Chronic Kidney Disease of Unknown Etiology (CKDu) – The Search for Causes and the Impact of Its Politicization

Abstract

Kidney disease of unknown aetiology (CKDu) has been identified in many countries extending from MesoAmerica and Egypt, to South-east Asia and China. Although CKDu has been linked by various authors to farming, it is an artifact of treating multi-modal disease distributions as unimodal. There is NO correlation of CKDu with agriculture since affected farming villages are often surrounded by other farming villages free of CKDu. Initial studies looked for a correlation of CKDu with toxic heavy metal residues of arsenic, cadmium etc., or herbicides like glyphosate that may be present in the environment, as the causative factors. There is now considerable consensus that their concentrations are below danger thresholds, be it in Mesoamerica or south-east Asia. The conceptual basis of a search for etiology within a systems approach is discussed, and attempts to name the disease to bias the identification of its etiology are reviewed. Current research has narrowed down the etiology to geochemical electrolytic contaminants like fluorides and ionic components in hard water, nanosilica (found in water as well as in the air), as well as renal toxins similar to indoxyl sulphates that may arise from interactions of ions with humic acids contained in aqueous organic matter. However, while agrochemical toxins are increasingly considered less relevant to the etiology of CKDu, it has become a firm public belief. In Sri Lanka this has spawned ideology-based agricultural policies for partial and complete banning of agrochemicals (2014-2021), followed by some back-tracking, disrupting the economy and the food supply. A farmer's uprising in 2022 was spawned by poor harvests. It triggered a larger popular uprising that led to the collapse of a government wedded to romanticized eco-extremist agricultural policies in a country already facing difficulties in the wake of Covid and Ukraine.

Science and opinion in decision making: A case study of the food security collapse in Sri Lanka

“…They attributed this insight to 'God Natha' rather than the use of the scientific method. 31,[40][41][42][43] Also, they claimed that they would not have discovered the link between arsenic and chronic kidney disease using Western scientific methods. 40 A graduate student who joined this team later published research linking arsenic and other heavy metals in groundwater to CKDu, attributing the contamination to the use of chemical fertilisers.…”

“…Representatives from the "Viyathmaga" lobby were elected to the parliament, and a member of this lobby who led a research team became the Minister of Health, and the State Minister of Production, Supply, and Regulation of Pharmaceuticals under the then 2020-2022 government. 64 During this period, this minister and his colleagues were able to influence the government's agricultural policy, which popularised organic farming in 2021 31,42 and led to a ban on agrochemicals and synthetic fertilisers by implementing a hasty policy change (Figure 1) and popularised organic farming in 2021. 31,42 Subsequent agriculture failure and economic loss fueled strong push-back from farmers and scientists and caused the government to revoke the ban within less than a year of its implementation (Figure 1).…”

“…64 During this period, this minister and his colleagues were able to influence the government's agricultural policy, which popularised organic farming in 2021 31,42 and led to a ban on agrochemicals and synthetic fertilisers by implementing a hasty policy change (Figure 1) and popularised organic farming in 2021. 31,42 Subsequent agriculture failure and economic loss fueled strong push-back from farmers and scientists and caused the government to revoke the ban within less than a year of its implementation (Figure 1).…”

“…The prevalence of 'Chronic Kidney Disease of unknown etiology' (CKDu) led to a dramatic political movement in the country in 2021 in support of organic farming, aiming to promote sustainable and environmentally friendly agricultural practices. 31,32 Although, Sri Lanka operates under a democratic political system, where the will of the people is reflected in the governance and decision-making processes, 33 misinformation and disinformation empowered a political movement to play a crucial role in influencing the ruling government by shaping agricultural policies and practices in Sri Lanka in 2021. This political movement included those that promoted organic farming to improve sustainability, advocated reductions in the use of chemical inputs, and those promoted healthier food systems.…”

“…The main features of the Sri Lankan catastrophic failure in organic farming involved its political system, economy, and agricultural landscape, and therefore constitutes an excellent case study to highlight the need for evidence‐based MCDM formulation of public policy. The prevalence of ‘Chronic Kidney Disease of unknown etiology’ (CKDu) led to a dramatic political movement in the country in 2021 in support of organic farming, aiming to promote sustainable and environmentally friendly agricultural practices 31,32 . Although, Sri Lanka operates under a democratic political system, where the will of the people is reflected in the governance and decision‐making processes, 33 misinformation and disinformation empowered a political movement to play a crucial role in influencing the ruling government by shaping agricultural policies and practices in Sri Lanka in 2021.…”