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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.
Highlights
Chronic kidney disease of unknown etiology (CKDu) is a new type of nephropathy reported in several countries over the last few decades [1, 2], and the root causes for this disease are still in question and research
Various studies have been conducted to postulate the potential causes for CKDu, no specific source or causative factor has been identified for this noncommunicable disease with a multifactorial origin [11]. erefore, environmental toxins related to the drinking water belong to prime suspected causative factors for CKDu as apparent causative factors and effect relationships remain unknown [4, 12,13,14,15]
It is expected that the findings of this investigation would have implications for the thousands of people living in CKDu prevalent areas in Sri Lanka, and this will provide important insights into the monitoring and management of drinking water resources in Girandurukotte GND, Badulla District in Sri Lanka for human health and the environment
Summary
CKDu is a new type of nephropathy reported in several countries over the last few decades [1, 2], and the root causes for this disease are still in question and research. Some early studies reported that most of the water samples collected from CKDu prevalence areas show low levels of heavy metal concentrations, which are not exceeded the safe upper limits [5, 13, 14, 64]. E reported health risk assessment of the nephrotoxic heavy metals and other risk factors in CKDu prevalent areas of Sri Lanka are less. E main objectives of the study were to (1) determine the major and trace ion constituents (nephrotoxic elements) in drinking water as possible causative factors for the onset of CKDu, (2) determine the heavy metal pollution levels and indices in the study area, (3) interpolate the spatial distribution of nephrotoxic heavy metals using geostatistical tools, and (4) assess the interrelationship between the water quality and health risk parameters using the comparative analysis of results of disease prevalent area and the reference area. It is expected that the findings of this investigation would have implications for the thousands of people living in CKDu prevalent areas in Sri Lanka, and this will provide important insights into the monitoring and management of drinking water resources in Girandurukotte GND, Badulla District in Sri Lanka for human health and the environment
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