Abstract
The prevalence of chronic kidney disease of uncertain etiology (CKDu) in the Uva Province (UP) of Sri Lanka has received much attention over the past two decades. Many scientists assumed that prolonged consumption of drinking water with high levels of contaminants may be the causative factor. Thus, the prime objective of this study is to develop a binary logistic regression model based on water quality parameters and the prevalence of CKDu to find out the geochemical risk factors that affect the CKDu. For this, 260 groundwater samples were collected following a stratified random sampling method and analyzed for its major cations, anions, and selected trace element contents. In the model, the dichotomous dependent variable defines the availability of CKDu patients, and explanatory variables define groundwater quality parameters. According to the best-fit model, F− and PO43- levels of the groundwater were found to be the geochemical risk factors that were significantly associated with the progression of CKDu in the study area. Furthermore, it was shown that geochemical processes such as dissolution of bedrocks are the causative phenomenon of the enhancement of F− levels in the groundwater sources. It has also been observed that the PO43- concentrations of the groundwater possibly increase because of the intensive application of agrochemicals in addition to geogenic sources. The results of this study can be used by the government authorities in groundwater management and the management of the prevalence of CKDu disease in the study area. Furthermore, the findings of this study will contribute to the policy-makers in Sri Lanka for providing safe drinking water to meet the sustainable development goals (SDGs).
Highlights
Chronic kidney disease (CKD) is a global health crisis (Noble et al, 2014; Wimalawansa, 2016; Wu and Wu, 2019) because the kidney-related disease had been recognized as the 12th most common disease that causes death and the 17th most common disease that causes disability (Murray et al, 2001; Jayasekara et al, 2015)
Previous studies revealed that CKD of unknown/uncertain etiology (CKDu) is caused by combined multifactors, making it difficult to recognize individual risk factors and possible interactions linked to the disease (Wanigasuriya, 2014; Levine et al, 2016)
Individual determination of the groundwater quality parameters is essential to identify the effects of those parameters on the prevalence of CKDu in the study area
Summary
Chronic kidney disease (CKD) is a global health crisis (Noble et al, 2014; Wimalawansa, 2016; Wu and Wu, 2019) because the kidney-related disease had been recognized as the 12th most common disease that causes death and the 17th most common disease that causes disability (Murray et al, 2001; Jayasekara et al, 2015). A particular form of CKD had emerged in the mid-1990s, in which the etiology does not link to the commonly known risk factors, viz., diabetes mellitus, glomerulonephritis, and hypertension (Jayatilake et al, 2013; Jayasumana et al, 2015) The reason for these CKD cases reported in Sri Lanka had not been clearly defined as yet, and the term CKD of unknown/uncertain etiology (CKDu) is used (Bandara et al, 2010; Wanigasuriya, 2012; Jayasumana et al, 2013; Noble et al, 2014). As explained by Abeysekara (2015), UP has been identified as one of the most prominent provinces that progressively show an increase in the number of patients with CKDu, and according to the official estimates, over 15,000 of patients with CKDu and over 4,500 deaths were recorded from Mahiyanganaya, Girandurukotte, Central Hettipola, Bakamuna, and Eastern Dehiatta of UP by the end of 2015 It has a direct impact on the daily life of patients. The determination of possible risk factors associated with CKDu is vital to control the prevalence of the disease
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