkers for assessing kidney disease.
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Affiliation(s)
- Pan-Pan Jia
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Yan Li
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Lan-Chen Zhang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Ming-Fei Wu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Tian-Yun Li
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - De-Sheng Pei
- School of Public Health, Chongqing Medical University, Chongqing 400016, China.
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Ranasinghe AV, Somatunga LC, Kumara GWGP, Karunarathna RH, De Silva AP, Gunawardena JMCN, Kumari SKCR, Sarjana MSF, De Silva MVC. Decreasing incidence of hospital diagnosed CKD/CKDu in North Central Province of Sri Lanka: is it related to provision of drinking water reverse osmosis plants? BMC Nephrol 2024; 25:91. [PMID: 38468233 PMCID: PMC10926649 DOI: 10.1186/s12882-024-03534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND We assessed the possible impact of provision of reverse osmosis (RO) water on the incidence of hospital diagnosed CKD/CKDu in North Central Province (NCP) of Sri Lanka. METHODS An ecological study was conducted on data from 2010-2020 on the incidence of hospital diagnosed CKD/CKDu, CKD/CKDu screening and provision of drinking water RO plants in NCP. Analysis was conducted using descriptive statistics, ANOVA and chi-square test. RESULTS The annual incidence of hospital diagnosed CKD/CKDu (per 100 000 population) in 2010-2013, 2014-2016 and 2017-2020 periods in Anuradhapura district were 129.07, 331.06 and 185.57 (p = 0.002) while in Polonnaruwa district these were 149.29, 326.12 and 296.73 (p = 0.04) respectively. In NCP provision of RO plants commenced after 2011 and the decline in the incidence of hospital diagnosed CKD/CKDu was seen in 25 of the 29 Divisional Secretary Divisions when more than 20% of the families received access to drinking RO water projects. CONCLUSIONS The annual incidence of hospital diagnosed CKD/CKDu increased in NCP from 2010 to 2016 and continuously decreased thereafter. Continuous declining of CKD/CKDu incidence was seen after more than 20% of the families received access to drinking water RO plants.
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Bu LK, Jia PP, Li WG, Li YZ, Li TY, Pei DS. Probiotics mitigate kidney damage after exposure to Sri Lanka's local groundwater from chronic kidney disease with uncertain etiology (CKDu) prevalent area in zebrafish. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2023; 262:106671. [PMID: 37657145 DOI: 10.1016/j.aquatox.2023.106671] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
Groundwater in Sri Lanka, contaminated with environmental toxins, is suspected to potentially induce chronic kidney disease of uncertain etiology (CKDu) in humans. This study aims to elucidate the potential mitigating effects of probiotics on kidney damage induced by exposure to this local groundwater (LW) in zebrafish. We used zebrafish as a model organism and exposed them to local groundwater to evaluate the risk of CKDu. Probiotics were then added at a concentration of 108 colony-forming units per milliliter (CFU/mL). Our findings revealed that exposure to local groundwater resulted in abnormalities, such as tail deletion and spinal curvature in zebrafish larvae. However, the addition of probiotics mitigated these effects, improving the hatching rate, heart rate, length, weight, deformity rate, survival rate, and abnormal behavior of zebrafish. It also positively influenced the differential expression levels of kidney development and immunity-related genes (dync2h1, foxj1, pkd2, gata3, slc20a1, il1β, and lyso). Furthermore, exposure to LW decreased both the diversity and abundance of microbiota in zebrafish larvae. However, treatment with probiotics, such as L. plantarum and L. rhamnosus partially restored the disrupted gut microbiota and significantly impacted the cellular process pathways of the microbial community, as determined by KEGG (Kyoto Encyclopedia of Genes and Genomes) analysis. In conclusion, this study highlights the risks associated with Sri Lanka's local groundwater from a CKDu prevalent area and confirms the beneficial effects of different probiotics. These findings may provide new insights into bacterial function in host kidney health.
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Affiliation(s)
- Ling-Kang Bu
- College of Life Science, Henan Normal University, Xinxiang 453007, China; School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Pan-Pan Jia
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Wei-Guo Li
- College of Life Science, Henan Normal University, Xinxiang 453007, China
| | - Yong-Zhi Li
- Chongqing Institute of Green and Intelligent Technology, Chongqing School of University of Chinese Academy of Sciences, CAS, Chongqing 400714, China
| | - Tian-Yun Li
- Chongqing Institute of Green and Intelligent Technology, Chongqing School of University of Chinese Academy of Sciences, CAS, Chongqing 400714, China
| | - De-Sheng Pei
- School of Public Health, Chongqing Medical University, Chongqing 400016, China.
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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.
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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
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Jia PP, Chandrajith R, Junaid M, Li TY, Li YZ, Wei XY, Liu L, Pei DS. Elucidating environmental factors and their combined effects on CKDu in Sri Lanka using zebrafish. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023:121967. [PMID: 37290634 DOI: 10.1016/j.envpol.2023.121967] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023]
Abstract
Chronic kidney disease with uncertain etiology (CKDu) in Sri Lanka has attracted much attention as a global health issue. However, how environmental factors in local drinking water induce kidney damage in organisms is still elusive. We investigated multiple environmental factors including water hardness and fluoride (HF), heavy metals (HM), microcystin-LR (MC-LR), and their combined exposure (HFMM) to elucidate their toxic effects on CKDu risk in zebrafish. Acute exposure affected renal development and inhibited the fluorescence of Na, K-ATPase alpha1A4:GFP zebrafish kidney. Chronic exposure influenced the body weight of both genders of adult fish and induced kidney damage by histopathological analyses. Furthermore, the exposure significantly disturbed differential expression genes (DEGs), diversity and richness of gut microbiota, and critical metabolites related to renal functions. The transcriptomic analysis revealed that kidney-related DEGs were linked with renal cell carcinoma, proximal tubule bicarbonate reclamation, calcium signaling pathway, and HIF-1 signaling pathway. The significantly disrupted intestinal microbiota was closely related to the environmental factors and H&E score, which demonstrated the mechanisms of kidney risks. Notably, the Spearman correlation analysis indicated that the changed bacteria such as Pseudomonas, Paracoccus, and ZOR0006, etc were significantly connected to the DEGs and metabolites. Therefore, the assessment of multiple environmental factors provided new insights on "bio-markers" as potential therapies of the target signaling pathways, metabolites, and gut bacteria to monitor or protect residents from CKDu.
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Affiliation(s)
- Pan-Pan Jia
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Rohana Chandrajith
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China; Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Muhammad Junaid
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Tian-Yun Li
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Yong-Zhi Li
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Xing-Yi Wei
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Li Liu
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - De-Sheng Pei
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China.
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Shi Q, Gao Z, Guo H, Zeng X, Sandanayake S, Vithanage M. Hydrogeochemical factors controlling the occurrence of chronic kidney disease of unknown etiology (CKDu). ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:2611-2627. [PMID: 36063240 DOI: 10.1007/s10653-022-01379-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Chronic kidney disease of unknown etiology (CKDu) has posed a serious threat to human health around the world. The link between the prevalence of CKDu and groundwater geochemistry is not well understood. To identify the potential geogenic risk factors, we collected 52 groundwater samples related to CKDu (CKDu groundwater) and 18 groundwater samples related to non-CKDu (non-CKDu groundwater) from the typical CKDu prevailing areas in Sri Lanka. Results demonstrated that CKDu groundwater had significantly higher Si (average 30.1 mg/L, p < 0.05) and F- (average 0.80 mg/L, p < 0.05) concentrations than those of non-CKDu groundwater (average 21.0 and 0.45 mg/L, respectively), indicating that Si and F- were the potential risk factors causing CKDu. The principal hydrogeochemical process controlling local groundwater chemistry was chemical weathering of silicates in Precambrian metamorphic rocks. Groundwater samples were mostly undersaturated with respect to amorphous silica and clay minerals such as talc and sepiolite, which was conducive to silicate weathering and elevated Si concentrations in groundwater. Decreased Ca2+ being facilitated by calcite precipitation and cation exchange between Ca2+ and Na+ favored fluorite dissolution and thus led to high groundwater F- concentrations. Competitive adsorption between [Formula: see text] and F- also enhanced the release of F- from solid surfaces. This study highlights the CKDu potential risk factors regarding groundwater geochemistry and their enrichment factors, which helps in preventing the prevalence of CKDu.
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Affiliation(s)
- Qiutong Shi
- MOE Key Laboratory of Groundwater Circulation and Environmental Evolution and School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China
- State Key Laboratory of Biogeology and Environmental Geology, China University of Geosciences (Beijing), Beijing, China
| | - Zhipeng Gao
- MOE Key Laboratory of Groundwater Circulation and Environmental Evolution and School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China
- State Key Laboratory of Biogeology and Environmental Geology, China University of Geosciences (Beijing), Beijing, China
| | - Huaming Guo
- MOE Key Laboratory of Groundwater Circulation and Environmental Evolution and School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China.
- State Key Laboratory of Biogeology and Environmental Geology, China University of Geosciences (Beijing), Beijing, China.
| | - Xianjiang Zeng
- MOE Key Laboratory of Groundwater Circulation and Environmental Evolution and School of Water Resources and Environment, China University of Geosciences (Beijing), Beijing, China
- State Key Laboratory of Biogeology and Environmental Geology, China University of Geosciences (Beijing), Beijing, China
| | - Sandun Sandanayake
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Meththika Vithanage
- Ecosphere Resilience Research Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Molecular Microbiology and Human Diseases, National Institute of Fundamental Studies, Kandy, Sri Lanka
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Geladari E, Vallianou N, Geladari C, Aronis K, Vlachos K, Andreadis E, Theocharopoulos I, Dourakis S. "Failing kidneys in a failing planet; CKD of unknown origin". REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:125-135. [PMID: 34881546 DOI: 10.1515/reveh-2021-0109] [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: 08/18/2021] [Accepted: 11/22/2021] [Indexed: 06/13/2023]
Abstract
The 'alarm clock' for human beings in the era of climate medicine has rung. Original diseases have appeared, that could not be explained and attributed to common causes, which are suggested to be linked to global warming and environmental factors. Such an indolent disease is the chronic kidney disease of unknown cause (CKDu), introduced also as Mesoamerican or Uddanam nephropathy. Scientists equate the climate impact on kidneys with the canary in the coal mine; coal miners used to carry caged canaries with them, so that if poisonous gases, such as methane or carbon monoxide leaked into the mine-shaft, the gases would kill the canary before killing the miners; similarly, kidneys are injured before devastating and lethal complications occur in humans. In some regions of Central America, the deaths due to chronic kidney disease increased by 177% with a death toll being as high as over 20,000. It was first documented in animals that periodic heat and dehydration have a major role in causing chronic kidney disease. Based on that observation, it is advocated that young male agricultural workers in Central America and South Asia, develop renal disease by getting exposed to extreme heat repeatedly. The clinico-pathological characteristics of this type of kidney injury, do not belong to an existing classification, even though a form of tubulo-interstitial renal disease has been proposed. In this review, we will discuss about CKDu, its epidemiology and pathophysiological mechanisms, clinical presentation and diagnostic biomarkers and examine potential therapeutic options.
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Affiliation(s)
- Eleni Geladari
- National and Kapodistrian University of Athens, Athens, Attica, Greece
| | | | | | | | | | | | | | - Spyros Dourakis
- National and Kapodistrian University of Athens, Athens, Attica, Greece
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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; 11:551. [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.
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Gunadasa SG, Tighe MK, Wilson SC. Arsenic and cadmium leaching in co-contaminated agronomic soil and the influence of high rainfall and amendments. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 316:120591. [PMID: 36347408 DOI: 10.1016/j.envpol.2022.120591] [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: 07/06/2022] [Revised: 10/03/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Arsenic (As) and cadmium (Cd) co-contaminate agricultural systems worldwide and threaten water resources, food security and human health. This column leaching study examined As and Cd mobility in an acidic sandy loam Alfisol soil collected from the dry zone of Sri Lankafor four co-contaminant concentration combinations (spiked and 1 year aged As at 20 & 100 mg kg-1 with co-added Cd at 3 & 20 mg kg-1) i, and under the influence of high rainfall (RF), phosphorus fertilizer (P) and lime amendments. In almost all treatments a synergistic co-contaminant adsorption effect was evident which reduced leaching of both elements, significantly in the higher spiked soil concentration treatments. The magnitude of leaching decrease varied with treatment but was greater for As due to its weaker retention in the soil. The co-sorbing effects, evident even under RF, were attributed to electrostatic sorption interactions, the formation of ternary bridging complexes and surface precipitation at higher concentrations. Liming significantly retarded mobilisation of both elements in all treatments, whereas P enhanced As leaching but suppressed Cd leaching, and both amendments moderated co-contaminant effects. An antagonistic effect of Cd on As sorption was evident in two treatments which showed increased As leaching with added Cd: the RF low spike concentration treatment, accredited to washout of stable As-Cd soluble complexes; the P high concentration treatment considered due to P disruption of As-Cd bridging complexes. This work is important for effective risk mitigation in these widely occurring co-contaminated agronomic systems, and demonstrates a strong system effect on synergistic or antagonistic co-contaminant interactions.
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Affiliation(s)
- Sajanee G Gunadasa
- School of Environmental and Rural Science, University of New England, Armidale, 2351, NSW, Australia.
| | - Matthew K Tighe
- School of Environmental and Rural Science, University of New England, Armidale, 2351, NSW, Australia.
| | - Susan C Wilson
- School of Environmental and Rural Science, University of New England, Armidale, 2351, NSW, Australia.
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Gamage CD, Nanayakkara S, Sarathkumara YD, Muthusinghe DS, Shimizu K, Arikawa J, Lokupathirage SMW, Nanayakkara N, Gunarathne L, Chandrajith R, Harada KH, Koizumi A, Yoshimatsu K. Hantavirus infection as a risk factor for chronic kidney disease of unknown aetiology (CKDu) and its prevalence in endemic areas of Sri Lanka since 2010 according to a retrospective serological analysis. J Med Microbiol 2022; 71. [PMID: 36748416 DOI: 10.1099/jmm.0.001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. Chronic kidney disease of unknown aetiology (CKDu) is a major public health problem in Sri Lanka, especially among agrarian communities. Although the cause of CKDu is still unknown, hantavirus infection has been proposed as a risk factor.Methods. This study was performed using serological samples collected from two CKDu-endemic areas, Anuradhapura (2010) and Badulla districts (2010 and 2016), and a non-endemic area, Matale (2016) district. The presence of anti-Thailand orthohantavirus IgG antibodies was investigated in serum samples. Hantavirus seroprevalence and demographic data were epidemiologically analysed.Results. Seroprevalence was higher in CKDu patients (40.6-60.0 %) and healthy individuals in CKDu-endemic areas (17.6-25.5 %) than in healthy individuals in non-endemic areas (3.0 %). Statistically significant odds ratios (ORs) for hantavirus infection in CKDu patients were detected in CKDu-endemic areas [ORs: 3.2 and 3.1; 95 % confidence interval (CI): 1.8-5.5 and 1.8-5.2 in Anuradhapura and Badulla districts in 2010; and OR: 4.4, 95 % CI: 2.3-8.5 in 2016 in Badulla district). Furthermore, the OR for hantavirus infection in Badulla district has increased in the last decade from 3.1 (95 % CI: 1.8-5.3) to 4.4 (95 % CI: 2.3-8.5).Conclusion. Hantavirus infection has been prevalent in two distant CKDu-endemic areas since 2010. The observed significant association of hantavirus seropositivity with CKDu indicates a possible role of hantavirus infection in CKDu pathogenesis.
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Affiliation(s)
- Chandika D Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, 20400 Peradeniya, Sri Lanka
| | - Shanika Nanayakkara
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW 2010, Australia.,Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8501, Japan
| | - Yomani D Sarathkumara
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, 20400 Peradeniya, Sri Lanka.,Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD 4870, Australia
| | - Devinda S Muthusinghe
- Graduate School of Infectious Diseases, Hokkaido University, Sapporo 060-0815, Japan.,Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815, Japan
| | - Kenta Shimizu
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Jiro Arikawa
- Department of Microbiology and Immunology, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Sithumini M W Lokupathirage
- Graduate School of Infectious Diseases, Hokkaido University, Sapporo 060-0815, Japan.,Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815, Japan
| | - Nishantha Nanayakkara
- Nephrology and Transplantation Unit, Teaching Hospital Kandy, 20000 Kandy, Sri Lanka
| | | | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, 20400 Peradeniya, Sri Lanka
| | - Kouji H Harada
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8501, Japan
| | - Akio Koizumi
- Institute of Public Health and Welfare Research, Ukyo-ku, Kyoto 616-8141, Japan.,Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto 606-8501, Japan
| | - Kumiko Yoshimatsu
- Graduate School of Infectious Diseases, Hokkaido University, Sapporo 060-0815, Japan.,Institute for Genetic Medicine, Hokkaido University, Sapporo 060-0815, Japan
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12
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Senarathne S, Jayawardana JMCK, Chandrajith R. Influence of climate on groundwater fluoride in different climatic domains in a hard rock terrain of Sri Lanka: implications to community health. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2022; 44:3677-3686. [PMID: 34689287 DOI: 10.1007/s10653-021-01090-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: 01/13/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Health risks associated with excessive intake of fluoride through drinking water are one of the geoenvironmental health problems observed in many parts of the world, mainly in countries of the humid tropical belt, including Sri Lanka. Fluoride-related health problems are widespread in the dry climatic region compared to the wet climatic zone of Sri Lanka. The potential health risks of fluoride for communities in a river basin which drains through two climatic zones, viz. wet and dry zones, were investigated in this study. Sixty-three groundwater samples were collected from wells in the Walawe river basin during pre- and post-monsoon periods. From collected samples, ten selected samples were analyzed for their tritium (3H) levels to find out the approximate resident time of groundwater. In the river basin, the dry zone segment is characterized by elevated levels of fluoride (> 1.0 mg/L) in groundwater. Groundwater fluoride in the region was primarily of geogenic origin. The tritium values showed older groundwater contained higher fluoride levels, showing a increased dissolution of fluoride-bearing minerals. The hazard quotient (HQfluoride) showed that about 45% of pre- and 55% of post-monsoon groundwater samples in the dry zone area were unsuitable for drinking purposes for school children who are vulnerable to non-carcinogenic risks and dental fluorosis. This study emphasizes the need for continuous water quality monitoring and mitigation measures to ensure the health of residents.
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Affiliation(s)
- Sachintha Senarathne
- Faculty of Graduate Studies, Sabaragamuwa University of Sri Lanka, Belihul Oya, Sri Lanka
- Department of Natural Resources, Faculty of Applied Sciences, Sabaragamuwa University of Sri Lanka, Belihul Oya, Sri Lanka
| | - J M C K Jayawardana
- Faculty of Graduate Studies, Sabaragamuwa University of Sri Lanka, Belihul Oya, Sri Lanka
- Department of Natural Resources, Faculty of Applied Sciences, Sabaragamuwa University of Sri Lanka, Belihul Oya, Sri Lanka
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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13
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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.
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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.
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14
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Holliday MW, Li Q, Bustamante EG, Niu J, Huang L, Espina IM, Dominguez JR, Truong L, Murray KO, Fan L, Anumudu SJ, Shah M, Fischer RS, Vangala C, Mandayam S, Perez J, Pan JS, Ali S, Awan AA, Sheikh-Hamad D. Potential Mechanisms Involved in Chronic Kidney Disease of Unclear Etiology. Clin J Am Soc Nephrol 2022; 17:1293-1304. [PMID: 35944911 PMCID: PMC9625092 DOI: 10.2215/cjn.16831221] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/15/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES The etiology of chronic kidney disease of unclear etiology, also known as Mesoamerican nephropathy, remains unclear. We investigated potential etiologies for Mesoamerican nephropathy in an immigrant dialysis population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Migrants with Mesoamerican nephropathy kidney failure (n=52) were identified by exclusion of known causes of kidney disease and compared using a cross-sectional survey with demographically similar patients with kidney failure from other causes (n=63) and age/sex/place of origin-matched healthy participants (n=16). Survey results were extended to the bench; C57BL/6 mice (n=73) received 10-15 weekly intraperitoneal injections of paraquat (a reactive oxygen species-generating herbicide) or vehicle. Kidney function, histology, and expression of organic cation transporter-2 (proximal tubule entry for paraquat) and multidrug and toxin extrusion 1 (extrusion pathway) were examined. Kidney biopsies from Nicaraguan patients with acute Mesoamerican nephropathy were stained for the above transporters and compared with patients with tubulointerstitial nephritis and without Mesoamerican nephropathy. RESULTS Patients with Mesoamerican nephropathy and kidney failure were young agricultural workers, almost exclusively men; the majority were from Mexico and El Salvador; and they had prior exposures to agrochemicals, including paraquat (27%). After adjustment for age/sex, exposure to any agrochemical or paraquat was associated with Mesoamerican nephropathy kidney failure (odds ratio, 4.86; 95% confidence interval, 1.82 to 12.96; P=0.002 and odds ratio, 12.25; 95% confidence interval, 1.51 to 99.36; P=0.02, respectively). Adjusted for age/sex and other covariates, 1 year of agrochemical exposure was associated with Mesoamerican nephropathy kidney failure (odds ratio, 1.23; 95% confidence interval, 1.04 to 1.44; P=0.02). Compared with 16 matched healthy controls, Mesoamerican nephropathy kidney failure was significantly associated with exposure to paraquat and agrochemicals. Paraquat-treated male mice developed kidney failure and tubulointerstitial nephritis consistent with Mesoamerican nephropathy. Organic cation transporter-2 expression was higher in male kidneys versus female kidneys. Paraquat treatment increased organic cation transporter-2 expression and decreased multidrug and toxin extrusion 1 expression in male kidneys; similar results were observed in the kidneys of Nicaraguan patients with Mesoamerican nephropathy. CONCLUSIONS Exposure to agrochemicals is associated with Mesoamerican nephropathy, and chronic exposure of mice to paraquat, a prototypical oxidant, induced kidney failure similar to Mesoamerican nephropathy.
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Affiliation(s)
- Michael W. Holliday
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases, Houston, Texas
| | - Qingtian Li
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Jingbo Niu
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Luping Huang
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ilse M. Espina
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jose R. Dominguez
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Luan Truong
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
| | - Kristy O. Murray
- School of Tropical Medicine and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Lei Fan
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Samaya J. Anumudu
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Maulin Shah
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Rebecca S.B. Fischer
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, Houston, Texas
| | - Chandan Vangala
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sreedhar Mandayam
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jose Perez
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jenny S. Pan
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sehrish Ali
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ahmed A. Awan
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - David Sheikh-Hamad
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases, Houston, Texas
- Department of Nutrition, Harris Health System, Houston, Texas
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15
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Villalvazo P, Carriazo S, Martin-Cleary C, Sanchez-Niño MD, Ortiz A. Solving the riddle of Aguascalientes nephropathy: nephron number, environmental toxins and family clustering. Clin Kidney J 2022; 15:1226-1230. [PMID: 35756744 PMCID: PMC9217524 DOI: 10.1093/ckj/sfac042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/20/2022] Open
Abstract
Aguascalientes, Mexico, has a high incidence and prevalence of advanced chronic kidney disease (CKD). CKD is especially frequent in young people ages 20-40 years in whom the cause of CKD was unknown, although kidney biopsies frequently showed focal segmental glomerulosclerosis (FSGS) and glomerulomegaly. Macias-Diaz et al. have now pursued this lead by screening teenagers in Calvillo, one of the hardest hit municipalities. They uncovered clinical, laboratory, kidney biopsy and exposure findings that define a new entity, Aguascalientes nephropathy, and are consistent with familial exposure to common environmental toxins, potentially consisting of pesticides. They hypothesize that prenatal exposure to these toxins may decrease nephron number. The young age of persons with FSGS would be consistent with a novel environmental toxin introduced more than 50 years ago but not present in the environment before. Key takeaways from this research are the need to screen teenagers for albuminuria, to provide kidney-protective strategies to patients identified as having CKD and for the research community to support Aguascalientes nephrologists and health authorities to unravel the cause and potential solutions for this CKD hotspot. In this regard, the screening approach and the cohort generated by Macias-Diaz et al. represent a giant step forward. The next steps should be to screen younger children for albuminuria and kidney size and to identify the putative toxins.
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Affiliation(s)
| | - Sol Carriazo
- IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Catalina Martin-Cleary
- IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Maria Dolores Sanchez-Niño
- IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Department of Pharmacology, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
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16
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Metals and Metallothionein Expression in Relation to Progression of Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka. Diseases 2022; 10:diseases10020034. [PMID: 35735634 PMCID: PMC9221887 DOI: 10.3390/diseases10020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease of unknown etiology was investigated for metal relations in an endemic area by a cross-sectional study with CKD stages G1, G2, G3a, G3b, G4, G5 (ESRD), and endemic and nonendemic controls (EC and NEC) as groups. Subjects with the medical diagnosis were classified into groups by eGFR (SCr, CKD-EPI) and UACR of the study. It determined 24 metals/metalloids in plasma (ICPMS) and metallothionein (MT) mRNA in blood (RT-PCR). MT1A at G3b and MT2A throughout G2−G5 showed increased transcription compared to NEC (ANOVA, p < 0.01). Both MT1A and MT2A remained metal-responsive as associations emerged between MT2A and human MT inducer Cr (in EC: r = 0.54, p < 0.05, n = 14), and between MT1A and MT2A (in EC pooled with G1−G5: r = 0.58, p < 0.001, n = 110). Human MT (hMT)-inducers, namely Zn, Cu, As, Pb, and Ni; Σ hMT-inducers; 14 more non-inducer metals; and Σ MT-binding metals remained higher (p < 0.05) in EC as compared to NEC. Declining eGFR or CKD progression increased the burden of Be, Mg, Al, V, Co, Ni, Rb, Cs, Ba, Mn, Zn, Sr, Σ hMT-inducers, and Σ MT-binding metals in plasma, suggesting an MT role in the disease. MT1A/2A mRNA followed UACR (PCA, Dendrogram: similarity, 57.7%). The study provides evidence that proteinuric chronic renal failure may increase plasma metal levels where blood MT2A could be a marker.
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17
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Premarathne S, Chandrajith R, Nanayakkara N, Gamage CD, Ratnatunga N, Wijetunge S, Badurdeen Z, Guruge S, Elladeniya N, Madushan KPS, Samarasiri KOCU, Hewavitharane P, Herath D, Senarathne S. Could Consumption of Trace Element-Contaminated Rice Be a Risk Factor for Acute Interstitial Nephritis with Uncertain Etiology in the Dry Zone of Sri Lanka? Biol Trace Elem Res 2022; 200:2597-2605. [PMID: 34431070 DOI: 10.1007/s12011-021-02880-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Ingestion of toxic trace elements in the human body has been considered one of the major reasons for renal dysfunction. Chronic kidney disease with uncertain etiological factors (CKDu) is a recently described clinical entity in which the disease is found in geographically isolated pockets in the dry zone of Sri Lanka. In CKDu regions, an increasing number of cases are reported with acute interstitial nephritis without any known reason (AINu). However, recent exposure to certain risk behaviors or nephrotoxins, or both, is suspected for the AINu. Consumption of foods that are contaminated with trace elements is one of the main pathways of human exposure to environmental toxins. The current study was carried out to assess the possibility of trace element-contaminated rice consumption on the etiopathogenesis of AINu. Samples of rice consumed by 32 clinically diagnosed AINu cases were collected and analyzed for possible nephrotoxic trace elements. Out of 32 patients, 26 were histologically confirmed with tubulointerstitial disease. The results revealed that the mean values of Cd, As, and Pb were 0.18, 0.055, and 0.135 mg/kg, with ranges of 0.020-1.06, 0.012-0.222, and 0.003-0.744 mg/kg (on dry weight basis), respectively. This study indicated that the investigated toxic trace element levels of rice consumed by AINu were reasonably below the recommended levels of the Codex Alimentarius Commission of FAO and WHO. Hence, it is less likely that rice consumption is to be a risk factor for the etiology of AINu.
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Affiliation(s)
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka.
| | | | - C D Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Zeid Badurdeen
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Shashika Guruge
- State Key Laboratory of Environmental Aquatic Chemistry, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, 100085, China
| | - N Elladeniya
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - K P S Madushan
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - K O C U Samarasiri
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | | | | | - Sachintha Senarathne
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
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18
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Balasooriya S, Diyabalanage S, Yatigammana SK, Ileperuma OA, Chandrajith R. Major and trace elements in rice paddy soils in Sri Lanka with special emphasis on regions with endemic chronic kidney disease of undetermined origin. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2022; 44:1841-1855. [PMID: 34282514 DOI: 10.1007/s10653-021-01036-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Environmental exposure to trace elements has been widely suspected as an etiological factor for the emergence of chronic kidney disease of undetermined origin (CKDu) that prevails in certain districts of the dry zone areas of Sri Lanka. Contaminated rice can be act as a host for potentially toxic trace elements that ultimately led to health hazards; thus, rice soils were investigated in detail, giving particular attentions to identified CKDu hotspots. A total of 102 rice soil samples were collected from main climatic zones viz. wet and dry zones including CKDu hotspots. In addition to pH, electrical conductivity and cation exchange capacity, acid extracted major and trace element contents in rice soils were determined by using ICP-MS. Significant differences were observed for Mn, Ni, Cu, Zn, and Pb contents between climatic zones. Arsenic and Pb contents in soils were lower than the levels reported in soils from other regions of the world, though significantly higher contents were observed in CKDu regions compared to non-endemic wet zone regions. Calculation of enrichment factor revealed that soils in both dry and wet zones were moderately enriched with As, Cd, and Pb, suggesting an influence of anthropogenic processes. Twenty percent of the wet zone samples showed significant enrichment of Ni, Cu, and Zn. Geo-accumulation index assorted that the studied soil samples were uncontaminated to moderately contaminated, implying that rice soils in both climatic zones are not alarmingly contaminated with toxic trace elements. However, regular and continuous monitoring of rice soil quality is extremely important.
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Affiliation(s)
- Shyamalie Balasooriya
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Saranga Diyabalanage
- 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
| | - Sudharma K Yatigammana
- Department of Zoology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - O A Ileperuma
- Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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19
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Upamalika SWAM, Wannige CT, Vidanagamachchi SM, Gunasekara SC, Kolli RT, De Silva PMCS, Kulasiri D, Jayasundara N. A review of molecular mechanisms linked to potential renal injury agents in tropical rural farming communities. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2022; 92:103850. [PMID: 35301132 DOI: 10.1016/j.etap.2022.103850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
The chronic kidney disease of unknown etiology (CKDu) is a global health concern primarily impacting tropical farming communities. Although the precise etiology is debated, CKDu is associated with environmental exposures including heat stress and chemical contaminants such as fluoride, heavy metals, and herbicide glyphosate. However, a comprehensive synthesis is lacking on molecular networks underpinning renal damage induced by these factors. Addressing this gap, here we present key molecular events associated with heat and chemical exposures. We identified that caspase activation and lipid peroxidation are common endpoints of glyphosate exposure, while vasopressin and polyol pathways are associated with heat stress and dehydration. Heavy metal exposure is shown to induce lipid peroxidation and endoplasmic reticulum stress from ROS activated MAPK, NFĸB, and caspase. Collectively, we identify that environmental exposure induced increased cellular oxidative stress as a common mechanism mediating renal cell inflammation, apoptosis, and necrosis, likely contributing to CKDu initiation and progression.
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Affiliation(s)
| | | | | | | | - Ramya Tulasi Kolli
- Nicholas School of the Environment, Duke University, NC 27708, United States.
| | | | - Don Kulasiri
- Department of Molecular Biosciences, and Centre for Advanced Computational Solutions (C-fACS), Lincoln University, New Zealand.
| | - Nishad Jayasundara
- Nicholas School of the Environment, Duke University, NC 27708, United States.
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20
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Major and Trace Elements in Human Kidney Stones: A Preliminary Investigation in Beijing, China. MINERALS 2022. [DOI: 10.3390/min12050512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Kidney stone disease affects people globally, with its prevalence on the rise. Given the importance of elements’ function in formation of kidney stones, this study investigated major and trace element content in thirty kidney stone samples from patients in Beijing. The kidney stone samples included inorganic components (calcium oxalate and carbonate apatite) and organic components (uric acid). Results showed that Ca is much higher in inorganic components than organic components. Compared to inorganic components, uric acid has a very low content of elements except for Cu and Se, which may be derived from the liver. Carbonate apatite stones have a higher element content (such as Na, K, Sr, Zn, Rb, Ba, Li, and Ti) than calcium oxalate stones, especially enrichment of Mg. The principal components analysis (PCA) extracted three principal components (PCs) with total variances of 91.91%, including the PC1 (45.08%): Na-Li-Ti-Ba-Sr-Zn, PC2 (30.05%): Rb, K, Mg, and PC3 (16.78%): Cu-Se, indicating that there are co-precipitated processes of these elements by their specific properties. A different distribution of stone types in the three components indicates a significant discrepancy in their element content, which can be an essential reference for patient intake elements.
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21
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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.
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Kodikara KAS, Lewandowski S, De Silva PMCS, Gunarathna SD, Madarasinghe SK, Ranasinghe P, Jayatissa LP, Dahdouh-Guebas F. Heavy metal pollution in selected upland tributaries of Sri Lanka: comprehension towards the localization of sources of pollution. JOURNAL OF WATER AND HEALTH 2022; 20:505-517. [PMID: 35350003 DOI: 10.2166/wh.2022.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study aimed to assess the heavy metal (HM) profile of the main upland tributaries of three major rivers, the Mahaweli, the Deduru and the Gin Rivers, which are commonly used for urban water supply in Sri Lanka. The HM profiles of arsenic (As), cadmium (Cd), lead (Pb) and mercury (Hg) were investigated by ICP-MS. Land-use classification was performed to locate the main sources of pollution. Mean pH, TDS and conductivity showed significant inter-site mean differences (p < 0.001). The mean contents of the HMs, considering all rivers, were observed in the order [Hg] > [As] > [Pb] > [Cd] at the sources and [As] > [Hg] > [Pb] > [Cd] at the river mouths. Particularly, in the Mahaweli River, the mean As content was 0.08 ± 0.05 μg·L-1 and showed an increasing trend from the source to the river mouth. In the Deduru River, the mean Hg content was 0.14 ± 0.15 μg·L-1, and of all rivers studied, the highest content of 0.50 ± 0.17 μg·L-1 was recorded. The Gin River showed significant inter-site mean differences (p < 0.05) in [Pb], [As] and [Hg]. In all rivers studied, [As] was significantly higher in water samples collected near agricultural lands and urban areas as compared with the other land-use/cover types, which was further proved by a significant positive correlation (coefficient = 0.479, p = 0.0325). We, therefore, emphasized that HM pollution is more likely due to anthropogenic activities in the upper catchment with less lithogenic contamination. However, national water quality management should be further strengthened and new policy enforcement is emphasized.
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Affiliation(s)
- K A S Kodikara
- Department of Botany, Faculty of Science, University of Ruhuna, Matara, Sri Lanka E-mail: ; First co-authors
| | - S Lewandowski
- Systems Ecology and Resource Management Research Unit, Département de Biologie des Organismes, Université Libre de Bruxelles - ULB, Av. F.D. Roosevelt 50, CPi 264/1, 1050 Brussels, Belgium; First co-authors
| | - P M C S De Silva
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, Sri Lanka
| | - S D Gunarathna
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, Sri Lanka
| | - S K Madarasinghe
- Department of Physics, Faculty of Science, University of Ruhuna, Matara, Sri Lanka
| | - P Ranasinghe
- Herbal Technology Section, Industrial Technology Institute, Colombo 7, Sri Lanka
| | - L P Jayatissa
- Department of Botany, Faculty of Science, University of Ruhuna, Matara, Sri Lanka E-mail:
| | - F Dahdouh-Guebas
- Systems Ecology and Resource Management Research Unit, Département de Biologie des Organismes, Université Libre de Bruxelles - ULB, Av. F.D. Roosevelt 50, CPi 264/1, 1050 Brussels, Belgium; Ecology & Biodiversity, Laboratory of Plant Biology and Nature Management, Biology Department, Vrije Universiteit Brussel - VUB, Pleinlaan 2, VUB-APNA-WE, 1050 Brussels, Belgium
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23
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Chronic Kidney Disease of Uncertain Etiology in Sri Lanka: Curing between Medicine and Traditional Culture. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic Kidney Disease of unknown origin (CKDu) has appeared across Sri Lanka’s North Central Province (NCP) since the 1990s as an epidemic, unexplained by conventional associated risk factors. During the past few decades, a large number of studies attempted to determine the unknown etiology of CKDu. Despite these investigations, no concrete conclusions were developed, though a number of contradictory hypotheses emerged. The present ethnographic study was carried out in two endemic areas, labelled as “CKDu hotspots”, and illuminates how curing takes place between biomedicine and traditional cultural practices. Our ethnographic study thoroughly scrutinized three decades of lived experience, lay-perceptions and local discourses on CKDu. We used a qualitative study design with a transcendental phenomenological approach and employed a mixture of ethnographic methods. Data collection techniques included participant observation, in-depth interviews, focus group discussions and key informant interviews. Data was analysed by using an interpretive thematic analysis model. Findings revealed that lay people have constructed a popular discourse on CKDu, and we explored their views on the origin, etiology and prevalence of CKDu in their locality over the past few decades. Patients’ narratives revealed that there were currently a number of gaps in service delivery. These were mainly due to distant relationships between healthcare providers and CKDu patients. Lay people in affected communities were marginalized throughout the investigation process to determine the unknown etiology, their involvement marginalized to merely acting as objects for scientific instigation. The affected communities strongly believed that CKDu was a recent phenomenon resulting from the mismanagement of the natural environment due to social and lifestyle changes. These findings highlight local dynamics of healthcare seeking behaviours which demand complementary medicine system, particularly given the number of limitations in the biomedical system. Empirical evidence generated from this study suggests a conceptual shift to an ethno-medical model to address CKDu. Improving cultural competency and communication skills among healthcare providers in public health are crucial in order to apply a “bio-psychosocial perspective” in healthcare delivery system and bridging the gap between hospital and the community.
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24
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Liyanage DND, Diyabalanage S, Dunuweera SP, Rajapakse S, Rajapakse RMG, Chandrajith R. Significance of Mg-hardness and fluoride in drinking water on chronic kidney disease of unknown etiology in Monaragala, Sri Lanka. ENVIRONMENTAL RESEARCH 2022; 203:111779. [PMID: 34339700 DOI: 10.1016/j.envres.2021.111779] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
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 Mg2+ 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 (Mg2+, Ca2+, Sr2+, Ba2+) 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-1). 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 Mg2+ levels have a possible relation with CKDu and may influence the disease progression.
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Affiliation(s)
- D N D Liyanage
- Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka; Postgraduate Institute of Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Saranga Diyabalanage
- 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
| | - S P Dunuweera
- Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka; Postgraduate Institute of Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Sanath Rajapakse
- Department of Molecular Biology and Biotechnology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - R M G Rajapakse
- Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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25
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Nanayakkara N, Medagedara A, Hewavitharane P, Chandrajith R, K. Abeysundara H, Thatil RO, Thennakoon S, Mahanama B, Weerasuriya N, Thilakarathne A. Comparison of biochemical characteristics between an endemic and a nonendemic area for CKDu Sri Lanka. ENVIRONMENTAL DISEASE 2022. [DOI: 10.4103/ed.ed_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Arambegedara D, Jayasinghe S, Udagama P. Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:4893-4910. [PMID: 34799798 PMCID: PMC8604553 DOI: 10.1007/s11356-021-17316-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/27/2021] [Indexed: 05/08/2023]
Abstract
Increasing prevalence of endemic chronic kidney disease of unknown etiology (CKDu) in Sri Lanka is a major health problem since the 1990s. Despite numerous studies on CKDu, research groups have been unable to develop a comprehensive approach to mitigate the disorder, and thereby to identify research gaps. We conducted a systematic literature review of 119 publications on CKDu in Sri Lanka from Pubmed, Google Scholar, and Scopus, published until end September 2020. A higher CKDu prevalence in the working population of the North Central Province was reported with recent studies indicating patients from non-endemic regions as well. A majority were etiological studies that recorded conflicting and inconclusive evidence on CKDu etiology. Studies on clinico-pathological, diagnostic, biochemical, and molecular biological aspects of CKDu, studies analyzing CKDu symptom burden, anthropological, and behavioral impacts of CKDu, were reviewed as well. A dearth of research exists on nutritional, demographical, immunological, and microbial aspects of CKDu. The overview of the reviewed literature indicated the absence of a comprehensive plan of action to mitigate this situation. Hence, we propose the "One Health" approach with a systems dynamics model as a potential way forward to alleviate the CKDu epidemic in Sri Lanka. This enables the representation of multiple causative agents (and interactions thereof) among environmental, animal, and human systems, in concert with the "exposome" that provides the totality of exposure the individual has undergone since birth.
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Affiliation(s)
- Dinushi Arambegedara
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka
| | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 8, Sri Lanka
| | - Preethi Udagama
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, 3, Sri Lanka.
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27
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Preliminary Data on Geochemical Characteristics of Major and Trace Elements in Typical Biominerals: From the Perspective of Human Kidney Stones. MINERALS 2021. [DOI: 10.3390/min11121396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The chemical composition of biominerals is essential for understanding biomineral formation and is regarded as an attractive subject in bio-mineralogical research on human kidney stones (urinary calculi). In order to obtain more geochemically interpreted data on biogenic minerals, mineralogical compositions and major and trace element concentrations of sixty-six kidney stone samples derived from kidney stone removal surgeries were measured. Infrared spectroscopy results showed that calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD) were the two main mineral components of kidney stones. Geochemical results indicated that major and trace element concentrations were present in the following order: Ca > Mg > Na > K > Zn > Fe > Pb > Ba > Cu > Ti > Mo > Cd > Cr. With the exception of Ca, Mg was the second-most abundant element. Zn exhibited higher concentrations relative to other trace elements, which suggests a potential substitution of calcium by metal ions with a similar charge and radius rather than by metals in kidney stone formation. Pb appeared in significantly higher concentrations than in previous studies, which indicates Pb enrichment in the environment. In order to discern multi-element relationships within kidney stones, principal component analysis was applied. Three principal components (PCs, eigenvalues >1) were extracted to explain 64.4% of the total variance. The first component exhibited positively correlated Na-Zn-Cr-Mo-Cd-Pb, while the second component exhibited more positively weighted Mg-K-Ba-Ti. Fe-Cu demonstrated a positive correlation in the third component. This study suggests that Ca exhibits a preference for uptake by oxalates during human urinary stone crystallization, while other alkali metals and alkaline earth metals precipitate with phosphate.
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28
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Seasonal Variations in Groundwater Quality and Hydrogeochemistry in the Endemic Areas of Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka. WATER 2021. [DOI: 10.3390/w13233356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Groundwater quality and geochemical processes were investigated in the endemic areas of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. Representative groundwater samples (n = 60) were collected from 30 dug wells located in the Anuradhapura district, over the dry and wet seasons. The samples were analyzed for pH, electrical conductivity (EC), total dissolved solids (TDS), alkalinity, major cations and major anions. Calcium-magnesium-bicarbonate ion combinations are predominant in this groundwater, and the simultaneous occurrence of high hardness (382–394 mg/L as CaCO3), alkalinity (364–379 mg/L as CaCO3) and ionicity is a salient characteristic. Alkalinity, TDS, hardness, and magnesium exceeded the safe limits for drinking in over half of the samples, regardless of the season. The major ion chemistry (Ca2+, Mg2+, Na+ and HCO3−) is primarily governed by the weathering of carbonate and silicate minerals, ion exchange, and evaporation which is accelerated by the semi-arid climate. Fluoride and chloride inputs are regulated by dissolution of fluoride-bearing minerals and anthropogenic causes, respectively. Saturation indices suggested supersaturation of carbonates and silicates, and undersaturation of evaporites and fluorite. Persistent high ionicity, and hardness of groundwater that is seldom impacted by seasonal variations might be playing a vital role in the genesis of CKDu.
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29
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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.
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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.
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30
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Villalvazo P, Carriazo S, Martin-Cleary C, Ortiz A. Aguascalientes: one of the hottest chronic kidney disease (CKD) hotspots in Mexico and a CKD of unknown aetiology mystery to be solved. Clin Kidney J 2021; 14:2285-2294. [PMID: 34754425 PMCID: PMC8573004 DOI: 10.1093/ckj/sfab136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/05/2023] Open
Abstract
In a recent issue of Clinical Kidney Journal (CKJ), Gutierrez-Peña et al. reported a high incidence and prevalence of advanced chronic kidney disease (CKD) in Aguascalientes, Mexico. This contradicts Global Burden of Disease estimates, which should be updated. A key component of this high burden of CKD relates to young people ages 20-40 years in whom the cause of CKD was unknown [CKD of unknown aetiology (CKDu)]. The incidence of kidney replacement therapy in this age group in Aguascalientes is among the highest in the world, second only to Taiwan. However, high-altitude Aguascalientes, with a year-round average temperature of 19°C, does not fit the geography of other CKDu hotspots. Furthermore, kidney biopsies in young people showed a high prevalence of focal segmental glomerulosclerosis. Potential causes of CKDu in Aguascalientes include the genetic background (no evidence, although podocytopathy genes should be explored) and environmental factors. The highest prevalence of CKD was found in Calvillo, known for guava farming. Thus guava itself, known to contain bioactive, potentially nephrotoxic molecules and pesticides, should be explored. Additionally, there are reports of water sources in Aguascalientes contaminated with heavy metals and/or pesticides. These include fluoride (increased levels found in Calvillo drinking water) as well as naturally occurring arsenic, among others. Fluoride may accumulate in bone and cause kidney disease years later, and maternal exposure to excess fluoride may cause kidney disease in offspring. We propose a research agenda to clarify the cause of CKDu in Aguascalientes that should involve international funders. The need for urgent action to identify and stem the cause of the high incidence of CKD extends to other CKD hotspots in Mexico, including Tierra Blanca in Veracruz and Poncitlan in Jalisco.
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Affiliation(s)
| | - Sol Carriazo
- IIS-Fundacion Jimenez Diaz UAM and School of Medicine, UAM, Madrid, Spain
| | | | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM and School of Medicine, UAM, Madrid, Spain
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Gunawardena SA, Ranasinghe M, Ranchamali T, Dileka P, Gunawardana JW. Kidney Cadmium Concentrations in an Urban Sri Lankan Population: an Autopsy Study. Biol Trace Elem Res 2021; 199:4045-4054. [PMID: 33409914 DOI: 10.1007/s12011-020-02541-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
Abstract
Contamination and bioaccumulation of toxic heavy metals in our geo-environment is a growing public health concern. Human biomonitoring is an essential step in assessing the population risk of chronic exposure to environmental contaminants. Whole kidneys collected from a cohort of 92 deceased individuals undergoing forensic autopsies in Colombo, Sri Lanka, were analysed for cadmium (Cd) bioaccumulation using ICP-MS. Mean age of the population was 55.4 ± 15.4 years. Mean and median renal Cd concentrations of the total population were 4.38 and 2.60 μg g-1 w/w, respectively, which were below estimated toxic ranges. Males accumulated higher levels of Cd than females (p = 0.377). Cd concentrations were higher in the < 60 age group than the > 60 age group (p = 0.92), while the highest levels were reported in 51-60 age group. However, no significant correlation was found between renal Cd concentration and age (Ʈb = - 0.005, p = 0.94). Individuals who smoked, chewed betel or consumed alcohol were found to have elevated renal Cd concentrations in comparison to those who did not use these substances. This is the largest autopsy study on renal Cd bioaccumulation in Sri Lanka, and the findings do not indicate a high exposure risk to environmental Cd contamination at present.
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Affiliation(s)
- S A Gunawardena
- Department of Forensic Medicine & Toxicology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 00800, Sri Lanka.
| | - M Ranasinghe
- Department of Forensic Medicine & Toxicology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 00800, Sri Lanka
| | - T Ranchamali
- Department of Forensic Medicine & Toxicology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 00800, Sri Lanka
| | - P Dileka
- Department of Forensic Medicine & Toxicology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 00800, Sri Lanka
| | - J W Gunawardana
- Department of Forensic Medicine & Toxicology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo, 00800, Sri Lanka
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32
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Young SM, Perera IA, Ishiga H. Geochemical variation between surface and subsurface soils and relationship to chronic kidney disease in North Central Province, Sri Lanka. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:4637-4663. [PMID: 33942215 DOI: 10.1007/s10653-021-00961-8] [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: 03/03/2018] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
Chronic kidney disease (CKD) in the North Central Province (NCP), Sri Lanka, is becoming a major cause of national burden with high mortality and morbidity. The origins of these kidney diseases are unknown, and the exact aetiology is not yet understood. Therefore, as an attempt to understand the effect of soil characteristics towards the disease, soil of surface (n = 25) and subsurface (50 cm depth, n = 25 of each) was collected from Horowpothana (HWP n = 50), Kabithigollawa (KBG n = 50), Medawachchiya (MWC n = 50) and Padaviya (PDW n = 50) of the NCP, where the highest number of patients is recorded. The soil samples were analysed using X-ray fluorescence for 22 major and trace elements, and the pH, electrical conductivity and oxygen reduction potential (ORP) for each sample were measured. The soil of all four villages mainly shows basic conditions. The high concentration of heavy mineral signatures in Horowpothana, Kabithigollawa, Padaviya and Medawachchiya could relate to high CKD patients in these four areas. The 50-cm soils of all four areas are in oxidized condition, while surface soil is in the anoxic condition. High fluctuation between surface and 50 cm may indicate high mobility of ions. According to the current study, P, F- and Fe2O3 ion could easily be mobilized into the groundwater of the area and thereby be related to the highest recorded CKD patients in these areas. Thus, as for the current study the heavy metals and elements that indicate the variations which causes health issues are Fe2O3, Pb, Zn, Cr, F-, Ti, Cu, Ni, V and Zr.
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Affiliation(s)
- Sansfica M Young
- Department of Environmental Technology, Faculty of Technology, University of Colombo, Colombo, Sri Lanka.
| | - Indeewari A Perera
- Department of Physical Sciences, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihinthale, Sri Lanka
| | - H Ishiga
- Department of Earth Science, Shimane University, Matsue, 690-8504, Japan
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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.
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Identification of Novel Rodent-Borne Orthohantaviruses in an Endemic Area of Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka. Viruses 2021; 13:v13101984. [PMID: 34696414 PMCID: PMC8539126 DOI: 10.3390/v13101984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 01/25/2023] Open
Abstract
We reported the genetic evidence of circulating hantaviruses from small mammals captured in a chronic kidney disease of unknown etiology (CKDu) hotspot area of Sri Lanka. The high seroprevalence of anti-hantavirus antibodies against Thailand orthohantavirus (THAIV) has been reported among CKDu patients and rodents in Sri Lankan CKDu hotspots. We captured 116 small mammals from CKDu endemic regions in the Polonnaruwa District of Sri Lanka. Seven animals (five out of 11 Mus booduga and two out of 99 Rattus rattus) were PCR-positive for the hantavirus. A rat-borne sequence was grouped with a THAIV-like Anjozorobe virus. In contrast, Mus-borne sequences belonged to the THAIV lineage, suggesting a novel orthohantavirus species according to the phylogenetic analyses and whole-genome comparisons. Our genetic evidence indicates the presence of two THAIV-related viruses circulating in this CKDu endemic area, suggesting a basis for further investigations to identify the infectious virus in patients with CKDu and the CKDu induction mechanism of these viruses.
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Natural and Anthropogenic Controls of Groundwater Quality in Sri Lanka: Implications for Chronic Kidney Disease of Unknown Etiology (CKDu). WATER 2021. [DOI: 10.3390/w13192724] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Poor groundwater quality in household wells is hypothesized as being a potential contributor to chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. However, the influencing factors of groundwater quality in Sri Lanka are rarely investigated at a national scale. Here, the spatial characteristics of groundwater geochemistry in Sri Lanka were described. The relationships of groundwater quality parameters with environmental factors, including lithology, land use, and climatic conditions, were further examined to identify the natural and anthropogenic controlling factors of groundwater quality in Sri Lanka. The results showed that groundwater geochemistry in Sri Lanka exhibited significant spatial heterogeneity. The high concentrations of NO3− were found in the districts that have a higher percentage of agricultural lands, especially in the regions in the coastal zone. Higher hardness and fluoride in groundwater were mainly observed in the dry zone. The concentrations of trace elements such as Cd, Pb, Cu, and Cr of all the samples were lower than the World Health Organization guideline values, while some the samples had higher As and Al concentrations above the guideline values. Principal component analysis identified four components that explained 73.2% of the total data variance, and the first component with high loadings of NO3−, hardness, As, and Cr suggested the effects of agricultural activities, while other components were primarily attributed to natural sources and processes. Further analyses found that water hardness, fluoride and As concentration had positive correlations with precipitation and negative correlations with air temperature. The concentration of NO3− and water hardness were positively correlated with agricultural lands, while As concentration was positively correlated with unconsolidated sediments. The environmental factors can account for 58% of the spatial variation in the overall groundwater geochemistry indicated by the results of redundancy analysis. The groundwater quality data in this study cannot identify whether groundwater quality is related to the occurrence of CKDu. However, these findings identify the coupled controls of lithology, land use, and climate on groundwater quality in Sri Lanka. Future research should be effectively designed to clarify the synergistic effect of different chemical constituents on CKDu.
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Wan ET, Darssan D, Karatela S, Reid SA, Osborne NJ. Association of Pesticides and Kidney Function among Adults in the US Population 2001-2010. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10249. [PMID: 34639548 PMCID: PMC8507643 DOI: 10.3390/ijerph181910249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease of unknown cause is prevalent in a range of communities; however, its etiology remains unclear. We examined the association between pesticide exposures and the risk of kidney function loss using four waves of the National Health and Nutrition Examination Survey (NHANES) to identify a pathological pathway. We pooled data from four cross-sectional waves of NHANES, with 41,847 participants in total. Exposure to malathion increased the risk of low kidney function (aOR = 1.26, 95% CI = 1.01-1.56) in the adjusted model. Increased risk of low kidney function was not found among those exposed to 2,4-D (aOR = 0.88, 95% CI = 0.72-1.09), 3,5,6-trichloropyridinol (aOR = 0.96, 95% CI = 0.83-1.12), and 3-PBA (aOR = 1.03, 95% CI = 0.94-1.13). Our findings provide evidence of altered kidney function in people exposed to malathion, highlighting the potential of organophosphate pesticides' role in renal injury.
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Affiliation(s)
- En-Tzu Wan
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
- Department of Strategy Planning, Far Eastern Memorial Hospital, Banqiao District, New Taipei City 22060, Taiwan
| | - Darsy Darssan
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
| | - Shamshad Karatela
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville 4870, Australia
| | - Simon A. Reid
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
| | - Nicholas John Osborne
- School of Public Health, The University of Queensland, Brisbane 4006, Australia; (E.-T.W.); (D.D.); (S.K.); (S.A.R.)
- European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK
- School of Population Health, University of NSW, Kensington 2052, Australia
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Paidi G, Iroshani Jayarathna AI, Salibindla DBAMR, Amirthalingam J, Karpinska-Leydier K, Alshowaikh K, Ergin HE. Chronic Kidney Disease of Unknown Origin: A Mysterious Epidemic. Cureus 2021; 13:e17132. [PMID: 34548965 PMCID: PMC8437007 DOI: 10.7759/cureus.17132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/12/2021] [Indexed: 12/19/2022] Open
Abstract
Amongst the many threats to health in our world, the most challenging ones are the ones with unknown causes. There is a mysterious epidemic of kidney disease called chronic kidney disease of unknown etiology (CKDu) that is occurring in many parts of the world. Unrelated to known risk factors such as diabetes and hypertension, CKDu mostly affects the young and middle-aged, with slight preponderance in males. It mostly occurs in people living in rural areas, especially working in agricultural jobs. Worldwide, the number of people with chronic kidney disease, and those who need dialysis and renal replacement, is increasing every year as compared to other chronic conditions like diabetes and AIDS. It's not just alarming but a great challenge to healthcare systems across the world, especially in resource-poor countries. CKDu has become a silent killer for most patients. The occurrence of end-stage renal disease (ESRD) in CKDu can be catastrophic for individuals, especially in countries with limited medical facilities, causing a significant socio-economic burden. Even within these economically developing nations, people affected by CKDu usually are from the most vulnerable and underserved populations. As a definitive etiology has not been postulated for CKDu to date, this comprehensive review was undertaken to throw light on the poorly understood epidemiologic risk factors and the course of the disease.
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Affiliation(s)
- Gokul Paidi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | | | - Jashvini Amirthalingam
- General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Khadija Alshowaikh
- Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Huseyin Ekin Ergin
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Imbulana S, Oguma K. Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review. JOURNAL OF WATER AND HEALTH 2021; 19:393-410. [PMID: 34152294 DOI: 10.2166/wh.2021.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The cause of Chronic Kidney Disease of unknown etiology (CKDu) in the rural dry zone of Sri Lanka remains unidentified, despite vast research efforts that brought about an extensive list of potential risk factors. Among these, the long-term exposure to various nephrotoxic elements through drinking groundwater was widely suspected owing to the unique geographical distribution of the disease. This review focuses on such well-known hypotheses suspecting the relations with fluoride, hardness, major ions, heavy metals, metalloids, organic matter, agrochemical residues, pathogens, and bacterial toxins in the groundwaters of the CKDu-endemic region. It was comprehensively discussed why each of these constituents was considered a risk factor of CKDu, how could they possibly trigger the pathogenesis of the disease, what was the evidence that supported or failed each hypothesis, and whether providing safe drinking water had been effective at mitigating the progression of the disease. Although plenty of circumstantial evidence supported an etiology related to groundwater for CKDu, it was impossible to elucidate the cause-effect relationships between drinking impaired groundwater and the occurrence of the disease. Future research should be effectively designed to clarify the role of groundwater in the onset of CKDu by taking into account the gaps in past research.
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Affiliation(s)
- Sachithra Imbulana
- Department of Urban Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan E-mail:
| | - Kumiko Oguma
- Department of Urban Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan E-mail:
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Fan Y, Su J, Wang Z, Deng L, Zhang H. Impact of C/N ratio on the fate of simultaneous Ca 2+ precipitation, F - removal, and denitrification in quartz sand biofilm reactor. CHEMOSPHERE 2021; 273:129667. [PMID: 33485132 DOI: 10.1016/j.chemosphere.2021.129667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/25/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
The coexistence of F-, Ca2+, nitrates, and other pollutants in water body has aroused widespread concern. In this research, a novel quartz sand biofilm reactor was established, aiming to study the key factors of different carbon to nitrogen (C/N) ratios (5:1, 4:1, and 3:1), initial Ca2+ concentration (180 mg L-1, 144 mg L-1, and 108 mg L-1), and hydraulic retention time (HRT) (4 h, 6 h, and 8 h) on simultaneous Ca2+ precipitation, F- removal, and denitrification. Results showed that the removal efficiencies of Ca2+, F-, and nitrate were 55.04%, 82.64%, and 97.69% under the low C/N ratio of 3:1, initial Ca2+ concentration of 180 mg L-1, and HRT of 8 h. 3-D Excitation-Emission Fluorescence Spectroscopy (3-D EEM) demonstrates that extracellular polymeric substances (EPS) was generated during the growth metabolism. Scanning Electron Microscopy (SEM) and X-ray diffractometer images showed that Ca2+, F- removed in the form of CaCO3, Ca5(PO4)3F and CaF2 under Acinetobacter sp. H12 induction. Moreover, high-throughput sequencing results display that the biomineralized bacteria Acinetobacter sp. H12 exerted great influence in the bioreactor. This research will underpin the practical use of multiple pollutants such as F- and Ca2+ wastewater under the different C/N ratios.
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Affiliation(s)
- Yuanyuan Fan
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
| | - Junfeng Su
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China.
| | - Zhao Wang
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
| | - Linyu Deng
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
| | - Han Zhang
- School of Environmental and Municipal Engineering, Xi'an University of Architecture and Technology, Xi'an, 710055, China
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Wijeyaratne WMDN, Kumari EACS. Heavy metal concentrations in the edible portions of Centella asiatica: Health risk toward chronic kidney disease of uncertain etiology. SN APPLIED SCIENCES 2021. [DOI: 10.1007/s42452-021-04666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractCentella asiatica is a commonly consumed green leafy vegetable in many developing countries due its high nutritious value and availability at low cost. The present study was conducted to assess the Cd, Cr and Pb uptake associated health risks of Centella asiatica harvested from organic and non-organic cultivations in a chronic kidney disease of uncertain etiology (CKDue) prevalent area in Sri Lanka. The health risk assessment was conducted in terms of the bioconcentration factor (BCF), soil-to-root and root-to-leaf translocation factors ($${\text{TF}}\,({\text{soil-root}})$$
TF
(
soil-root
)
and $${\text{TF}}\,({\text{root-leaf}})$$
TF
(
root-leaf
)
), Target hazard quotient for each heavy metal (THQ) and hazard index (HI). In addition, the spatial variation of physical and chemical parameters of the root zone soil were assessed using MINITAB 17 statistical software. Results indicated significant spatial variations in conductivity, organic matter content and Cr concentrations among organic and non-organic study sites. The Cr, Cd and Pb concentrations recorded from roots and leaves of Centella asiatica were higher than the safe limits for consumption established by the European Union. The health risk analysis indicated that there is a potential of hyper-accumulating Cd in the roots of Centella asiatica. Further, the THQ and HI of the heavy metals indicated possible adverse non-cancer health risks associated with long-term consumption of leaves of Centella asiatica. Therefore, necessary precautionary actions to prevent the excessive buildup of Cr, Cd and Pb in the edible portions of Centella asiatica are essential in order to ensure consumer safety.
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Davoudi M, Barjasteh-Askari F, Sarmadi M, Ghorbani M, Yaseri M, Bazrafshan E, Mahvi AH, Moohebati M. Relationship of fluoride in drinking water with blood pressure and essential hypertension prevalence: a systematic review and meta-analysis. Int Arch Occup Environ Health 2021; 94:1137-1146. [PMID: 34014395 DOI: 10.1007/s00420-021-01714-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/29/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Previous studies showed controversial results of the relationship between fluoride exposure through drinking water and elevated blood pressure. We conducted a systematic review and meta-analysis to assess the direct relationship of drinking water fluoride exposure with blood pressure and essential hypertension prevalence in general populations. METHODS We conducted a systematic search in databases including Web of Knowledge, PubMed, Scopus, and Embase by MeSH and non-MeSH terms for relevant studies with any design published until August 2019, with no limitation in time and language. The pooled effect measure was calculated within a 95% confidence interval (CI). RESULTS Our search retrieved 630 journal articles, six of which were eligible for data extraction. The random-effects model found significantly higher systolic blood pressure (mean difference = 6.49 mmHg; 95% CI 3.73-9.25; p value < 0.01) and diastolic blood pressure (mean difference = 4.33 mmHg; 95% CI 1.39-7.26; p value < 0.01) in groups exposed to high-fluoride drinking water than in groups exposed to normal/low-fluoride drinking water. A significant relationship was also found between high-fluoride drinking water and essential hypertension (odds ratio = 2.14; 95% CI 1.02-4.49; p value = 0.045). CONCLUSION The risk of elevated blood pressure increases in the general population of fluoride endemic areas. However, more research is needed to make a firm conclusion about the adverse effects of excess fluoride intake on the cardiovascular system at the individual level.
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Affiliation(s)
- Mojtaba Davoudi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Environmental Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fateme Barjasteh-Askari
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, PourSina St., Enghelab St., Tehran, 1417613151, Iran
| | - Mohammad Sarmadi
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mohammad Ghorbani
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Edris Bazrafshan
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Amir Hossein Mahvi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, PourSina St., Enghelab St., Tehran, 1417613151, Iran.
- Center for Solid Waste Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Moohebati
- Atherosclerosis Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Hettiarachchi TW, Fernando BNTW, Sudeshika T, Badurdeen Z, Anand S, Kularatne A, Wijetunge S, Abeysundara HTK, Nanayakkara N. Prevalence, risk factors and predicted risk of cardiac events in chronic kidney disease of uncertain aetiology in Sri Lanka: A tubular interstitial nephropathy. PLoS One 2021; 16:e0249539. [PMID: 33852602 PMCID: PMC8046203 DOI: 10.1371/journal.pone.0249539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/21/2021] [Indexed: 11/19/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with 'traditional' chronic kidney disease (CKD). However, chronic kidney disease of uncertain aetiology (CKDu), a tubular interstitial nephropathy is typically minimally proteinuric without high rates of associated hypertension or vascular disease and it is unknown if the rates of CVD are similar. This study aimed to identify the prevalence and the risk of CVD in patients with CKDu. This cross-sectional study included patients with confirmed CKDu who were attending two renal clinics in CKDu endemic-area. A detailed medical history, blood pressure, electrocardiogram (resting and six minutes vigorous walking), echocardiograms, appropriate laboratory parameters and medical record reviews were used to collect data at baseline. The WHO/Pan American Health Organization, cardiovascular risk calculator was employed to determine the future risk of CVD. The clinics had recorded 132 number of patients with CKDu, of these 119 consented to participation in the study. The mean age was 52 (± 9.5) years and mean eGFR was 51.1 (± 27.61); a majority (81.5% (n = 97)) were males. Thirty-four patients (28.6%) had evidence of ischaemic heart disease (IHD). Troponin-I (p = 0.02), Age >50 years (p = 0.01) and hyperuricemia (p = 0.01) were significantly associated with IHD in CKDu. Left ventricular hypertrophy was reported in 20.2% (n = 24). According to the risk calculator, 97% of the enrolled patients were at low risk (<10%) for experiencing a cardiovascular event within the next 10 years. Patients with CKDu have low prevalence and risk for CVD, implying that a majority are likely to survive to reach end-stage kidney disease. Our findings highlight the need for developing strategies to minimize the progression of CKDu to end-stage renal disease.
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Affiliation(s)
- Thilini W. Hettiarachchi
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka
| | - Buddhi N. T. W. Fernando
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
| | - Thilini Sudeshika
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Galaha, Sri Lanka
| | - Zeid Badurdeen
- Centre for Education, Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, United States of America
| | | | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Galaha, Sri Lanka
| | - Hemalika T. K. Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Galaha, Sri Lanka
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Senarathne S, Jayawardana JMCK, Edirisinghe EANV, Chandrajith R. Influence of regional climatic on the hydrogeochemistry of a tropical river basin-a study from the Walawe river basin of Sri Lanka. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:15701-15715. [PMID: 33244694 DOI: 10.1007/s11356-020-11712-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/16/2020] [Indexed: 06/11/2023]
Abstract
The Walawe river basin is one of the important watersheds in Sri Lanka subjected to water scarcity due to intensive exploitation for irrigation and domestic purposes. The groundwater resource in the basin is under-explored for its capacity to sustain a continuous supply of water for future demand while facing the growing climate change challenges. The objective of this study was to identify the behavior of groundwater in the Walawe river basin that flows through two major climatic zones in Sri Lanka. The study approach includes hydrogeochemical and stable isotope analysis in order to differentiate the geochemical evolution of groundwater in the basin with respect to climatic factors. Water samples from thirty-eight (38) deep wells (> 20 m), 25 shallow wells, and 14 surface water bodies were collected and measured for their major ions, and isotope ratios of δ2H and δ18O. The results indicated a clear difference in the geochemistry of groundwater between the two climatic zones of the basin. The dry zone area was characterized by a higher content of dissolved minerals as compared to that in the wet zone area. Silicate weathering, calcite dissolution, and ion exchange processes were found to be the main control of groundwater geochemistry in the basin. The Ca-HCO3-type water was found to be the predominant water type. The isotope data suggested that the groundwater in the study area is recharged mainly from the northeast monsoon rain. Isotope characteristics also suggested that direct infiltration is prominent in the wet zone regions, whereas modifications of shallow groundwater by evaporation were dominated in the dry zone areas. The findings of the study suggest that water quality management in the dry zone areas of the basin is critical for the future sustainability of the water resource of the basin.
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Affiliation(s)
- Sachintha Senarathne
- Department of Natural Resources, Faculty of Applied Sciences and Faculty of Graduate Studies, Sabaragamuwa University of Sri Lanka, Belihuloya, Balangoda, Sri Lanka
- Faculty of Graduate Studies, Sabaragamuwa University of Sri Lanka BelihulOya, Balangod, Sri Lanka
| | - Jayawardana Mudiyanselage Chandramali Kumari Jayawardana
- Department of Natural Resources, Faculty of Applied Sciences and Faculty of Graduate Studies, Sabaragamuwa University of Sri Lanka, Belihuloya, Balangoda, Sri Lanka
- Faculty of Graduate Studies, Sabaragamuwa University of Sri Lanka BelihulOya, Balangod, Sri Lanka
| | | | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Kandy, Sri Lanka.
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Diyabalanage S, Kalpage MD, Mohotti DG, Dissanayake CKK, Fernando R, Frew RD, Chandrajith R. Comprehensive Assessment of Essential and Potentially Toxic Trace Elements in Bovine Milk and Their Feeds in Different Agro-climatic Zones of Sri Lanka. Biol Trace Elem Res 2021; 199:1377-1388. [PMID: 32728936 DOI: 10.1007/s12011-020-02242-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
Abstract
Fresh milk is an important source of essential mineral supplement for humans. However, the levels of trace elements in milk are an important component of its safety and quality. Trace elements also act as a bio-indicator of agricultural pollution. Samples of raw cow milk (n = 68), animal feed [forage (n = 36) and concentrates (n = 14)], and water (n = 35) were collected from different agro-climatic regions of Sri Lanka. The concentrations of 15 trace elements including toxic heavy metals such as Cd, Pb, and As were quantified using inductively coupled plasma mass spectrometry after microwave-assisted digestion. Among the studied trace elements, the mean elemental concentrations of Se, Cd, As, and Cu in cow milk were 18.1, 1.45, 7.35, and 71.7 μg L-1, respectively. The mean concentrations of these elements in forage were 0.216, 0.066, 0.046, and 9.21 mg kg-1, and in concentrate feed were 0.329, 0.202, 0.229, and 2.28 mg kg-1, respectively. The As content of the studied milk was well below the maximum permissible level while 15% of the samples had Pb exceeding the permissible limit of 20 μg L-1. However, As, Cd, and Pb levels in drinking water provided to animals were well below the WHO permissible limits. The results of this study revealed that the trace elements in cow milk depend mainly on the feed, and hence, levels of these contaminants in feed materials should be monitored. Although due to the consumption of milk, the populations have a minor exposure to trace elements and also minimum health risks, a detailed study with a large number of samples is highly recommended.
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Affiliation(s)
- Saranga Diyabalanage
- Instrument Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | | | | | - Ruchika Fernando
- Department of Veterinary Public Health and Pharmacology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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Kulathunga MRDL, Wijayawardena MAA, Naidu R. Heavy metal(loid)s and health risk assessment of Dambulla vegetable market in Sri Lanka. ENVIRONMENTAL MONITORING AND ASSESSMENT 2021; 193:230. [PMID: 33772647 DOI: 10.1007/s10661-021-09020-2] [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: 11/25/2020] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
Vegetables are essential for a healthy diet in humans. However, vegetables can carry harmful metal(loid) contaminants such as As, Cd and Pb which are deleterious to health in the long term. It has been postulated that long-term heavy metal(loid) exposure by vegetable consumption is associated with chronic kidney disease of unknown aetiology (CKDu) that prevails in North Central Province of Sri Lanka. We performed a human health risk assessment to identify if there is any link between heavy metal(loid) exposure from vegetable consumption and the prevalence of CKDu. The study includes a survey of food consumption in CKDu-impacted areas and determination of the heavy metal(loid) contents of market vegetables. We found that Solanum tuberosum (potato) and Momordica charantia (bitter gourd) accumulated Pb to a greater extent than other vegetables and exceeded the permissible concentration for foodstuffs. The Cd content of Solanum melongena (Brinjal) also exceeded permissible levels. However, the As content was below permissible levels for all the vegetables tested. The weekly total heavy metal(loid) intake of Cd, As and Pb in vegetables in CKDu-impacted areas was lower than permissible limits. The consumption of an average amount of vegetables does not pose a chronic health risk to the consumers. There was no evidence of a link between the consumption of heavy metal(loid)s in vegetables and CKDu. Since, few vegetables showed marked heavy metal(loid) accumulation, periodical monitoring of heavy metal(loid) concentrations in vegetables will be beneficial for avoidance of future possible health risks.
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Affiliation(s)
- M R D L Kulathunga
- Global Centre for Environmental Remediation (GCER), The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Fruit Research and Development Institute, Kananwila, Horana, Sri Lanka.
| | - M A Ayanka Wijayawardena
- Global Centre for Environmental Remediation (GCER), The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Ravi Naidu
- Global Centre for Environmental Remediation (GCER), The University of Newcastle, Callaghan, NSW, 2308, Australia
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW, 2308, Australia
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Rajatheja MKJC, Chandrajith R, Bentota A, Jayasinghe GY. A Comparative Assessment of Trace Element Accumulation in Native and Improved Rice (Oryza sativa L.) Varieties Grown Under Different Conditions of Fertilizer Application. Biol Trace Elem Res 2021; 199:1153-1160. [PMID: 32472354 DOI: 10.1007/s12011-020-02213-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
Rice (Oryza sativa L.) is the main food crop cultivated in Sri Lanka, and different varieties of rice are grown under different conditions of fertilizer application throughout the country. Since the consumption of rice is extremely high, it is considered as the major dietary source for macro- and micro-nutrients and also for toxic trace elements. The main objective of this study was to investigate and compare trace element levels in native and improved rice varieties that were grown under both organic and inorganic chemical fertilizers and also under unfertilized conditions. Rice grains were collected from a plot experiment with seven native and seven improved rice varieties that were treated with organic and inorganic fertilizers. Contents of macro-nutrients (Na, K, Ca and Mg) and trace elements (Cd, As, Pb, Cr, Mn, Co, Ni, Cu, Zn and Ba) in rice grains were measured by inductively coupled plasma mass spectrometry. The results indicated that rice cultivated using inorganic fertilizers showed the highest mean trace element contents while organic fertilizer-treated improved rice varieties showed the lowest Cd (0.10 mg/kg) which is lower than the maximum permissible level (0.2 μg g-1). The highest mean value of Cd (0.32 mg/kg) was recorded in native rice varieties grown in plots with chemical fertilizer applications. However, the As content in rice samples collected from all treatment conditions indicated contents lower than the maximum permissible level. Rice cultivated in plots that were treated with chemical fertilizer showed the highest mean macro-nutrient contents.
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Affiliation(s)
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Amita Bentota
- Rice Research and Development Institute (RRDI), Batalagoda, Sri Lanka
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M Pry J, Jackson W, Rupasinghe R, Lishanthe G, Badurdeen Z, Abeysekara T, Chandrajith R, Smith W, Wickramasinghe S. A pilot case-control study using a one health approach to evaluate behavioral, environmental, and occupational risk factors for chronic kidney disease of unknown etiology in Sri Lanka. ONE HEALTH OUTLOOK 2021; 3:4. [PMID: 33829142 PMCID: PMC8011406 DOI: 10.1186/s42522-020-00034-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/29/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Chronic kidney disease of unknown etiology (CKDu) was first recognized in Sri Lanka in the early 1990s, and since then it has reached epidemic levels in the North Central Province of the country. The prevalence of CKDu is reportedly highest among communities that engage in chena and paddy farming, which is most often practiced in the dry zone including the North Central and East Central Provinces of Sri Lanka. Previous studies have suggested varied hypotheses for the etiology of CKDu; however, there is not yet a consensus on the primary risk factors, possibly due to disparate study designs, sample populations, and methodologies. METHODS The goal of this pilot case-control study was to evaluate the relationships between key demographic, cultural, and occupational variables as risk factors for CKDu, with a primary interest in pesticide exposure both occupationally and through its potential use as an ingredient in brewed kasippu alcohol. An extensive one health focused survey was developed with in cooperation with the Centre for Research, Education, and Training on Kidney Diseases of Sri Lanka. RESULTS A total of 56 CKDu cases and 54 control individuals were surveyed using a proctored, self-reported questionnaire. Occupational pesticide exposure and alcohol consumption were not found to be significant risk factors for CKDu. However, a statistically significant association with CKDu was observed with chewing betel (adjusted odds ratio [aOR]: 6.11, 95% confidence interval [CI]: 1.93, 19.35), age (aOR: 1.07, 95% CI: 1.02, 1.13), owning a pet dog (aOR: 3.74, 95% CI: 1.38, 10.11), water treatment (aOR: 3.68, 95% CI: 1.09, 12.43) and pests in the house (aOR: 5.81, 95% CI: 1.56, 21.60). CONCLUSIONS The findings of this study suggest future research should focus on practices associated with chewing betel, potential animal interactions including pests in the home and pets, and risk factors associated with water. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s42522-020-00034-3.
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Affiliation(s)
- Jake M Pry
- Implementation Science Unit, Centre for Infectious Disease Research Zambia (CIDRZ), 10101 Lusaka, Zambia
- School of Medicine, Washington University, St. Louis, MO USA
| | - Wendi Jackson
- School of Veterinary Medicine, University of California, Davis, USA
| | | | | | - Zied Badurdeen
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Tilak Abeysekara
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | | | - Woutrina Smith
- School of Veterinary Medicine, University of California, Davis, USA
| | - Saumya Wickramasinghe
- School of Veterinary Medicine, University of California, Davis, USA
- Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Kandy, Sri Lanka
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Risk Assessment of Trace Element Contamination in Drinking Water and Agricultural Soil: A Study in Selected Chronic Kidney Disease of Unknown Etiology (CKDu) Endemic Areas in Sri Lanka. J CHEM-NY 2021. [DOI: 10.1155/2021/6627254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Unexplained or unclear etiology of chronic kidney disease (CKDu) has been reported in Sri Lanka’s North Central Province (NCP) for more than two decades. Meanwhile, high exposure to heavy metals/metalloids and their accumulation are recognized as the origin of many acute and chronic diseases in certain vulnerable human tissues including kidneys. This study evaluates the contamination status of heavy metals/metalloids of the drinking water and agricultural soil in two CKDu endemic areas compared with a reference area in Sri Lanka based on common indexes and attribute of the commonly used fertilizers evaluated to identify the basic sources of toxic metals in the agricultural soil. Mean concentrations of heavy metals/metalloids such as Mn, Co, As, Cd, Pb, Cu, Zn, and Fe in drinking water of CKDu endemic areas were far below Sri Lankan water quality standards (permissible limits). In addition, all sampling locations dropped below the medium range of the heavy metal pollution index of water (HPI 15–40). Geoaccumulation indexes (Igeo) of soil reveal that paddy soil in CKDu endemic areas is being moderately polluted with toxic metals/metalloids such as As, Pb, Cu, Ni, Cr, Zn, and Cd. On the other hand, the application of fertilizers, which contained a high dose of toxic metals, could be the driving force for agricultural soil pollution, and limitless application of low-quality fertilizer would lead to more soil contamination with heavy metals. Hence, hazardous metals can be incorporated into the food chains via contaminated paddy soil.
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Faleel RA, Jayawardena UA. Progression of potential etiologies of the chronic kidney disease of unknown etiology in Sri Lanka. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, TOXICOLOGY AND CARCINOGENESIS 2020; 38:362-383. [PMID: 33356855 DOI: 10.1080/26896583.2020.1852012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Chronic kidney disease of unknown etiology (CKDu) is a major health issue in agricultural areas in Sri Lanka. Despite many attempts to identifying causative factors of CKDu, the real cause/s remain/s elusive to date. Understanding the progression of potential etiologies may provide valuable insight into this quest. Literature relevant to CKDu addresses several etiologies, including quality of drinking water in the affected areas including hardness, fluoride, ionicity, agrochemical and heavy metal contaminations, consumption of contaminated food, and the genetic makeup of vulnerable populations. Progression of the etiologies revealed persistent interest in heavy metals of multiple origins: waterborne, foodborne, or soilborne. Secondary factors, such as water hardness, fluoride, and ionicity appear to act synergistically, aggravating the role of heavy metals on the onset, and the progression of CKDu. Demographical factors, such as male sex, over 50 years of age, agriculture-related occupation, and the consumption of contaminated water and food are intricately related with the disease progression while other minor risk factors such as smoking, alcohol consumption, etc. exasperate the disease condition. Since, none of these etiologies are examined adequately, conducting laboratory exposure studies under in-vivo and in-vitro settings to understand their role in CKDu is crucial.
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Affiliation(s)
- Ranaa Aqeelah Faleel
- Department of Zoology, Faculty of Natural Sciences, The Open University of Sri Lanka, Nawala, Sri Lanka
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Abdissa D. Purposeful Review to Identify Risk Factors, Epidemiology, Clinical Features, Treatment and Prevention of Chronic Kidney Disease of Unknown Etiology. Int J Nephrol Renovasc Dis 2020; 13:367-377. [PMID: 33363397 PMCID: PMC7754091 DOI: 10.2147/ijnrd.s283161] [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: 09/25/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
The global burden of chronic kidney disease (CKD) has risen, and chronic kidney disease of unknown etiology (CKDu) contributes considerably to the national burden of CKD. It is characterized by irreversible, slowly advancing disease, and symptoms often appear in the late stages of the disease. It is a serious, novel cause of kidney failure and leads to premature deaths. Many hypotheses have emerged; however, the etiology of CKDu continues to be elusive and debatable and it is claimed that the etiology is multifactorial, encompassing environmental, genetic, occupational, and social factors. The dominant histopathological feature is chronic tubulointerstitial nephritis. It predominantly affects individuals with low socio-economic status, of working age, largely without chronic comorbidities, who perform strenuous labor in extreme conditions in various tropical areas of the world. It is often fatal due to fast progression and limited access to dialysis or transplant options in the involved geographic areas. Early recognition and appropriate interventions at the earliest possible stage are imperative for decreasing its associated morbidity and mortality. In this review, I tried to summarize available evidence on the risk factors, epidemiology, clinical features, treatment, and prevention of CKDu. The literature search for this review was conducted comprehensively by using different electronic databases and by using appropriate search terms.
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Affiliation(s)
- Daba Abdissa
- Department of Biomedical Sciences, College of Medical Science, Institute of Health Science, Jimma University, Jimma, Ethiopia
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