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By G.R. Diwyanjalee
In the last few decades, Sri Lanka has been witnessing an alarming rise in an inexplicable kidney disease called ‘Chronic Kidney Disease of Unknown Origin (CKDu),’ and experts have found that climate change may be one of the factors. According to reports, men in their 30s and 40s have arrived at hospitals in Sri Lanka with late-stage kidney failure since the 1990s and in some communities, the rate of infection is as high as one in five young men.
CFC Sri Lanka talked to various experts regarding this who largely stated that the illness is most likely caused by extreme heat, worsened by climate change, leading to dehydration. Additionally, the overuse of toxic pesticides, which have contaminated the groundwater, is also a significant factor.
What is Chronic Kidney Disease of Unknown Origin (CKDu)?
Chronic Kidney Disease of Unknown Origin (CKDu) is a perplexing condition primarily affecting individuals without traditional risk factors like diabetes or hypertension. Predominantly observed in agricultural workers in countries such as Sri Lanka, El Salvador, and India, CKDu is linked to strenuous labor in hot climates, leading to kidney failure. Unlike other forms of chronic kidney disease (CKD), the exact cause of CKDu remains elusive, thus earning its designation “of unknown origin”. Read more at Sarah E. Young et al.
Types of Kidney Disease in Sri Lanka
In Sri Lanka, kidney diseases are categorized into three main types:
Chronic Kidney Disease (CKD): Typically associated with known risk factors such as diabetes, hypertension, and glomerulonephritis.
Chronic Kidney Disease of Unknown Origin (CKDu): Affects agricultural workers in dry zone areas of Sri Lanka and is characterized by the absence of traditional CKD risk factors. Now, refer as Chronic Interstitial Nephritis in Agricultural Communities (CINAC).
Acute Kidney Injury (AKI): Often linked to acute illnesses, dehydration, or exposure to nephrotoxic agents, exacerbated by extreme environmental conditions (Sarah E. Young et al.).
Can dehydration affect your kidneys?
Yes, dehydration can significantly impact your kidneys. When you lose too much body water through diarrhea, vomiting, sweating, or other causes, it can impair kidney function. Dehydration makes it harder for your kidneys to filter wastes and maintain electrolyte balance, which can lead to kidney damage. Severe dehydration may cause kidney stones, urinary tract infections, and even acute kidney injury, which can contribute to chronic kidney disease. It’s crucial to stay hydrated, especially during physical exertion and in hot conditions, to support kidney health and prevent these complications.
Factors Contributing to CKDu
Several factors are believed to contribute to CKDu. While some experts pointed out heat stress and climate change to be a crucial factor, others pointed out that there is an indirect connection with climate change in the form of groundwater quality and dehydration.
Role of Climate and Heat Stress
Dr. Channa Jayasumana, a professor in Medicine and Allied Sciences at Rajarata University and former State Minister of Pharmaceutical Production, Supply, and Regulation, emphasized that Chronic Interstitial Nephritis in Agricultural Communities (CINAC), a term now used to describe CKDu, is the most pressing public health issue in paddy farming areas. He noted that over 70,000 patients have been estimated, with numerous deaths linked to this condition.
Dr. Jayasumana also pointed out that certain natural and man-made toxins, heat stress, repeated dehydration, and infections like Hantavirus contribute to the development of CINAC. He explained that prolonged exposure to a hot climate, especially when combined with the presence of toxins in the body, enhances the harmful effects of these toxins on the kidneys. He highlighted that in the past three decades, temperatures in affected areas have risen by 2-3 degrees Celsius, leading to more frequent and severe dehydration, which in turn makes toxins more damaging to the kidneys.
Prof. Rohana Chandrajith, Professor in Geology, University of Peradeniya, Sri Lanka addressed the potential connections between climate change, groundwater quality, and CKDu. He clarified that while climate change itself does not directly cause CKDu, it significantly impacts groundwater quality and dehydration, both of which are believed to contribute to the disease. Prof. Chandrajith noted that climate change influences groundwater quality, which is linked to CKDu in Sri Lanka’s North Central Province.
Prof. Sunil Wimalawansa, Academic and Clinical Professor of Medicine Endocrinology & Nutrition and expert in CKDu prevention in Sri Lanka, stated that CKDu is directly related to factors such as population distribution, overexploitation of groundwater, and extended drought periods during the middle of the year. He explained that these conditions lead to the use of naturally contaminated groundwater, often containing high levels of calcium and fluoride. Prolonged consumption of this water over more than a decade can result in kidney failure due to calcium fluoride and other mineral crystallization in the renal tubules and kidney interstitial tissues. Prof. Wimalawansa emphasized that the over-exploitation of groundwater is a man-made disaster that continues to this day. Read the complete research papers here and here
Studies have also found that climate change is also associated with rising air pollution from wildfires and industrial wastes and infectious diseases associated with flooding and changing habitats, all of which heighten the risk of acute and CKD.
Groundwater Quality and Dehydration
Prof. Rohana Chandrajith also noted that many researchers believe groundwater contamination directly influences CKDu. He highlighted the relationship between Acute Kidney Injury (AKI) and CKDu, suggesting that poor groundwater quality may contribute to the development of CKDu. Prof. Chandrajith’s research in the Anuradhapura district suggested that water hardness and fluoride levels play a synergistic role in CKDu. He pointed out that CKDu cases are most prevalent in rural areas where well water is the primary source of drinking water, while cases are rare in areas where surface water is used. This geographic distribution supports the belief that groundwater quality is a major risk factor for CKDu. Read the complete research papers here and here
Nishad Jayasundara’s research emphasizes the impact of hard mineral-rich water and pesticide persistence. He notes that dehydration combined with exposure to chemical contaminants significantly contributes to CKDu.
Toxins and Herbicides
Dr. Channa Jayasumana concluded that toxins, particularly herbicides (including glyphosate), are the primary contributing factor to CINAC. He stated that prolonged exposure to sunlight is the second most significant factor, followed by the presence of heavy metals like arsenic. Although arsenic was initially considered a major factor in CKDu, recent research indicates that toxins and sun exposure play a more substantial role in the development of CINAC. Read the complete research papers here and here
Prof. Sunil Wimalawansa stated that the field research since 2001 confirms that CKDu originates from consuming contaminated groundwater and not from food. He clarified that agrochemicals, particularly phosphates, contaminate surface water. He further confirmed that while earlier researchers considered glyphosate a major causative factor for CKDu, no scientific evidence has proven it, and it may be a minor factor. Read here
How groundwater gets contaminated
Groundwater contamination in CKDu-endemic areas is a complex interplay of environmental and human factors. The contamination of groundwater with agrochemicals, heavy metals, and high levels of water hardness, combined with the socio-economic realities of the affected regions, likely contributes to the development and progression of CKDu. Prof. Wimalawansa emphasized that the over-exploitation of groundwater is a man-made disaster that continues to this day.
In conclusion, Chronic Kidney Disease of Unknown Origin (CKDu) in Sri Lanka is a multifaceted condition that poses significant public health challenges, particularly in agricultural communities. While the exact cause of CKDu remains elusive, it is clear that the disease is influenced by a complex interplay of factors, including groundwater contamination, dehydration, heat stress, and exposure to toxins.
The ongoing debate among experts highlights the need for more comprehensive research to fully understand the contributing factors and to develop effective prevention and treatment strategies. Climate change, while not a direct cause, exacerbates the conditions that may contribute to CKDu, particularly through its impact on groundwater quality and increased heat stress. Addressing CKDu requires a multifaceted approach that considers environmental, social, and economic factors, with a focus on improving water quality, mitigating exposure to harmful substances, and adapting to the changing climate.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102238
https://pubmed.ncbi.nlm.nih.gov/34123277
https://www.researchgate.net/profile/Rohana-Chandrajith
https://pubmed.ncbi.nlm.nih.gov/25596925
https://scholar.google.com/citations?user=vYLer8UAAAAJ
Images
Aboodi Vesakaran on Unsplash
https://www.srilankafoundation.org/eradication-of-chronic-kidney-disease-in-sri-lanka
