Paper Review of Literature on 158 Unknown Etiology (CKDu ...

IWMI Working Paper

158

Review of Literature on Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka

Andrew Noble, Priyanie Amerasinghe, Herath Manthrithilake and Sutharsiny Arasalingam

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IWMI Working Paper 158

Review of Literature on Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka

Andrew Noble Priyanie Amerasinghe Herath Manthrithilake

and Sutharsiny Arasalingam

International Water Management Institute

The authors: Andrew Noble is Director of the CGIAR Research Program on Water, Land and Ecosystems (WLE) at the headquarters of the International Water Management Institute (IWMI) in Colombo, Sri Lanka; Priyanie Amerasinghe is Head of Office and Senior Researcher at the Hyderabad Office of IWMI in India; Herath Manthrithilake is Head, Sri Lanka Development Initiative, at the headquarters of IWMI in Colombo, Sri Lanka; and Sutharsiny Arasalingam is a Consultant with the Sri Lanka Development Initiative at the headquarters of IWMI in Colombo, Sri Lanka.

Noble, A.; Amerasinghe, P.; Manthrithilake, H.; Arasalingam, S. 2014. Review of literature on chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. Colombo, Sri Lanka: International Water Management Institute (IWMI). 41p. (IWMI Working Paper 158). doi: 10.5337/2014.206

/ kidney diseases / chronic course / aetiology / water quality / drinking water / groundwater / contamination / arsenic / toxicity / cadmium / phosphates / fluorides / aluminium / agrochemicals / health hazards / food chains / farmers / wells / literature / research / Sri Lanka /

ISSN 2012-5763 e-ISSN 2478-1134 ISBN 978-92-9090-788-6

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Acknowledgements

The authors would like to thank all the people whose work contributed to the content of this paper. In particular, we are grateful to Dr. T. Abeysekara, Consultant Nephrologist and Former Head, Dept. of Nephrology and Transplantation ? Teaching Hospital, Kandy; Prof. O. Ileperuma, Department of Chemistry, University of Peradeniya; Prof. R. Chandrajith, Department of Geology, University of Peradeniya; and Mr. S.G.G. Rajkumar, Deputy General Manager, National Water Supply & Drainage Board, Ratmalana.

Contents

Acronyms ............................................................................................................................. vi Summary ............................................................................................................................ vii Introduction .............................................................................................................................. 1 What Do We Know About the Disease in Sri Lanka?................................................................. 3

An Overview of Medical Evidence Associated with CKDu................................................. 3 Criteria Used in Classifying the Disease ..................................................................... 3 Patient Cohorts Described in the Scientific Literature ................................................ 5 Some Potential Causal Factors of CKDu, Reported in the Literature ....................................... 7

Aflotoxins Associated with the Consumption of Stored Grains .......................................... 7 Arsenic (As) Toxicity: .......................................................................................................... 7 Critical Values of Arsenic (As) in Water and Food ............................................................. 7 Evidence of Arsenic (As) Contamination in Sri Lanka ....................................................... 8 Review of Articles in the Media Related to Arsenic ................................................. 14 Cadmium (Cd) as a Causal Factor ..................................................................................... 14 Background ................................................................................................................ 14 Research into Cd ........................................................................................................ 14 Fluoride and Aluminum ...................................................................................................... 19 Where are the Gaps that IWMI Could Assist in Filling? ......................................................... 22 Discussion ........................................................................................................................... 23 What Conclusions can be Drawn from the Research to Date? .......................................... 23 References ........................................................................................................................... 25 Annex 1 ........................................................................................................................... 29

v

Acronyms

Al As CKD CKDu CP CRF DZ EP ESRD F GFR NCP NP NWP P PTWI ROP SABP SP SLMA TSP UP UTI WHO WP

Aluminum Arsenic Chronic Kidney Disease Chronic Kidney Disease of Unknown Etiology Central Province Chronic Renal Failure Dry Zone Eastern Province End Stage Renal Disease Flouride Glomerular Filtration Rate North Central Province Northern Province North Western Province Phosphorus Provisional Tolerable Weekly Intake Registrar of Pesticides Sabaragamuwa Province Southern Province Sri Lanka Medical Association Triple Super Phosphate Uva Province Urinary Tract Infection World Health Organization Western Province

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