Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause?

Wanigasuriya, Kamani; Peiris‐John, Roshini; Wickremasinghe, Rajitha

doi:10.1186/1471-2369-12-32

Cited by 130 publications

(131 citation statements)

References 19 publications

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“…The reported findings are weak, and interpretations are not irrefutable [21], which further supports the theory that the aetiology of this illness is multi-factorial [4,22], and synergistic interactions between these chemicals and/or conditions leading to enhanced renal toxicity are possible. Nevertheless, overall data suggest that agrochemicals are one of the leading candidates in precipitating this disease.…”

Section: Postulated Causes For Ckd-mfosupporting

confidence: 61%

“…Most of the common forms of CKD are caused by longstanding hypertension, diabetes, and in certain cases, glomerulonephritis [4][5][6]. The common form of CKD is distributed uniformly in cities and villages across Sri Lanka, which is similar to the distribution of CKD globally.…”

Section: Uniqueness Of the Ckd-mfomentioning

confidence: 99%

“…Irrespective of the aetiology, due to the inherent pathological mechanisms, all CKD types lead to development of hypertension, and thus, these diseases commonly co-exist. Not surprisingly, recent studies suggest a higher incidence of hypertension amongst those with CKD-mfo [4,18]. However, it is unknown whether the hypertension was pre-existing, caused by the renal failure, or contributed to the precipitation of CKD-mfo.…”

Section: Uniqueness Of the Ckd-mfomentioning

confidence: 99%

“…Worldwide, CKD of unknown/uncertain aetiology has been reported after chronic exposure to certain heavy metals, including arsenic, cadmium, mercury, chromium, uranium, gold, platinum, silver, thallium, and antimony, as well as fluoride [4,19,20] and agrochemicals [7][8][9][10][11]. Despite the epidemiological studies carried out over the past 40 years, other than the reported associations and correlations (except arsenic in ground-water, Bihar, India), no causative factor has been identified for CKDu across the continent.…”

Section: Postulated Causes For Ckd-mfomentioning

confidence: 99%

“…Various researchers have reported that arsenic, cadmium, fluoride, and agrochemicals as potential causes of CKD-mfo in the NCP [4,21]. High levels of arsenic consumption from contaminated food [41], water, and rice are a major concern in certain Asian countries [17,[42][43][44].…”

Section: Role Of Arsenic and Cadmiummentioning

confidence: 99%

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Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: causes, solutions, and recommendations

Wimalawansa

2014

Environ Health Prev Med

125

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During the last two decades, Sri Lanka, located close to the equator, has experienced an escalating incidence of chronic kidney disease (CKD) of unknown aetiology (CKDue) in dry zonal areas. Similar incidences of unusual CKDs have been reported in the dry zonal, agricultural areas of several other equatorial countries. In Sri Lanka, the incidence of CKDue is highest in the North Central Province (NCP), where approximately 45 % of the country's paddy fields are located. However, in recent years, the disease has spread into areas adjacent to as well as distant from the NCP. The cause of CKD in Sri Lanka is unknown, and may likely due to interactions of different potential agents; thus, CKD is of multi-factorial origin (CKD-mfo). These factors include, the negative effects from overuse of agrochemicals. Nevertheless, the potential interactions and synergism between probable agents have not been studied. This systematic review discusses the proposed hypotheses and causes of CKD-mfo in Sri Lanka, and ways to decrease the incidence of this disease and to eradicate it, and provide some recommendations. During the past decade, a number of groups have investigated this disorder using different methodologies and reported various correlations, but failed to find a cause. Research has focussed on the contamination of water with heavy metals, agrochemicals, hard water, algae, ionicity, climate change, and so forth. Nevertheless, the levels of any of the pollutants or conditions reported in water in NPC are inconsistent not correlated with the prevalence of the disease, and are too low to be the sole cause of CKD-mfo. Meanwhile, several nephrotoxins prevalent in the region, including medications, leptospirosis, toxic herbs, illicit alcohol, locally grown tobacco, and petrochemicals, as well as the effects of changed habits occured over the past four decades have not been studied to date. Taken together, the geographical distribution and overall findings indicate that combinations of factors and/or their interactions are likely to precipitate CKD-mfo, which kills more than 5,000 people annually in Sri Lanka; most victims are middleaged male farmers. Much anecdotal evidence from this region suggests that consumption of contaminated water is the most likely source of this deadly disease. Although the aetiology is unknown, prevention of this ''environmentally acquired'' disease seems relatively straightforward. Solutions include (a) preventing environmental pollution, (b) stopping the irresponsible use and decreasing the usage of agrochemicals, and encouraging the use of environmentally friendly agricultural methods, (c) taking proper precautions when using agrochemicals and safe disposal of their containers, (d) changing the risky behaviour of farmers and educating them to preserve the environment, and (e) providing clean potable water to all affected regions. Implementing a well-coordinated, in-depth, region-wide, broad-based research study together with a long-term effective surveillance programme across the country i...

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Section: Postulated Causes For Ckd-mfosupporting

confidence: 61%

Section: Uniqueness Of the Ckd-mfomentioning

confidence: 99%

Section: Uniqueness Of the Ckd-mfomentioning

confidence: 99%

Section: Postulated Causes For Ckd-mfomentioning

confidence: 99%

Section: Role Of Arsenic and Cadmiummentioning

confidence: 99%

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Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: causes, solutions, and recommendations

Wimalawansa

2014

Environ Health Prev Med

125

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Transport of colloids and colloid-facilitated heavy metals in agricultural soils: Could it be a potential causative factor for the chronic kidney disease with unknown etiology (CKDu) in Sri Lanka?

Balakrishnan

Gunawardhana

Deepagoda

2022

Preprint

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Educating and Empowering Children for Governing in the Anthropocene: A Case Study of Children's Homes in Sri Lanka

Ariyadasa¹

2016

Syst. Res

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Educating children and young people on how to care for the environment is the focus of this paper. Today's children will encounter the adverse effects of global population growth and subsequent pollution by adults at the expense of the environment. Thus, it is important to draw children's attention to carbon footprints and climatic changes. Through participation, they will have opportunities to learn more about the implications of the way we choose to live our lives in the short, medium, and long terms. Children learn about their rights and responsibilities by being given the opportunity to express their ideas and to translate policy into practice through small‐scale interventions that make a difference to this generation and succeeding ones. Such interventions can include lessons on recycling, use, and reuse of resources, composting, organic and ethical farming, water and energy conservation techniques, and much more. The essence of this paper has been extracted from my Participatory Action Research (PAR) on the life chances of young children in voluntary children's homes in Sri Lanka. This PAR largely employs qualitative investigations to manipulate the information collected during the study in order to assess and evaluate the findings. During the PAR, it was identified that some children's homes have initiated a few enhanced ecosystem governance practices that redress problems associated with the worst aspects of industrialization. These practices promote the harmonious coexistence of humanity and nature and have adopted the concerns of critical systemic thinking with consequent improvement of human well‐being and ecosystem health. The potential of these homes to provide education for these vulnerable children by improving their ability to deliver stewardship responsibilities towards the environment should never be underestimated. Copyright © 2016 John Wiley & Sons, Ltd.

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Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause?

Cited by 130 publications

References 19 publications

Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: causes, solutions, and recommendations

Escalating chronic kidney diseases of multi-factorial origin in Sri Lanka: causes, solutions, and recommendations

Transport of colloids and colloid-facilitated heavy metals in agricultural soils: Could it be a potential causative factor for the chronic kidney disease with unknown etiology (CKDu) in Sri Lanka?

Educating and Empowering Children for Governing in the Anthropocene: A Case Study of Children's Homes in Sri Lanka

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