Abstract
Chronic Kidney Disease of unknown aetiology (CKDu) is a major health concern in North Central Province (NCP) of Sri Lanka. Anuradhapura and Polonnaruwa are the two most affected districts in NCP. This research was designed to identify main suspected CKDu causative agents in drinking water in NCP. Drinking water samples were collected from shallow wells of CKDu patients and non-patients in Anuradhapura and Polonnaruwa districts. They were tested for chemical ions: chloride, fluoride, nitrate, phosphate, calcium, magnesium, sodium, cadmium and arsenic. An analytical framework was developed to analyse water quality data using statistical methods, namely univariate analysis of variance (ANOVA) and Dunnett’s T3 post hoc test, Kruskal–Wallis (KW) and Mann–Whitney’s post hoc test, discriminant analysis, factorial analysis followed by reliability tests. ANOVA, KW and their post hoc tests were applied to show the significant differences at p < 0.05 in mean and median values of chemical constituents between CKDu patient and non-patient samples. Discriminant analysis was applied to show the degree of accuracy in original sampling groups. Factorial analysis was applied to identify the ion combinations in each group. A secondary set of data obtained from drinking water samples of CKDu endemic and non-endemic areas were also analysed independently using the same analytical techniques to compare the results.
Highlights
Chronic Kidney Disease (CKD) is a major health concern in Sri Lanka which is characterized by permanent loss of kidney function over time
Agriculture is the main sector of employment with more than 50% of the population involved in farming (Central Bank of Sri Lanka 2010)
Discriminant analysis results for secondary data (Table 12) showed a total of 68.1% samples falling under the right classification with 93.5% of Girandurukotte samples, 58.8% of Nikawewa samples, 50% of Padaviya samples and 65.5% of Huruluwewa samples classified under their own classification
Summary
Chronic Kidney Disease (CKD) is a major health concern in Sri Lanka which is characterized by permanent loss of kidney function over time. A low prevalence of CKDu has been reported among consumers of spring water (1.5%), and high prevalence (7.7%) among consumers from shallow wells in the endemic area of Sri Lanka (Jayasekara et al 2015). Jayatilake et al (2013) indicate a significantly higher cadmium concentration in the nails of CKDu cases compared to controls from the endemic area in Sri Lanka. Same authors have shown no significant dose–effect relationship between the concentration of arsenic, lead or selenium in urine and the stage of CKDu but the hardness of water and high fluoride content on top of inadequate intake of water to influence the excretion of heavy metals and oxidative damage to the kidneys caused by heavy metals (Jayatilake et al 2013). There are no other findings that suggest higher Na+/Ca2+ ratio favouring CKDu
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