Effect of Water Hardness on Non-Communicable Diseases, Including Chronic Kidney Disease of Multifactorial Origin (CKDmfo/CKDuo)

Abstract

Environmental pollution, including air and water contamination, causes or aggravates many acute and chronic human diseases. Although scientific literature prior to the last decade showed some associations between hardness/softness of water with cardiovascular diseases, recent data do not support this proposition. Previously postulated associations were derived from the data generated from observations and uncontrolled epidemiological and cohort studies; the results of which have not been confirmed. It was claimed that consumption of soft water increased cardiovascular diseases whereas hard water decreased them. Critical evaluation of recent data support neither of these claims. Recently, an association between drinking hard water (or ionicity) and chronic kidney disease of multifactorial origin (CKDmfo/CKDuo) has been proposed but disputed by others. CKDmfo/CKDuo is prevalent in dry-zonal, agriculture-based tropical countries, including Sri Lanka. Most regions affected by CKDmfo had hard water for centuries, but this disease has manifested only during the past few decades. However, during the past four decades, there had been several key changes in these agricultural regions, such as the increased use of agrochemicals associated with the green revolution, environmental pollution, and human behavioral changes including abandoning traditional agricultural methods and unhealthful food habits. Despite the absence of scientific data, few claim that CKDmfo is caused by the hypothetical complexes of pesticides, heavy metals, and hard water. Even if such complexes are formed, these components are insoluble in water and highly unlikely to be absorbed through the gastrointestinal tract. Apart from the well-known association of the consumption of hard water and chronic dehydration with urinary stones, there are no other scientifically established associations of water hardness with human diseases. Considering the pathophysiology and after a detailed review of published literature, the author concludes there is no confirmatory scientific evidence to support these hypotheses.

Experimental rat model for acute tubular injury induced by high water hardness and high water fluoride: efficacy of primary preventive intervention by distilled water administration

“…Jayasumana et al (2014), reported high water hardness (up to 820 mg/L) in CKDu endemic areas which showed a correlation with the prevalence of CKDu [3,18]. But, unexpected low occurrence of CKDu was found in Jaffna and Puttalam districts even with reported higher water hardness (approximately 1500 mg/L) [19,20].…”

Public health interventions for chronic diseases: cost–benefit modelizations for eradicating chronic kidney disease of multifactorial origin (CKDmfo/ CKDu) from tropical countries

“…Lifestyle changes needed in the said population include, consuming a nutritionally balanced diet, engaging in age-appropriate physical activities, and avoiding smoking, alcohol, and illicit drugs. In addition to CKD, these would also reduce the risks of other chronic diseases, such as type 2 diabetes, metabolic syndrome, obesity, and osteoporosis [35, 36].…”

“…The origin (the causation) of CKDmfo is multifactorial. Poverty-driven malnutrition, unhealthy lifestyles and habits, excessive use of agrochemicals, and ineffective governmental policies, all can be intricately interconnected [16, 35]. These factors likely to make individuals vulnerable, while chronic and prolonged ingestion of nephrotoxins contribute to precipitate CKDmfo.…”

“…As with other public health models, the described holistic approach necessitates simultaneously implementation of multiple programs across the region, to reduce the incidence and eventually eliminate the disease from the country [35]. This would markedly reduce the cost to affected families, communities, the public, and the government, and increase food security, boost the nation's economy and prosperity.…”

Occupational Health Sufferings of Child Waste Workers in South Asia: A Scoping Review

“…This also echoes the findings of research in Dhaka, Bangladesh reporting that the total microbial count in household waste collectors was about 20,000 times higher than in general [ 45 ]. The scarcity of clean drinking water also creates abdominal pains and gastrointestinal problems [ 46 , 47 ].…”