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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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Kandasamy G, Manisekaran R, Arthikala MK. Chitosan nanoplatforms in agriculture for multi-potential applications - Adsorption/removal, sustained release, sensing of pollutants & delivering their alternatives - A comprehensive review. ENVIRONMENTAL RESEARCH 2024; 240:117447. [PMID: 37863167 DOI: 10.1016/j.envres.2023.117447] [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: 08/02/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023]
Abstract
An increase in the global population has led to an increment in the food consumption, which has demanded high food production. To meet the production demands, different techniques and technologies are adopted in agriculture the past 70 years, where utilization of the industry-manufactured/synthetic pesticides (SPTCs - e.g., herbicides, insecticides, fungicides, bactericides, nematicides, acaricides, avicides, and so on) is one of them. However, it has been later revealed that the usage of SPTCs has negatively impacted the environment - especially water and soil, and also agricultural products - mainly foods. Though preventive measures are taken by government agencies, still the utilization rate of SPTCs is high, and consequently, their maximum residual limit (MRL) levels in food are above tolerance, which further results in serious health concerns in humans. So, there is an immediate need for decreasing the utilization of the SPTCs by delivering them effectively at reduced levels in agriculture but with the required efficacy. Apart from that, it is mandatory to detect/sense and also to remove them to lessen the environmental pollution, while developing effective alternative techniques/technologies. Among many suitable materials that are developed/idenified, chitosan, a bio-polymer has gained great attention and is comprehensively implemented in all the above-mentioned applications - sensing, delivery and removal, due to their excellent and required properties. Though many works are available, in this work, a special attention is given to chitosan and its derivatives (i.e., chitosan nanoparticles (CNPs))based removal, controlled release and sensing of the SPTCs - specifically herbicides and insecticides. Moreover, the chitosan/CNPs-based protective effects on the in vivo models during/after their exposure to the SPTCs, and the current technologies like clustered regularly interspaced short palindromic repeats (CRISPR) as alternatives for SPTCs are also reviewed.
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Affiliation(s)
- Ganeshlenin Kandasamy
- Department of Biomedical Engineering, Vel Tech Rangarajan Dr. Sagunthala R&D Institute of Science and Technology, Chennai, 600062, Tamil Nadu, India.
| | - Ravichandran Manisekaran
- Interdisciplinary Research Laboratory (LII), Nanostructures & Biomaterials, Escuela Nacional de Estudios Superiores (ENES) Unidad León-Universidad Nacional Autónoma de México (UNAM), León, Guanajuato C.P. 37689, Mexico
| | - Manoj-Kumar Arthikala
- Interdisciplinary Research Laboratory (LII), Ciencias Agrogenómicas, Escuela Nacional de Estudios Superiores (ENES) Unidad León-Universidad Nacional Autónoma de México (UNAM), León, Guanajuato C.P. 37689, Mexico
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Wei XY, Jia PP, Hu H, Liu L, Li TY, Li YZ, Pei DS. Multi-omics reveal mechanisms underlying chronic kidney disease of unknown etiology (CKDu) pathogenesis using zebrafish. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 337:122524. [PMID: 37683759 DOI: 10.1016/j.envpol.2023.122524] [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: 07/24/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
Chronic kidney disease of unknown etiology (CKDu) is an endemic disease in the dry zone of farming communities, Sri Lanka. The drinking water in a CKDu prevalent area contains a high concentration of F-, hardness and other environmental pollutants, including heavy metals and microcystin, which are considered possible etiology of CKDu in these areas. Here, multi-omics data with host transcriptome, metabolome and gut microbiomes were obtained using simulated local drinking water of Sri Lanka after their exposure to adult zebrafish. Based on an integrated multi-omics analysis in the context of host physiology in the kidney injury samples with different pathologic grades, two common pathways necroptosis and purine metabolism were identified as potentially important pathways that affect kidney injury. The key metabolite acetyl adenylate in the purine metabolism pathway was significantly positively correlated with Comamonas (rho = 0.72) and significantly negatively correlated with Plesiomonas (rho = -0.58). This crucial metabolite and two key gut bacteria genera may not only be potential markers but also potential therapeutic targets in the uric acid metabolic pathway, which is an important factor in the pathogenesis of acute kidney injury (AKI) in general, as well as of chronic kidney disease (CKD). Based on this, we revealed the urea metabolism pathway of kidney injury in zebrafish and provided a new avenue for the treatment of CKDu in Sri Lanka.
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Affiliation(s)
- Xing-Yi Wei
- Key Laboratory of Hydraulic and Waterway Engineering of the Ministry of Education, School of River and Ocean Engineering, Chongqing Jiaotong University, Chongqing 400074, China; Chongqing Institute of Green and Intelligent Technology, Chongqing School of University of Chinese Academy of Sciences, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Pan-Pan Jia
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Huan Hu
- Key Laboratory of Hydraulic and Waterway Engineering of the Ministry of Education, School of River and Ocean Engineering, Chongqing Jiaotong University, Chongqing 400074, China; Chongqing Institute of Green and Intelligent Technology, Chongqing School of University of Chinese Academy of Sciences, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Li Liu
- Chongqing Institute of Green and Intelligent Technology, Chongqing School of University of Chinese Academy of Sciences, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Tian-Yun Li
- Chongqing Institute of Green and Intelligent Technology, Chongqing School of University of Chinese Academy of Sciences, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Yong-Zhi Li
- Chongqing Institute of Green and Intelligent Technology, Chongqing School of University of Chinese Academy of Sciences, Chinese Academy of Sciences, Chongqing, 400714, China
| | - De-Sheng Pei
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China.
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Hossain MM, Karim MM, Seo KD, Park DS, Shim YB. Capillary and Electrodynamic Forces-Driven Separation Detection of Metal Ions Using a Disposable Microfluidic Sensor with a Composite Electrode. Anal Chem 2023; 95:16701-16709. [PMID: 37922203 DOI: 10.1021/acs.analchem.3c03518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
A disposable microfluidic channel sensor printed on a plastic platform was developed to analyze heavy metal ions (HMIs) as a model target species. Precise separation and detection of multiple targets were established by symmetrically applying a small AC potential on the carbon channel walls to induce an electrodynamic force. The separation device was constructed by covering it with a plastic lid to achieve capillary action in the channel. The sample flow rate was regulated by the hydrophilicity of the lid plastic and electrodynamic convection by the AC field, which was characterized by the contact angle measurement and the additional electrodynamic force. The flow variables and their relevance to the capillary phenomena were demonstrated, and the analytical parameters were optimized. The working electrode was modified with poly(diamino terthiophene) anchored with nanosized graphene oxide (pDATT/GO) to enhance the detection performance. The experimental variables for separating and detecting the target species were optimized according to the AC frequency and amplitude, sample flow rate, electrolytes, pH, temperature, and applied potential for detection. The linear dynamic ranges were between 0.1 and 200.0 ppb, with detection limits of 0.04 ± 0.023, 0.29 ± 0.05, 0.07 ± 0.011, and 0.14 ± 0.06 ppb for Cu2+ Cd2+, Hg2+, and Pb2+, respectively. Finally, the reliability of the proposed method was evaluated through analysis of HMIs in real water samples. The results were matched to those obtained through parallel analysis using ICP-MS at a 95% confidence level.
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Affiliation(s)
- Mozammal Md Hossain
- Department of Chemistry and Chemistry Institute for Functional Materials, Pusan National University, Busan 46241, Republic of Korea
| | - Md Mobarok Karim
- Department of Chemistry and Chemistry Institute for Functional Materials, Pusan National University, Busan 46241, Republic of Korea
| | - Kyeong-Deok Seo
- Department of Chemistry and Chemistry Institute for Functional Materials, Pusan National University, Busan 46241, Republic of Korea
| | - Deog-Su Park
- Department of Chemistry and Chemistry Institute for Functional Materials, Pusan National University, Busan 46241, Republic of Korea
| | - Yoon-Bo Shim
- Department of Chemistry and Chemistry Institute for Functional Materials, Pusan National University, Busan 46241, Republic of Korea
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Nursultanova L, Kabulbayev K, Ospanova D, Tazhiyeva A, Datkhayev U, Saliev T, Tanabayeva S, Fakhradiyev I. Prevalence of chronic kidney disease in Kazakhstan: evidence from a national cross-sectional study. Sci Rep 2023; 13:14710. [PMID: 37679536 PMCID: PMC10485008 DOI: 10.1038/s41598-023-42031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/04/2023] [Indexed: 09/09/2023] Open
Abstract
To date, there have been no large-scale national studies of the prevalence of chronic kidney disease in Kazakhstan. It includes the research based on the analysis of the estimated glomerular filtration rate (eGFR). The aim of this study was to investigate the population prevalence of CKD and associated risk factors in Kazakhstan. The cross-sectional study consisted of a nationally representative sample of n = 6 720 adults aged 18 to 69 from 14 regions and 3 major cities in Kazakhstan. The study covered the period from October 2021 to May 2022. The WHO STEPS questionnaire was used for the survey. For the diagnosis of CKD, creatinine levels in collected blood samples were measured to assess eGFR. Demographic characteristics were collected and studied. The total and adjusted prevalence of factors associated with the presence of CKD were calculated and analysed using logistic regression. 73.5% (n = 4940) of participants had normal eGFR, while 25.2% (n = 1695) had mild CKD (eGFR = 60-89 mL/min/1.7 m2). The overall prevalence of CKD with eGFR < 60 ml/min/1.7 m2 was 1.3% (n = 85), of which 0.2% (n = 15) had eGFR < 45 ml/min/1.7 m2. A mild degree of CKD was most often determined in residents of the East Kazakhstan region in 10.4%, and in 7.8-8.0% of cases. The majority of CKD patients was detected in the East Kazakhstan region and Almaty city, 15.3% and 10.6% of cases respectively. In mild and CKD with GFR < 60 ml/min/1.7 m2, the age of participants was 50-69 years in 61.5% and 78.8% of cases, respectively (p < 0.001). In addition to the association with the place of residence, a statistically significant relationship was found between the risk of developing CKD and underweight (OR 1.43, 95% CI (1.09-1.88), p < 0.001), as well as the presence of obesity (OR 1.24, 95% CI (0.99-1.53), p = 0.04). We observed the prevalence of CKD with eGFR < 60 ml/min/1.7 m2 at the level of 1.3%. However, a fairly large part of study participants had a mild CKD (25.2%). The results of this study can be used for the optimization of the doctors workload and the timely provision of care to patients with CKD.
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Affiliation(s)
- Liza Nursultanova
- Kazakhstan's Medical University "KSPH", Almaty, Republic of Kazakhstan
| | - Kairat Kabulbayev
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Dinara Ospanova
- Al Farabi Kazakh National University, Almaty, Republic of Kazakhstan
| | - Aigul Tazhiyeva
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Ubaidilla Datkhayev
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Timur Saliev
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Shynar Tanabayeva
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Ildar Fakhradiyev
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan.
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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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Nawaz R, Nasim I, Irfan A, Islam A, Naeem A, Ghani N, Irshad MA, Latif M, Nisa BU, Ullah R. Water Quality Index and Human Health Risk Assessment of Drinking Water in Selected Urban Areas of a Mega City. TOXICS 2023; 11:577. [PMID: 37505543 PMCID: PMC10385057 DOI: 10.3390/toxics11070577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023]
Abstract
The present study was conducted to evaluate the quality of drinking water and assess the potential health hazards due to water contaminants in selected urban areas of Lahore, Pakistan. Water samples were collected from ten sites and analyzed for different physico-chemical parameters including turbidity, color, pH, total dissolved solids (TDS), nitrates, fluoride, residual chlorine, and total hardness. Additionally, heavy metal (arsenic) and microbial parameters (E. coli) were also determined in the water samples. Drinking water quality evaluation indices, including the water quality index (WQI) for physico-chemical and biological parameters and human health risk assessment (HHRA) for heavy metal were estimated using the analytical results of the target parameters. It was found in most of the areas that the levels of arsenic, fluoride, TDS, and residual chlorine were higher than those recommended by the National Environmental Quality Standard (NEQS) and World Health Organization (WHO) guidelines. In addition to the physico-chemical parameters, microbial content (E. coli) was also found in the drinking water samples of the selected areas. Statistical analysis of the results indicated that levels of target parameters in drinking water samples are significantly different between sampling sites. The WQI for all physico-chemical and microbial parameters indicated that drinking water in most of the areas was unfit and unsuitable (WQI > 100) for drinking purposes except for the water of Bhatti Gate and Chota Gaon Shahdara with a WQI of 87 and 91, respectively. Drinking water in these areas had a very poor WQI rating. According to HHRA, drinking water from the selected sites was found to be of high risk to children and adults. The carcinogenic risk of arsenic indicated that all samples were of high risk to both adults and children (4.60 and 4.37 × 10-3, respectively). Regular monitoring of drinking water quality is essential, and proactive measures must be implemented to ensure the treatment and availability of safe drinking water in urban areas.
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Affiliation(s)
- Rab Nawaz
- Department of Environmental Sciences, The University of Lahore, Lahore 54000, Pakistan
- Research and Knowledge Transfer, INTI International University, Putra Nilai 71800, Malaysia
| | - Iqra Nasim
- Department of Environmental Sciences, The University of Lahore, Lahore 54000, Pakistan
- Department of Environmental Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Ali Irfan
- Department of Chemistry, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Amjad Islam
- College of Chemistry and Chemical Engineering, Shantou University, Shantou 515031, China
| | - Ayesha Naeem
- Department of Environmental Sciences, The University of Lahore, Lahore 54000, Pakistan
| | - Nadia Ghani
- Department of Environmental Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Muhammad Atif Irshad
- Department of Environmental Sciences, The University of Lahore, Lahore 54000, Pakistan
| | - Maria Latif
- Department of Environmental Sciences, The University of Lahore, Lahore 54000, Pakistan
| | - Badar Un Nisa
- Department of Chemistry, The University of Lahore, Sargodha 40100, Pakistan
| | - Riaz Ullah
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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Honore PM, Bousbiat I, Perriens E, Blackman S. Letter to the Editor: "Prolonged sedation with sevoflurane in comparison to intravenous sedation in critically ill patients - A randomized controlled trial". J Crit Care 2023:154348. [PMID: 37302930 DOI: 10.1016/j.jcrc.2023.154348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Patrick M Honore
- FCCM, ICU, CHU UCL Godinne Namur, UCL Louvain Medical Shool, Belgium.
| | - Ibrahim Bousbiat
- ULB University, Centre Hospitalier Universitaire Brugmann,Brussels, Belgium
| | - Emily Perriens
- ULB University, Centre Hospitalier Universitaire Brugmann,Brussels, Belgium
| | - Sydney Blackman
- ULB University, Centre Hospitalier Universitaire Brugmann,Brussels, Belgium
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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: 0] [Impact Index Per Article: 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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Priyadarshani WVD, de Namor AFD, Silva SRP. Rising of a global silent killer: critical analysis of chronic kidney disease of uncertain aetiology (CKDu) worldwide and mitigation steps. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:2647-2662. [PMID: 36094692 DOI: 10.1007/s10653-022-01373-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/22/2022] [Indexed: 06/01/2023]
Abstract
Chronic kidney disease of uncertain aetiology (CKDu) is an advanced version of chronic kidney disease (CKD) which bears a high burden on the world health economy. More than 200 articles were analysed to understand the disease responsible for more than 30,000 deaths per year. CKDu is a non-communicable occupational disease that has a progressive deterioration of the kidney in the absence of CKD risk factors such as hypertension, diabetes and glomerulonephritis, while the diagnosis is only possible at the later stages when kidney function is no longer effective. Published evidence for the existence of CKDu was found for around 35 countries. This is a growing health issue in Asia, Central America, Africa and Middle East with identified hot spots. Despite many research studies over decades, the exact root causes are still uncertain. Six main suspected causative factors are identified. Those are heat stress, strenuous labour, dehydration, use of agrochemicals, exposure to heavy metals and the use of polluted water and agricultural lands. This review summarizes four key areas which are CKDu and its general medical background, worldwide prevalence, suspected causative factors and potential circumventing steps to mitigate against CKDu. The importance of further studies addressing early detection and surveillance methods, contribution of nephrotoxins in environmental health, soil chemistry on transporting nephrotoxins, geological parameters which influence the prevalence of the disease and other related sectors to overcome the mysterious nature is highlighted. Mitigation steps to lessen the burden of CKDu are also identified.
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Affiliation(s)
| | | | - S Ravi P Silva
- Advanced Technology Institute, University of Surrey, Guildford, UK.
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11
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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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12
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Xie YQ, Han MM, Zhang YM, Chen H, Zhang HB, Ren CY, Li L, Wu R, Yao H, Shi XN, Lin Q, Wei TB. A novel fluorescent probe with high sensitivity for sequential detection of CN− and Al3+ in highly aqueous medium and its applications in living cell bioimaging. J Photochem Photobiol A Chem 2023. [DOI: 10.1016/j.jphotochem.2022.114488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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13
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Absence of significant association of trace elements in nails with urinary KIM-1 biomarker among residents of Addis Ababa in Upper Awash Basin, Ethiopia: a cross-sectional study. Biometals 2022; 35:1341-1358. [PMID: 36163536 DOI: 10.1007/s10534-022-00448-8] [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: 07/26/2022] [Accepted: 09/17/2022] [Indexed: 12/14/2022]
Abstract
The Akaki River in the Upper Awash Basin, which flows through Addis Ababa, the capital city of Ethiopia, has been highly polluted by sewage from factories and residential areas. A population-based cross-sectional study was used to assess the association between trace elements and kidney injury from residents living in polluted areas downstream (Akaki-Kality) versus upstream (Gullele) in Sub-Cities of Addis Ababa. A total of 95 individuals (53 from Akaki-Kality and 42 from Gullele) were included in the study. Kidney injury molecule 1 (KIM-1), lead, arsenic, cadmium, cobalt, lead, manganese, zinc, iron, copper, chromium and nickel were evaluated in residents' urine and nail samples. A large proportion (74%) of the sample population contained KIM-1, including 81% residents in Akaki-Kality and 64% residents in Gullele. KIM-1 was, however, not significantly different (p = 0.05) between the two Sub-Cities, with median of 0.224 ng/mL in Akaki-Kality and 0.152 ng/mL in Gullele. Most of the analyzed elements, except Pb, As, Cd and Co, were found in all of the nail samples, with median (µg/g) in the range of 442‒714 Fe, 97.0‒246 Zn, 11.6‒24.1 Mn, 4.49‒5.85 Cu, 1.46‒1.66 Cr and 1.22‒1.41 Ni. The high incidence of KIM-1 indicates a potential for long term renal tubular damage among residents of the Sub-Cities. The concentrations of the elements in nails were, however, not significantly associated (p = 0.05) with the corresponding levels of KIM-1 in urine. Hence, the observed KIM-1 might be related to exposure to toxic substances or factors other than those included in this study.
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14
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Feng S, Deng S, Tang Y, Liu Y, Yang Y, Xu S, Tang P, Lu Y, Duan Y, Wei J, Liang G, Pu Y, Chen X, Shen M, Yang F. Microcystin-LR Combined with Cadmium Exposures and the Risk of Chronic Kidney Disease: A Case-Control Study in Central China. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:15818-15827. [PMID: 36269891 DOI: 10.1021/acs.est.2c02287] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Increasing evidence indicates that exposure to microcystin-LR (MC-LR) can cause kidney damage. However, the association between MC-LR exposure and chronic kidney disease (CKD) risk in humans has not been studied. Therefore, we conducted a population-based case-control study involving 135 CKD cases and 135 matched controls in central China and analyzed the effects of MC-LR alone as well as combined with the known risk factor cadmium (Cd). Compared to the lowest quartile of MC-LR exposure, the highest quartile had a 6.56-fold (95% confidence interval [CI]: 2.46, 17.51) significantly increased risk for CKD, displaying a dose-response relationship (ptrend < 0.001). Our animal study also showed that MC-LR exposure induced kidney injury via the PI3K/AKT/mTOR signaling pathway. Comparing the highest Cd quartile to the lowest, the adjusted odds ratio for CKD was 3.88 (95% CI: 1.47, 10.28), exhibiting a dose-response relationship (ptrend < 0.006). Furthermore, a positive additive interaction was observed between MC-LR and Cd (relative excess risk due to interaction = 1.81, 95% CI: 0.42, 3.20; attributable proportion of interaction = 0.70, 95% CI: 0.35, 1.05). Our study firstly revealed that MC-LR exposure is an independent risk factor for CKD and has a synergistic relationship with Cd. MC-LR and Cd exposures are associated with CKD risk in a dose-response manner.
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Affiliation(s)
- Shuidong Feng
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
| | - Shuxiang Deng
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
| | - Yan Tang
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
| | - Ying Liu
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
| | - Yue Yang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha410000, China
| | - Shuaishuai Xu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha410000, China
| | - Peng Tang
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
| | - Yao Lu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha410000, China
| | - Yanying Duan
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha410000, China
| | - Jia Wei
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha410000, China
| | - Geyu Liang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing210000, China
| | - Yuepu Pu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing210000, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha410000, China
| | - Minxue Shen
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha410000, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha410000, China
| | - Fei Yang
- Department of Epidemiology and Health Statistics, The Key Laboratory of Typical Environmental Pollution and Health Hazards of Hunan Province, School of Basic Medicine, School of Public Health, Hengyang Medical School, University of South China, Hengyang 421001, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha410000, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing210000, China
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15
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Lv J, Guo L, Gu Y, Xu Y, Xue Q, Yang X, Wang QN, Meng XM, Xu DX, Pan XF, Xu S, Huang Y. National temporal trend for organophosphate pesticide DDT exposure and associations with chronic kidney disease using age-adapted eGFR model. ENVIRONMENT INTERNATIONAL 2022; 169:107499. [PMID: 36087379 DOI: 10.1016/j.envint.2022.107499] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Whilst certain environmental organochlorine pesticide exposure may still pose significant burden, the associations between dichloro-diphenyl-trichloroethane (DDT) and chronic kidney disease (CKD) remain disputable notwithstanding the potentially inaccurate disease definition between age groups. National DDT exposure burden atlas was depicted from 92,061 participants by measuring their serum concentrations of DDT congeners and major metabolite in the US from 1999 to 2016. Temporal analyses of these toxicant exposure suggested that although serum DDT concentrations exhibited recent decline, the detection rates remain up to 99.8% every year, posing great concern for exposure risk. A total of 3,039 US adults were further included from these participants demonstrating the weighted CKD prevalence of 40.2% using the new age-adapted CKD-EPI40 model compared to 28.0% using the current CKD-EPI method. After adjustment for covariates, logistic regression model results showed individual metabolites and total DDT burden were positively, yet monotonically, associated with risk of CKD incidence (P-trend for all < 0.05), particularly among adults 40 years of age and older. Much heightened renal disease risk was also observed with high DDT exposure (OR, 1.55; 95 % CI, 1.11-2.15) in those who were hypertensive (P for heterogeneity < 0.001) but not with diabetes. The current high DDT exposure risk combined with elevated probability for CKD incidence call for health concerns and management for the environmentally persistent pollutants.
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Affiliation(s)
- Jia Lv
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Lijuan Guo
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Yue Gu
- Department of Nephrology, Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Ying Xu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qingping Xue
- Department of Epidemiology and Biostatistics, Public School, Chengdu Medical College, Chengdu, China
| | - Xue Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qu-Nan Wang
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Xiao-Ming Meng
- School of Pharmacy, Anhui Medical University, The Key Laboratory of Anti-Inflammatory of Immune Medicines, Ministry of Education, Hefei, China
| | - De-Xiang Xu
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Xiong-Fei Pan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Wenjiang Institute of Women's and Children's Health, Wenjiang Maternal and Child Health Hospital, Chengdu, China.
| | - Shen Xu
- Department of Urology, Second Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Yichao Huang
- Department of Toxicology, School of Public Health, Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China.
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16
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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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17
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Analogize of metal-organic frameworks (MOFs) adsorbents functional sites for Hg2+ ions removal. Sep Purif Technol 2022. [DOI: 10.1016/j.seppur.2022.121471] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Abstract
Drinking water is largely from groundwater in Sri Lanka, so quality management is of great concern. In order to achieve the 6th goal of United Nations (UN) Sustainable Development Goals (SDG), more efforts are being undertaken to secure drinking water quality. In this paper, the current status, challenges and opportunities of groundwater quality management and improvement in Sri Lanka were reviewed and discussed, based on previous studies. There are Ca-HCO3 type, Ca–Mg-HCO3 type and Na–SO4–Cl type groundwater dominated in the wet zone, intermediate and the dry zone, respectively. Elevated levels of hardness, fluoride, DOC, and alkalinity, and salinity are reported in the groundwater in the dry zone controlled by geology and arid climate. Although groundwater in some regions contain significant levels of nitrates, arsenic, cadmium and lead, the majority remain at acceptable levels for drinking purposes. As for treatment technologies, existing membrane-based drinking water treatment technologies such as RO (Reverse Osmosis) stations can produce safe and clean drinking water to the community, but this has still a limited coverage. To achieve a safe drinking water supply for all, especially in rural communities of Sri Lanka under the 6th goal of the UN SDG, more efforts in building up the infrastructure and man power are needed to monitor and assess groundwater quality regularly so as to develop management strategies. Research and development can be directed towards more cost-effective water treatment technologies. Protection of groundwater from being polluted, and educational and awareness programs for the stakeholders are also essential tasks in the future.
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19
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Jolly AM, Thomas J. Chronic kidney disease of unknown etiology in India: a comparative study with Mesoamerican and Sri Lankan nephropathy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:15303-15317. [PMID: 34984612 DOI: 10.1007/s11356-021-16548-w] [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: 06/10/2021] [Accepted: 09/11/2021] [Indexed: 06/14/2023]
Abstract
Chronic kidney disease of unknown etiology [CKDu] is a condition characterized by decline in kidney function and is not associated with diabetic nephropathy or hypertensive nephropathy. In this review, we have done a detailed literature analysis on CKDu in India, and then had a comparison with that of Mesoamerica and Sri Lanka. In India, CKDu became the second most common type of CKD after diabetic nephropathy. Silica was seen in the groundwater of both India and Sri Lanka, whereas in Mesoamerica silica exposure through particulate matter was seen among CKDu communities. DDE is a common agrochemical seen in both India and Sri Lanka. The risk factors vary from region to region and it is important to categorize CKDu population based on the risk factors to avoid misinterpretation of the condition as non-CKDu category and to evade further complications. More studies have to be conducted to reveal the detailed pathophysiological mechanisms and its relation with irrational exploitation of environmental resources.
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Affiliation(s)
- Aleeta Maria Jolly
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Jaya Thomas
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India.
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20
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Kamal GM, Rehmani MN, Iqbal SZ, Uddin J, Nazir S, Rehman JU, Hussain AI, Mousavi Khaneghah A. The determination of potentially toxic elements (PTEs) in milk from the Sothern Cities of Punjab, Pakistan: a health risk assessment study. J Food Compost Anal 2022. [DOI: 10.1016/j.jfca.2022.104446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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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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22
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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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23
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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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Sargazi S, Mollashahi B, Sargazi S, Heidari Nia M, Saravani R, Mirinejad S, Alidadi A. Prevalence of miR146a Gene Polymorphisms in Diabetic and Non-diabetic Patients with Chronic Kidney Disease. IRANIAN JOURNAL OF SCIENCE AND TECHNOLOGY, TRANSACTIONS A: SCIENCE 2021. [DOI: 10.1007/s40995-021-01229-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ulrich JC, Ferguson PL. Development of a sensitive direct injection LC-MS/MS method for the detection of glyphosate and aminomethylphosphonic acid (AMPA) in hard waters. Anal Bioanal Chem 2021; 413:3763-3774. [PMID: 33846826 PMCID: PMC8154743 DOI: 10.1007/s00216-021-03324-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 01/15/2023]
Abstract
Glyphosate is currently the most widely used herbicide in the world; however, the zwitterionic and highly polar properties of glyphosate make current pesticide analysis methods unsuitable for its trace analysis in natural waters. Additionally, current glyphosate analysis methods do not account for waters of varying hardness, which is vital as glyphosate can complex with cationic species such as Ca2+ and Mg2+ in the environment. We detail here a robust LC-MS/MS method for the quantitation of glyphosate and its primary transformation product aminomethylphosphonic acid (AMPA) in environmental waters of varying water hardness. Chromatographic separation was achieved with a reversed-phase and weak anion-exchange mixed-mode column. We found that the addition of EDTA into hard water samples increases the response of both glyphosate and AMPA in the mass spectrometer. Limits of detection of 0.23 and 0.30 μg L-1 for glyphosate and AMPA in EDTA-amended hard water were achieved, respectively. We have demonstrated that the accuracy of the method was consistent over a wide range of water hardness levels up to a maximum of ~340 mg mL-1 CaCO3 hardness. We validated the method using matrix fortification of uncontaminated environmental samples from US river water. We then demonstrated that the method was successful at quantifying glyphosate and AMPA across surface and drinking water samples of varying water hardness from North Carolina and Sri Lanka. Measured concentrations of glyphosate and AMPA ranged from 1.6 to 13 μg L-1 and 0.50 to 2.5 μg L-1, respectively. This study represents a significant increase in sensitivity for LC-MS/MS analysis of glyphosate in hard water systems. Graphical abstract.
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Affiliation(s)
- Jake C Ulrich
- Department of Civil and Environmental Engineering, Duke University, 121 Hudson Hall, Box 90287, Durham, NC, 27708-0287, USA
| | - P Lee Ferguson
- Department of Civil and Environmental Engineering, Duke University, 121 Hudson Hall, Box 90287, Durham, NC, 27708-0287, USA.
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Indika S, Wei Y, Hu D, Ketharani J, Ritigala T, Cooray T, Hansima MACK, Makehelwala M, Jinadasa KBSN, Weragoda SK, Weerasooriya R. Evaluation of Performance of Existing RO Drinking Water Stations in the North Central Province, Sri Lanka. MEMBRANES 2021; 11:membranes11060383. [PMID: 34073869 PMCID: PMC8225030 DOI: 10.3390/membranes11060383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
Reverse osmosis (RO) drinking water stations have been introduced to provide safe drinking water for areas with prevailing chronic kidney disease with unknown (CKDu) etiology in the dry zone of Sri Lanka. In this investigation, RO drinking water stations established by community-based organizations (CBO) in the North Central Province (NCP) were examined. Water samples were collected from source, permeate, and concentrate in each station to determine water quality and performance. Furthermore, the operators of the systems were interviewed to evaluate operational and maintenance practices to identify major issues related to the RO systems. Results show that the majority (>93%) of RO systems had higher salt rejection rates (>92%), while water recovery varied from 19.4% to 64%. The removal efficiencies of hardness and alkalinity were averaged at 95.8% and 86.6%, respectively. Most dominant ions such as Ca2+, Mg2+, K+, Na+, Ba2+, Sr2+ Cl−, F−, and SO42− showed higher rejections at averaged values of 93.5%, 97.4%, 86.6%, 90.8%, 95.4%, 96.3%, 95.7%, 96.6%, and 99.0%, respectively. Low recovery rates, lower fluoride levels in product water, and membrane fouling were the main challenges. Lack of knowledge and training were the major issues that could shorten the lifespan of RO systems.
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Affiliation(s)
- Suresh Indika
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; (S.I.); (D.H.); (T.R.)
- Laboratory of Water Pollution Control Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yuansong Wei
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; (S.I.); (D.H.); (T.R.)
- Laboratory of Water Pollution Control Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
- National Institute of Fundamental Studies, Hanthana Road, Kandy 20000, Sri Lanka;
- Correspondence: ; Tel.: +86-10-6284-9690
| | - Dazhou Hu
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; (S.I.); (D.H.); (T.R.)
- Laboratory of Water Pollution Control Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jegetheeswaran Ketharani
- Department of Civil Engineering, University of Peradeniya, Peradeniya 20400, Sri Lanka; (J.K.); (K.B.S.N.J.)
| | - Tharindu Ritigala
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; (S.I.); (D.H.); (T.R.)
- Laboratory of Water Pollution Control Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Titus Cooray
- Department of Applied Earth Sciences, Uva Wellassa University, Badulla 90000, Sri Lanka;
| | - M. A. C. K. Hansima
- Post Graduate Institute of Science (PGIS), University of Peradeniya, Peradeniya 20400, Sri Lanka;
| | - Madhubashini Makehelwala
- China-Sri Lanka Joint Research and Demonstration Center for Water Technology, Ministry of Water Supply, Meewathura, Peradeniya 20400, Sri Lanka;
| | - K. B. S. N. Jinadasa
- Department of Civil Engineering, University of Peradeniya, Peradeniya 20400, Sri Lanka; (J.K.); (K.B.S.N.J.)
| | | | - Rohan Weerasooriya
- National Institute of Fundamental Studies, Hanthana Road, Kandy 20000, Sri Lanka;
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Fox J, Macaluso F, Moore C, Mesenbring E, Johnson RJ, Hamman RF, James KA. Urine tungsten and chronic kidney disease in rural Colorado. ENVIRONMENTAL RESEARCH 2021; 195:110710. [PMID: 33460634 PMCID: PMC7987874 DOI: 10.1016/j.envres.2021.110710] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a cause of global morbidity and mortality in agricultural communities. The San Luis Valley (SLV) is a rural agricultural community in southern Colorado with geographic and sociodemographic risk factors for CKD, including a water supply contaminated by heavy metals. METHODS We obtained pre-existing sociodemographic, clinical, and urine trace metal data for 1659 subjects from the San Luis Valley Diabetes Study, a prospective cohort study. We assessed prospective associations between urine tungsten (W) and time-to-CKD using accelerated failure time models (n = 1659). Additionally, logistic models were used to assess relationships between urine W and renal injury markers (NGAL, KIM1) using Tobit regression (n = 816), as well as epidemiologically-defined CKD of unknown origin (CKDu) using multiple logistic regression (n = 620). RESULTS Elevated urine W was strongly associated with decreased time-to-CKD, even after controlling for hypertension and diabetes. Depending on how CKD was defined, a doubling of urine W was associated with a 27% (95% CI 11%, 46%) to 31% (14%, 51%) higher odds of developing CKD within 5 years. The relationship between urine W and select renal injury markers was not significant, although urine NGAL was modified by diabetes status. Elevated (>95%ile) urinary W was significantly associated with CKDu (OR 5.93, 1.83, 19.21) while adjusting for known CKD risk factors. CONCLUSIONS Our data suggest that increased exposure to W is associated with decreased time-to-CKD and may be associated with CKDu. Given persistence of associations after controlling for diabetes and hypertension, W may exert a primary effect on the kidney, although this needs to be evaluated further in future studies.
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Affiliation(s)
- Jacob Fox
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Francesca Macaluso
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Camille Moore
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA; Center for Genes, Environment and Health, National Jewish Health, Smith Building; A647, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Elise Mesenbring
- Colorado School of Public Health, Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Richard J Johnson
- School of Medicine, Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Richard F Hamman
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
| | - Katherine A James
- Colorado School of Public Health, Departments of Environmental & Occupational Health and Epidemiology, University of Colorado Anschutz Medical Campus, Fitzsimons Building, 3rd Floor, 13001 E. 17th Place, B119, Aurora, CO, 80045, USA.
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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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Redmon JH, Levine KE, Lebov J, Harrington J, Kondash AJ. A comparative review: Chronic Kidney Disease of unknown etiology (CKDu) research conducted in Latin America versus Asia. ENVIRONMENTAL RESEARCH 2021; 192:110270. [PMID: 33035557 DOI: 10.1016/j.envres.2020.110270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The incidence of chronic kidney disease of unknown or uncertain etiology (CKDu) is recognized as a global non-communicable health crisis. The goal of this work is to compare the types of research studies in Latin America and Asia, two regions with increasing CKDu incidence. METHODS A comparative literature review was conducted to evaluate the CKDu research design for peer-reviewed articles published from 2015 to 2019. Full texts were reviewed to identify study location, study type, study design, risk factors evaluated, and if applicable, sample type and number. RESULTS In Asia and Latin America, 82 and 65 articles were identified in total, respectively, with 55 field studies in Asia versus 34 in Latin America. In Asia, research was focused on drinking water (34), heavy metals (20), and agrochemical product usage (19) as potential risk factors. In Latin America, research focused mostly on heat stress/dehydration (36) and agrochemical product usage (18) as potential CKDu risk factors. Biological samples were collected more frequently than environmental samples, especially in Latin America. DISCUSSION Research to pinpoint the risk factors associated with CKDu to date is not standardized and typically limited in geographical scope. The emphasis of CKDu research varies by geographic region, with a greater priority placed on water quality and chemical exposure in Asia, versus dehydration and heat stress in Latin America. Using a harmonized approach to CKDu research would yield improved understanding of the risk factors associated with CKDu and how they compare across affected regions.
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Affiliation(s)
| | | | - Jill Lebov
- RTI International, Research Triangle Park, NC, USA
| | | | - A J Kondash
- RTI International, Research Triangle Park, NC, USA
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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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Nikagolla C, Meredith KT, Dawes LA, Banati RB, Millar GJ. Using water quality and isotope studies to inform research in chronic kidney disease of unknown aetiology endemic areas in Sri Lanka. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 745:140896. [PMID: 32731068 DOI: 10.1016/j.scitotenv.2020.140896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/22/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
Chronic Kidney Disease of unknown aetiology (CKDu) is a major public health concern in dry climatic, agricultural regions of Sri Lanka. The chemistry of groundwater (the main source of drinking water) in the area has been studied extensively, in relation to the occurrence of CKDu. This paper investigates water quality studies published in CKDu affected areas of Sri Lanka and also presents a new data set of 27 hydrochemical and isotopic samples collected from groundwater wells in selected CKDu endemic areas in Sri Lanka. The study outcomes do not provide evidence of pollutants such as heavy metals in groundwater. However, the study identifies elevated concentrations of silica which requires further investigation. Two groups of groundwater have been identified based on the isotopic results suggesting different sources or origins. The available water quality data, including the data from this study, is not sufficient to answer questions on whether the chemistry of groundwater is related to the CKDu occurrence. However, this study identifies the importance of detailed investigation into degradation products of agrochemicals, the organic matter content and the influence of elevate silica concentration in groundwater. The study also provides research directions in the form of isotopic tracers and the frequency of sampling that is needed to capture potential pollutants in future groundwater quality studies in CKDu endemic areas in Sri Lanka.
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Affiliation(s)
- Chandima Nikagolla
- School of Civil and Environmental Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland 4000, Australia.
| | - Karina T Meredith
- Australian Nuclear Science and Technology Organisation, New Illawarra Road, Lucas Heights, NSW 2234, Australia
| | - Les A Dawes
- School of Civil and Environmental Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland 4000, Australia
| | - Richard B Banati
- Australian Nuclear Science and Technology Organisation, New Illawarra Road, Lucas Heights, NSW 2234, Australia; Discipline of Medical Imaging & Radiation Sciences, Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia
| | - Graeme J Millar
- School of Mechanical, Biomedical and Process Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland 4000, Australia
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Babich R, Ulrich JC, Ekanayake EMDV, Massarsky A, De Silva PMCS, Manage PM, Jackson BP, Ferguson PL, Di Giulio RT, Drummond IA, Jayasundara N. Kidney developmental effects of metal-herbicide mixtures: Implications for chronic kidney disease of unknown etiology. ENVIRONMENT INTERNATIONAL 2020; 144:106019. [PMID: 32818823 DOI: 10.1016/j.envint.2020.106019] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
Chronic kidney disease of unknown etiology (CKDu) is an emerging global concern affecting several agricultural communities in the Americas and South Asia. Environmental contaminants such as heavy metals (e.g., Cd, As, Pb, and V) and organic pesticides (e.g., glyphosate) in the drinking water have been hypothesized to play a role in childhood onset and progression of this disease. However, a comprehensive analysis of chemical contaminants in the drinking water and effects of these compounds and their mixtures on kidney development and function remains unknown. Here, we conducted targeted and non-targeted chemical analyses of sediment and drinking water in CKDu affected regions in Sri Lanka, one of the most affected countries. Using zebrafish Danio rerio, a toxicology and kidney disease model, we then examined kidney developmental effects of exposure to (i) environmentally derived samples from CKDu endemic and non-endemic regions and (ii) Cd, As, V, Pb, and glyphosate as individual compounds and in mixtures. We found that drinking water is contaminated with various organic chemicals including nephrotoxic compounds as well as heavy metals, but at levels considered safe for drinking. Histological studies and gene expression analyses examining markers of kidney development (pax2a) and kidney injury (kim1) showed novel metal and glyphosate-metal mixture specific effects on kidney development. Mitochondrial dysfunction is directly linked to kidney failure, and examination of mixture specific mitochondrial toxicity showed altered mitochondrial function following treatment with environmental samples from endemic regions. Collectively, we show that metals in drinking water, even at safe levels, can impede kidney development at an early age, potentiating increased susceptibility to other agrochemicals such as glyphosate. Drinking water contaminant effects on mitochondria can further contribute to progression of kidney dysfunction and our mitochondrial assay may help identify regions at risk of CKDu.
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Affiliation(s)
- Remy Babich
- Department of Molecular and Biomedical Sciences, University of Maine, Orono, ME 04469, USA.
| | - Jake C Ulrich
- Civil and Environmental Engineering, Duke University, Durham, NC 27708, USA
| | | | - Andrey Massarsky
- Nicholas School of the Environment, Duke University, Durham, NC 27708, USA; Cardno ChemRisk, Aliso Viejo, CA 92656, USA
| | | | - Pathmalal M Manage
- Centre for Water Quality and Algae Research, Department of Zoology, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Brian P Jackson
- Department of Earth Sciences, Dartmouth College, Hanover, NH 03755, USA
| | - P Lee Ferguson
- Civil and Environmental Engineering, Duke University, Durham, NC 27708, USA
| | | | - Iain A Drummond
- Mount Desert Island Biological Laboratory, Bar Harbor, ME 04609, USA
| | - Nishad Jayasundara
- Department of Molecular and Biomedical Sciences, University of Maine, Orono, ME 04469, USA; Nicholas School of the Environment, Duke University, Durham, NC 27708, USA; School of Marine Sciences, University of Maine, Orono, ME 04469, USA
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Kulathunga MRDL, Wijayawardena MAA, Naidu R, Wimalawansa SJ, Wijeratne AW. Association between body mass index and estimated glomerular filtration rate in patients with chronic kidney disease of unknown aetiology in Sri Lanka. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2020; 42:2645-2653. [PMID: 32020376 DOI: 10.1007/s10653-019-00472-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/08/2019] [Indexed: 05/24/2023]
Abstract
Chronic kidney disease of unknown aetiology (CKDu), which is widespread in the North Central Province (NCP) of Sri Lanka, is not associated with commonly known factors such as diabetes, hypertension, and glomerulonephritis. The pathogenicity of CKDu is not well understood, but people with a low body mass index (BMI) and mineral and nutrient deficiencies are more vulnerable to develop CKDu. To understand this situation, the relationship between BMI and the estimated glomerular filtration rate (eGFR) was investigated in people with CKDu in comparison with unaffected age-matched control groups in disease-endemic areas of the NCP. This community-based cross-sectional study was performed in Medirigiriya in the Polonnaruwa district of Sri Lanka, which has one of the highest densities of patients with CKDu. The data for identifying demographic factors and the relationship between CKDu and BMI were investigated by using a validated survey questionnaire. Findings indicated that the group with the highest number of people affected with CKDu (i.e. eGFR of less than 60 mL/min/1.73 m2) had the lowest BMI compared to those with normal eGFR. The majority affected were male farmers. The severity of the disease was inversely associated with BMI values and had a higher prevalence of smoking and alcohol consumption. In addition, those who consume water from household dug wells had significantly lower eGFR (p < 0.0001). A linear regression analysis revealed a significant positive association between lower eGFR and lower BMI (p < 0.001). We hypothesised that the low BMI in those with CKDu may have increased susceptibility to develop CKDu, in the presence of exposure to multiple nephrotoxins and adverse conditions.
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Affiliation(s)
- M R D L Kulathunga
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia
- Fruit Research and Development Institute, Kananwila, Horana, Sri Lanka
| | - M A A Wijayawardena
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 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, The University of Newcastle, Callaghan, 2308, Australia
- Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW, 2308, Australia
| | | | - A W Wijeratne
- Faculty of Agricultural Sciences, Sabaragamuwa University of Sri Lanka, Belihuloya, Sri Lanka
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Wimalawansa SJ. Does fluoride cause the mysterious chronic kidney disease of multifactorial origin? ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2020; 42:3035-3057. [PMID: 31997043 DOI: 10.1007/s10653-019-00503-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/18/2019] [Indexed: 06/10/2023]
Abstract
A chronic kidney disease of multifactorial origin (CKDmfo), also known as CKD of unknown origin, started to manifest during the past four decades in certain economically poor, peri-equatorial agricultural countries. CKDmfo is an environmentally induced, occupationally-mediated, chronic tubulointerstitial disease. Prolonged exposure to environmental nephrotoxic agents and extenuating conditions are prerequisites for its manifestation. More than 30 causative factors have been postulated, but none one has been properly scientifically tested, to be able to include or exclude. In recent years, fluoride has come to be considered a key contender as a causative agent of CKDmfo. Therefore, this review examines the pros and cons of that theory and the potential plausibility that fluoride causes CKDmfo. It also examines the potential interactions and additive or synergistic effects of certain geogenic factors, especially, the plausibility of CaPO4-3 apatite and fluorapatite crystals and nanotube formation in concentrated tubular filtrate and within tubular cells, in renal tubules. The information presented is based on published work and data collected over the past two decades in Sri Lanka. However, the evidence and concepts are applicable to all CKDmfo-affected countries. Thus, the presented content might facilitate scientists to narrowed down causative factors to just a few and government departments to implement effective programs for preventing this disease. The findings suggest that in addition to the geogenic components, disease manifestation requires (A) prolonged exposure to environmental nephrotoxins and factors, (B) interactions among elements (Ca2+, PO4-3 , F-, and Mg2+), and (C) vulnerability of the person, such as chronic dehydration, and antioxidant and micronutrient deficiencies. In vivo precipitation of nanominerals in renal tubular tissues that arising over several years causes tubulointerstitial disease-CKDmfo. Inherent vulnerabilities and conditions, together with nanomineral precipitation, trigger renal tubular cell oxidative stresses, inflammation, and fibrosis, and eventually causing tubulointerstitial chronic renal failure-CKDmfo.
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Dharma-Wardana MWC. Letter to the Editor re: Jayasinghe and Zhu (2020). THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 721:137529. [PMID: 32169309 DOI: 10.1016/j.scitotenv.2020.137529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/14/2020] [Accepted: 02/22/2020] [Indexed: 06/10/2023]
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Factors Affecting the Environmentally Induced, Chronic Kidney Disease of Unknown Aetiology in Dry Zonal Regions in Tropical Countries—Novel Findings. ENVIRONMENTS 2019. [DOI: 10.3390/environments7010002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A new form of chronic tubulointerstitial kidney disease (CKD) not related to diabetes or hypertension appeared during the past four decades in several peri-equatorial and predominantly agricultural countries. Commonalities include underground stagnation of drinking water with prolonged contact with rocks, harsh climatic conditions with protracted dry seasons, and rampant poverty and malnutrition. In general, the cause is unknown, and the disease is therefore named CKD of unknown aetiology (CKDu). Since it is likely caused by a combination of factors, a better term would be CKD of multifactorial origin (CKDmfo). Middle-aged malnourished men with more than 10 years of exposure to environmental hazards are the most vulnerable. Over 30 factors have been proposed as causative, including agrochemicals and heavy metals, but none has been properly tested nor proven as causative, and unlikely to be the cause of CKDmfo/CKDu. Conditions such as, having favourable climatic patterns, adequate hydration, and less poverty and malnutrition seem to prevent the disease. With the right in vivo conditions, chemical species such as calcium, phosphate, oxalate, and fluoride form intra-renal nanomineral particles initiating the CKDmfo. This article examines the key potential chemical components causing CKDmfo together with the risk factors and vulnerabilities predisposing individuals to this disease. Research findings suggest that in addition to drinking water from stagnant sources that contain high ionic components, more than 10 years of exposure to environmental nephrotoxins and micronutrient malnutrition are needed to contract this fatal disease.
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Wimalawansa SJ. Public health interventions for chronic diseases: cost-benefit modelizations for eradicating chronic kidney disease of multifactorial origin (CKDmfo/ CKDu) from tropical countries. Heliyon 2019; 5:e02309. [PMID: 31720441 PMCID: PMC6838989 DOI: 10.1016/j.heliyon.2019.e02309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/29/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background In the mid-1970s, an unusual chronic kidney disease of multifactorial origin (CKDmfo), also known as CKD of unknown aetiology (CKDu), began to manifest in several economically poor, tropical, agricultural countries. This preventable, environmentally induced, occupational disease affects several peri-equatorial countries; it first manifested in Sri Lanka in the mid-1990s. The study goal was to estimate the costs of eradicating CKDmfo and the resulting cost savings, using CKDmfo in Sri Lanka as an example. This chronic disease model is applicable to CKDu and few other chronic diseases in other countries. Methodology Eight cost-effective, key interventions were identified that are essential to eradicate CKDmfo. A systematic assessment was performed on these interventions (including providing clean water, behavioural and lifestyle changes, alleviating malnutrition, reducing irresponsible and overuse of agrochemicals, and cost-effective treatment options), the cost of prevention, and the resultant cost savings. A cost–benefit analysis was based on the data collected during the past 20 years of work in Sri Lanka. Findings The yearly cost required to eradicate the disease was approximately one-tenth of the current annual operating and opportunity costs due to CKDmfo. Analysis indicates that implementation of a focussed chronic disease-prevention plan using essential multiple interventions, CKDmfo can be eradicated within 15 years. This includes provision of potable water; real-time disease surveillance program; public and professional education; prevention of environmental pollution; alleviation of poverty and associated malnutrition; sustainable self-sufficiency in food, clean water, energy, and security; diversification of economy and job opportunities; sustainable economic development; regionwide programs of effective screening, early diagnosis and intervention to reverse the disease progression at earliest possible; and effective treatment of CKDmfo. Interpretation This analysis is based on multiple population-level, chronic disease-eradication strategies that include an interdisciplinary, geographic information system (GIS)-based, regionwide, long-term research and intervention program; economic diversification; and environmental, socioeconomic, and behavioural improvements. Such an approach will facilitate identification of root causes and key risk factors, enabling implementation of cost-effective longer-term interventions to eradicate chronic diseases, applicable to other countries as well.
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Kulathunga MRDL, Ayanka Wijayawardena MA, Naidu R, Wijeratne AW. Chronic kidney disease of unknown aetiology in Sri Lanka and the exposure to environmental chemicals: a review of literature. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:2329-2338. [PMID: 30815780 DOI: 10.1007/s10653-019-00264-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 02/10/2019] [Indexed: 06/09/2023]
Abstract
Chronic kidney disease of unknown aetiology (CKDu) has emerged as a serious health issue in Sri Lanka. The disease has been recorded in the North Central Province of the country. While studies have elicited many hypotheses concerning the pathogenicity of CKDu, none adequately explains the cause of CKDu and the measures needed to minimise its occurrence. Nephrotoxic heavy metal (oid)s such as cadmium, arsenic, lead, and chromium are present in biological samples of people from endemic areas. This review appraises evidence on the effects of long-term exposure to low concentration of nephrotoxic heavy metals, which could be the principal cause of CKDu. Although a considerable variation exists in metal concentrations in patients' blood and urine, higher levels of heavy metals were consistently observed in affected areas. This review finds that the populations in the endemic areas are exposed to heavy metal (oid)s at low concentrations, which are considered as safe levels; nevertheless, it influences the incidence of CKDu. Recent global studies on chronic kidney disease (CKD) revealed a low concentration of heavy metals in diseased patients. Research findings indicated that CKDu patients in Sri Lanka demonstrated similar blood levels of Cd, Pb, and higher concentrations of Cr than that have been reported globally. Further studies on the influence of combinations of nephrotoxic heavy metals at low concentrations on reduced glomerular filtration rate and other renal biomarkers could explain CKDu pathogenicity.
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Affiliation(s)
- M R D L Kulathunga
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia
- Fruit Research and Development Institute, Kananwila, Horana, Sri Lanka
| | - M A Ayanka Wijayawardena
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia.
| | - Ravi Naidu
- Global Centre for Environmental Remediation, The University of Newcastle, Callaghan, 2308, Australia
| | - A W Wijeratne
- Faculty of Agricultural Sciences, Sabaragamuwa University of Sri Lanka, Balangoda, Sri Lanka
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Madani-Tonekaboni M, Sadat aghayan N, Rafiei Nazari R, Mirzamohammadi S, Abdolshahi A, Abbasi-bastami N, Arabameri M. Monitoring and Risk Assessment of Lead and Cadmium in Milks from East of Iran Using Monte Carlo Simulation Method. NUTRITION AND FOOD SCIENCES RESEARCH 2019. [DOI: 10.29252/nfsr.6.2.29] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Wimalawansa SJ. There is no evidence that organochlorine pesticides, such as DDT, cause chronic kidney disease of unknown etiology. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 649:1636-1637. [PMID: 30243793 DOI: 10.1016/j.scitotenv.2018.09.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/08/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Sunil J Wimalawansa
- Cardio-Metabolic and Endocrine Institute, Darmody Avenue, North Brunswick, N.J. 08902, U.S.A.
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Wu MY, Wu MS. Taiwan renal care system: A learning health-care system. Nephrology (Carlton) 2019; 23 Suppl 4:112-115. [PMID: 30298659 DOI: 10.1111/nep.13460] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 01/26/2023]
Abstract
Taiwan renal care system is an evolving learning health-care system. There are four facets of this system. From the early history of dialysis and Taiwan Renal Registry Data System, it facilitates the generation of data to knowledge. National multidisciplinary pre-end-stage renal disease care project and outcome enhances knowledge to practice. Early chronic kidney disease (CKD) programs and 2015 Taiwan CKD clinical guidelines implicate the practice to customer, and then explore the causes of CKD help to resume customer to data. A learning health-care system allows better and safer care at lower cost, enhancement of public health and patient empowerment. The successful development of a learning health-care system was to collect, accumulate and analyze data, interpret results, deliver tailored message and take action to change practice. Through the established database and data analysis, an integrated care system would be able to improve clinical outcomes and achieve the most cost-effectiveness care. Acute kidney injury, CKD with unknown origin, palliative care and kidney transplant are our new focuses to struggle.
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Affiliation(s)
- Mei-Yi Wu
- Department of Nephrology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mai-Szu Wu
- Department of Nephrology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Ileperuma O, Weeraratne S, Wimalawansa SJ. Acronyms, CINAC, ACN, KDUCAL or NUCAL and so on are inappropriate to use for describing CKDu. J Epidemiol Community Health 2018; 72:967-968. [PMID: 30018059 DOI: 10.1136/jech-2018-210959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/16/2018] [Indexed: 01/18/2023]
Affiliation(s)
| | - Stanley Weeraratne
- Soils and water resources, University of Rajarata, Anuradhapura, Sri Lanka
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Wimalawansa S, Ileperuma O, Weeraratna C. Attempts to Change the Globally Accepted Term, CKDu, to KDUCAL, NUCAL, or CINAC Are Inappropriate. Am J Kidney Dis 2018. [DOI: 10.1053/j.ajkd.2018.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Huang YH, Jin XY, Zhao YY, Cong H, Tao Z. A fluorescence-enhanced chemosensor based on multifarene[2,2] and its recognition of metal cations. Org Biomol Chem 2018; 16:5343-5349. [DOI: 10.1039/c8ob01315b] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A selective and sensitive fluorescent chemosensor based on an anthracene-functionalized triazole-linked multifarene[2,2] was successfully synthesized and investigated with regard to the recognition of metal ions.
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Affiliation(s)
- Yin-Hui Huang
- Key Laboratory of Macrocyclic and Supramolecular Chemistry of Guizhou Province
- Guizhou University
- Guiyang 550025
- China
| | - Xian-Yi Jin
- Key Laboratory of Macrocyclic and Supramolecular Chemistry of Guizhou Province
- Guizhou University
- Guiyang 550025
- China
- School of Materials and Metallurgical Engineering
| | - Yong-Yi Zhao
- Key Laboratory of Macrocyclic and Supramolecular Chemistry of Guizhou Province
- Guizhou University
- Guiyang 550025
- China
| | - Hang Cong
- Key Laboratory of Macrocyclic and Supramolecular Chemistry of Guizhou Province
- Guizhou University
- Guiyang 550025
- China
| | - Zhu Tao
- Key Laboratory of Macrocyclic and Supramolecular Chemistry of Guizhou Province
- Guizhou University
- Guiyang 550025
- China
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Benedetti M, De Santis M, Manno V, Minerba S, Mincuzzi A, Morabito A, Panocchia N, Soggiu ME, Tanzarella A, Pastore T, Bossola M, Giua R, Leogrande S, Nocioni A, Conti S, Comba P. Spatial distribution of kidney disease in the contaminated site of Taranto (Italy). Am J Ind Med 2017; 60:1088-1099. [PMID: 29027241 DOI: 10.1002/ajim.22781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Exposure to heavy metals has been associated with kidney disease. We investigated the spatial distribution of kidney disease in the industrially contaminated site of Taranto. METHODS Cases were subjects with a first hospital discharge diagnosis of kidney disease. Cases affected by specific comorbidities were excluded. Standardized Hospitalization Ratios (SHRs) were computed for low/high exposure area and for modeled spatial distribution of cadmium and fine particulate matter. RESULT Using the high/low exposure approach, in subjects aged 20-59 years residing in the high exposure area a significant excess of hospitalization was observed in males and a non-significant excess in females. No excesses were observed in subjects aged 60 years and over. The analysis by the modeling approach did not show a significant association with the greatest pollution impact area. CONCLUSION Due to the excesses of hospitalization observed in the high/low exposure approach, a continuing epidemiological surveillance of residents and occupational groups is warranted.
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Affiliation(s)
- Marta Benedetti
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| | - Marco De Santis
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| | - Valerio Manno
- Unit of Statistics; Istituto Superiore di Sanità; Rome Italy
| | - Sante Minerba
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale Taranto; Taranto Italy
| | - Antonella Mincuzzi
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale Taranto; Taranto Italy
| | - Angela Morabito
- Apulia Region Environmental Protection Agency (ARPA PUGLIA); Bari Italy
| | - Nicola Panocchia
- Haemodialysis Service; Department of Surgery; Università Cattoloca del Sacro Cuore; Rome Italy
| | - Maria Eleonora Soggiu
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
| | | | - Tiziano Pastore
- Apulia Region Environmental Protection Agency (ARPA PUGLIA); Bari Italy
| | - Maurizio Bossola
- Haemodialysis Service; Department of Surgery; Università Cattoloca del Sacro Cuore; Rome Italy
| | - Roberto Giua
- Apulia Region Environmental Protection Agency (ARPA PUGLIA); Bari Italy
| | - Simona Leogrande
- Epidemiological and Statistical Unit; Azienda Sanitaria Locale Taranto; Taranto Italy
| | | | - Susanna Conti
- Unit of Statistics; Istituto Superiore di Sanità; Rome Italy
| | - Pietro Comba
- Department of Environment and Health (DAMSA); Istituto Superiore di Sanità; Rome Italy
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Turan IS, Seven O, Ayan S, Akkaya EU. Amplified Chemiluminescence Signal for Sensing Fluoride Ions. ACS OMEGA 2017; 2:3291-3295. [PMID: 31457653 PMCID: PMC6641604 DOI: 10.1021/acsomega.7b00537] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/23/2017] [Indexed: 05/25/2023]
Abstract
Bringing together the concepts of self-immolative linkers and chemiluminogen dioxetane modules, a chemiluminescence-based sensor for fluoride with signal amplification is presented. Signal amplification is obtained by triggering two chemiluminescence events for each reacting fluoride ion that in turn releases two fluoride ions for each ion. As expected, the chemiluminescence signal starts to rise following an induction period. In addition to the analytical potential, this chemical system is also of interest as a demonstration of positive feedback loop character.
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Affiliation(s)
- Ilke S. Turan
- UNAM—National
Nanotechnology Research Center and Department of Chemistry, Bilkent University, 06800 Ankara, Turkey
| | - Ozlem Seven
- UNAM—National
Nanotechnology Research Center and Department of Chemistry, Bilkent University, 06800 Ankara, Turkey
| | - Seylan Ayan
- UNAM—National
Nanotechnology Research Center and Department of Chemistry, Bilkent University, 06800 Ankara, Turkey
| | - Engin U. Akkaya
- UNAM—National
Nanotechnology Research Center and Department of Chemistry, Bilkent University, 06800 Ankara, Turkey
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Bundschuh J, Maity JP, Mushtaq S, Vithanage M, Seneweera S, Schneider J, Bhattacharya P, Khan NI, Hamawand I, Guilherme LRG, Reardon-Smith K, Parvez F, Morales-Simfors N, Ghaze S, Pudmenzky C, Kouadio L, Chen CY. Medical geology in the framework of the sustainable development goals. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 581-582:87-104. [PMID: 28062106 DOI: 10.1016/j.scitotenv.2016.11.208] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 05/23/2023]
Abstract
Exposure to geogenic contaminants (GCs) such as metal(loid)s, radioactive metals and isotopes as well as transuraniums occurring naturally in geogenic sources (rocks, minerals) can negatively impact on environmental and human health. The GCs are released into the environment by natural biogeochemical processes within the near-surface environments and/or by anthropogenic activities such as mining and hydrocarbon exploitation as well as exploitation of geothermal resources. They can contaminate soil, water, air and biota and subsequently enter the food chain with often serious health impacts which are mostly underestimated and poorly recognized. Global population explosion and economic growth and the associated increase in demand for water, energy, food, and mineral resources result in accelerated release of GCs globally. The emerging science of "medical geology" assesses the complex relationships between geo-environmental factors and their impacts on humans and environments and is related to the majority of the 17 Sustainable Development Goals in the 2030 Agenda of the United Nations for Sustainable Development. In this paper, we identify multiple lines of evidence for the role of GCs in the incidence of diseases with as yet unknown etiology (causation). Integrated medical geology promises a more holistic understanding of the occurrence, mobility, bioavailability, bio-accessibility, exposure and transfer mechanisms of GCs to the food-chain and humans, and the related ecotoxicological impacts and health effects. Scientific evidence based on this approach will support adaptive solutions for prevention, preparedness and response regarding human and environmental health impacts originating from exposure to GCs.
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Affiliation(s)
- Jochen Bundschuh
- Deputy Vice-Chancellor's Office (Research and Innovation), University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; Faculty of Health, Engineering and Sciences, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; KTH-International Groundwater Arsenic Research Group, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 76, SE-10044 Stockholm, Sweden.
| | - Jyoti Prakash Maity
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Min-Hsiung, Chiayi County 62102, Taiwan.
| | - Shahbaz Mushtaq
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Meththika Vithanage
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; Chemical and Environmental Systems Modeling Research Group, National Institute of Fundamental Studies, Kandy 20000, Sri Lanka.
| | - Saman Seneweera
- Centre for Crop Health, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Jerusa Schneider
- Sanitation and Environment Dept., School of Civil Engineering, Architecture and Urban Design, State University of Campinas, 113083-889 Campinas, (SP), Brazil.
| | - Prosun Bhattacharya
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia; KTH-International Groundwater Arsenic Research Group, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 76, SE-10044 Stockholm, Sweden.
| | - Nasreen Islam Khan
- College of Medicine, Biology and Environment, Australian National University, Canberra, ACT 0200, Australia; GIS Social Science Division, International Rice Research Institute (IRRI), Los Banos, Laguna 4031, Philippines.
| | - Ihsan Hamawand
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Luiz R G Guilherme
- Soil Science Department, Federal University of Lavras (UFLA), Campus Universitário, Caixa Postal 3037, CEP: 37200-000 Lavras, Minas Gerais, Brazil.
| | - Kathryn Reardon-Smith
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Faruque Parvez
- Department of Environmental Health Sciences, Mailman, School of Public Health, Columbia University, 722 West 168th St., 10032 NewYork, NY, USA.
| | | | - Sara Ghaze
- Faculty of Health, Engineering and Sciences, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Christa Pudmenzky
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Louis Kouadio
- International Centre for Applied Climate Science, University of Southern Queensland, West Street, Toowoomba 4350 QLD, Australia.
| | - Chien-Yen Chen
- Department of Earth and Environmental Sciences, National Chung Cheng University, 168 University Road, Min-Hsiung, Chiayi County 62102, Taiwan.
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Wimalawansa SA, Wimalawansa SJ. Environmentally induced, occupational diseases with emphasis on chronic kidney disease of multifactorial origin affecting tropical countries. Ann Occup Environ Med 2016; 28:33. [PMID: 27499855 PMCID: PMC4974668 DOI: 10.1186/s40557-016-0119-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/26/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Environmentally induced, occupational diseases are increasing worldwide, especially in rural agricultural communities. Poverty-associated malnutrition, environmental hazards and pollution, and lack of access to clean water, safe sanitation, and modern healthcare facilities are often associated with these chronic illnesses. METHOD The authors systematically reviewed occupational public health issues that have been related to the environment. General interpretations of results were included as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Pertinent publications from research databases were reviewed on (A) the risk-benefits, (B) the prevalence of risk factors for various diseases, (C) the benefits of not ignoring the risk factors (i.e., broader evidence), and (D) the risks, effects, and outcomes of different types of interventions. The authors used chronic kidney disease of multifactorial origin (CKDmfo) as an example to explore the theme. Emphasis was given to the regions with emerging economies and developing countries located in the vicinity of the equator. FINDINGS Geographical, socio-economic and aetiological similarities exist for many chronic non-communicable diseases that are affecting tropical countries around the equator. The authors identified manufacturing, mining, and agriculture as the biggest polluters of the environment. In addition, deforestation and associated soil erosion, overuse of agrochemicals, and irresponsible factory discharge (e.g., chemicals and paint, from rubber and textile factories, etc.), all contribute to pollution. To decrease the escalating incidences of environmentally induced diseases, governments should work proactively to protect the environment, especially watersheds, and take steps to minimise harmful occupational exposures and strictly enforce environmental regulations. CONCLUSION Creating public awareness of environmental issues and their relationship to public health is essential. This includes regular monitoring and periodic publication of the quality of water, air and soil; preventing deforestation and man-made soil erosion, increasing forest and ground cover, preventing occupational injuries, judicious and safe use of agrochemicals, sustainable agriculture and development programs, and implementing legislation to protect and conserve water heriage and the environment. These actions are essential both for a healthier environment and for the health of the people who live in that environment. Such measures would also decrease public health threats from such, including global-warming-related erratic environmental changes and the occurrence and the spread of non-communicable diseases, such as CKDmfo.
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Rajapakse S, Shivanthan MC, Selvarajah M. Chronic kidney disease of unknown etiology in Sri Lanka. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:259-264. [PMID: 27399161 DOI: 10.1080/10773525.2016.1203097] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION In the last two decades, chronic kidney disease of unknown etiology (CKDu) has emerged as a significant contributor to the burden of chronic kidney disease (CKD) in rural Sri Lanka. It is characterized by the absence of identified causes for CKD. The prevalence of CKDu is 15.1-22.9% in some Sri Lankan districts, and previous research has found an association with farming occupations. METHODS A systematic literature review in Pubmed, Embase, Scopus, and Lilacs databases identified 46 eligible peer-reviewed articles and one conference abstract. RESULTS Geographical mapping indicates a relationship between CKDu and agricultural irrigation water sources. Health mapping studies, human biological studies, and environment-based studies have explored possible causative agents. Most studies focused on likely causative agents related to agricultural practices, geographical distribution based on the prevalence and incidence of CKDu, and contaminants identified in drinking water. Nonetheless, the link between agrochemicals or heavy metals and CKDu remains to be established. No definitive cause for CKDu has been identified. DISCUSSION Evidence to date suggests that the disease is related to one or more environmental agents, however pinpointing a definite cause for CKDu is challenging. It is plausible that CKDu is multifactorial. No specific guidelines or recommendations exist for treatment of CKDu, and standard management protocols for CKD apply. Changes in agricultural practices, provision of safe drinking water, and occupational safety precautions are recommended by the World Health Organization.
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Affiliation(s)
- Senaka Rajapakse
- a Faculty of Medicine, Department of Clinical Medicine , University of Colombo , Colombo , Sri Lanka
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