Chronic Kidney Disease of Unknown Etiology (CKDu) and Arsenic in Groundwater in Sri Lanka

Abstract

In recent years a significant increase in patients of Chronic Kidney Disease of unknown etiology (CKDu) has been observed in some parts of Sri Lanka, especially in Medawachchiya, Padaviya, Kebitigolawa, Medirigiriya (North Central Province), Nikawewa (North Western Province), Dehiattakandiya (Eastern Province) and Giradurukotte (Uva Province). Uniqueness of this disease is that its victims do not share the same history as other kidney patients who have had it either due to diabetes, high blood pressure, past snake bites or urinary tract infections. Etiology of this disease has since been attributed to a range of causes, including presence of the heavy metal cadmium in water that would potentially have introduced to water from inorganic fertilizer used in paddy fields, presence of excessive amounts of fluoride in drinking water and prevalent use of low quality aluminum utensils, presence of toxins produced by microorganisms such as cynobacteria in water. Despite the effort of about 60 researchers including those who were funded by WHO (World Health Organization) over the last decade, none of these hypotheses have been supported with evidence; in fact, the data available prove them not to be the cause. The causative factors and etiology of this chronic kidney disease therefore is still considered uncertain or unknown and abbreviated as CKDu with recommendations of the National Research Programme for CKD of the Ministry of Health in Sri Lanka.