Escalating chronic kidney diseases of multi-factorial origin (CKD-mfo) in Sri Lanka: causes, solutions, and recommendations—update and responses

Wimalawansa, Sunil J.

doi:10.1007/s12199-015-0447-5

Cited by 27 publications

(29 citation statements)

References 13 publications

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“…The epidemic has been increasing since the 1980s, and currently affects more than 100,000 individuals (74). The primary population affected are young to middle-aged male rice farmers, although women working in the fields are also at risk (73,74).…”

Section: Sri Lanka Nephropathymentioning

confidence: 99%

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy

Glaser¹,

Lemery²,

Rajagopalan³

et al. 2016

CJASN

348

264

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Climate change has led to significant rise of 0.8˚C-0.9˚C in global mean temperature over the last century and has been linked with significant increases in the frequency and severity of heat waves (extreme heat events). Climate change has also been increasingly connected to detrimental human health. One of the consequences of climate-related extreme heat exposure is dehydration and volume loss, leading to acute mortality from exacerbations of pre-existing chronic disease, as well as from outright heat exhaustion and heat stroke. Recent studies have also shown that recurrent heat exposure with physical exertion and inadequate hydration can lead to CKD that is distinct from that caused by diabetes, hypertension, or GN. Epidemics of CKD consistent with heat stress nephropathy are now occurring across the world. Here, we describe this disease, discuss the locations where it appears to be manifesting, link it with increasing temperatures, and discuss ongoing attempts to prevent the disease. Heat stress nephropathy may represent one of the first epidemics due to global warming. Government, industry, and health policy makers in the impacted regions should place greater emphasis on occupational and community interventions.

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Section: Sri Lanka Nephropathymentioning

confidence: 99%

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy

Glaser¹,

Lemery²,

Rajagopalan³

et al. 2016

CJASN

348

264

View full text Add to dashboard Cite

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“…Despite this, proteinuria continues to be used by the Department of Health in Sri Lanka and all other CKDmfo-affected countries. This testing method identifies fewer than half of those with early stages of CKDmfo, causing harm to those whose disease remains unidentified [10,24,27].…”

Section: Urinary Biomarkers For Ckdmfomentioning

confidence: 99%

“…Such underground deposits occur in the Eppawala region in NCP, where there is a large phosphate deposit that extends about 120 km to the south. In fact, since 2013, new cases of CKDmfo have been reported in the southern region within and around the "fluoride belt" of Sri Lanka [6,10,27]. However, whether this is related to groundwater fluoride remains unknown.…”

Section: Summary Of Proposed Causes Of Ckdmfomentioning

confidence: 99%

“…Renal tubular cell failure manifests after exposure to nephrotoxins. It leads to tubular cell damage and obstruction associated with interstitial inflammation, reno-microvascular contraction, and chronic intravascular volume depletion, in part caused by chronic dehydration and the effects of raised renin-angiotensin hormonal system [27,45], which exacerbates tubular oxidative stress [46]. CKDmfo is a fatal chronic tubulointerstitial disease in which renal tubules get blocked and inflamed in early stages [6,47].…”

Section: Ckdmfo: General Pathologymentioning

confidence: 99%

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Factors Affecting the Environmentally Induced, Chronic Kidney Disease of Unknown Aetiology in Dry Zonal Regions in Tropical Countries—Novel Findings

Wimalawansa¹,

Dissanayake

2019

Environments

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A new form of chronic tubulointerstitial kidney disease (CKD) not related to diabetes or hypertension appeared during the past four decades in several peri-equatorial and predominantly agricultural countries. Commonalities include underground stagnation of drinking water with prolonged contact with rocks, harsh climatic conditions with protracted dry seasons, and rampant poverty and malnutrition. In general, the cause is unknown, and the disease is therefore named CKD of unknown aetiology (CKDu). Since it is likely caused by a combination of factors, a better term would be CKD of multifactorial origin (CKDmfo). Middle-aged malnourished men with more than 10 years of exposure to environmental hazards are the most vulnerable. Over 30 factors have been proposed as causative, including agrochemicals and heavy metals, but none has been properly tested nor proven as causative, and unlikely to be the cause of CKDmfo/CKDu. Conditions such as, having favourable climatic patterns, adequate hydration, and less poverty and malnutrition seem to prevent the disease. With the right in vivo conditions, chemical species such as calcium, phosphate, oxalate, and fluoride form intra-renal nanomineral particles initiating the CKDmfo. This article examines the key potential chemical components causing CKDmfo together with the risk factors and vulnerabilities predisposing individuals to this disease. Research findings suggest that in addition to drinking water from stagnant sources that contain high ionic components, more than 10 years of exposure to environmental nephrotoxins and micronutrient malnutrition are needed to contract this fatal disease.

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“…Moreover, only less than 20% of the affected people are drinking water from sources other than shallow dug wells. Aforementioned facts exclude both salt content (ionicity) and the phosphate as a causative factor for CKDmfo [79] .…”

Section: Drinking Water Containing Phosphate Does Not Cause Ckdmfomentioning

confidence: 99%

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

Wimalawansa¹,

Internationals²

2016

JEHS

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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.

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Escalating chronic kidney diseases of multi-factorial origin (CKD-mfo) in Sri Lanka: causes, solutions, and recommendations—update and responses

Cited by 27 publications

References 13 publications

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy

Factors Affecting the Environmentally Induced, Chronic Kidney Disease of Unknown Aetiology in Dry Zonal Regions in Tropical Countries—Novel Findings

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

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