Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review

The cause of Chronic Kidney Disease of unknown etiology (CKDu) in the rural dry zone of Sri Lanka remains unidentified, despite vast research efforts that brought about an extensive list of potential risk factors. Among these, the long-term exposure to various nephrotoxic elements through drinking g...

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Autores principales:	Sachithra Imbulana, Kumiko Oguma
Formato:	article
Lenguaje:	EN
Publicado:	IWA Publishing 2021
Materias:	chronic kidney disease of unknown etiology drinking water groundwater water quality Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/9f679b81e12c4251a69ace5f721c58e4
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spelling	oai:doaj.org-article:9f679b81e12c4251a69ace5f721c58e42021-11-06T06:05:02ZGroundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review1477-89201996-782910.2166/wh.2021.079https://doaj.org/article/9f679b81e12c4251a69ace5f721c58e42021-06-01T00:00:00Zhttp://jwh.iwaponline.com/content/19/3/393https://doaj.org/toc/1477-8920https://doaj.org/toc/1996-7829The cause of Chronic Kidney Disease of unknown etiology (CKDu) in the rural dry zone of Sri Lanka remains unidentified, despite vast research efforts that brought about an extensive list of potential risk factors. Among these, the long-term exposure to various nephrotoxic elements through drinking groundwater was widely suspected owing to the unique geographical distribution of the disease. This review focuses on such well-known hypotheses suspecting the relations with fluoride, hardness, major ions, heavy metals, metalloids, organic matter, agrochemical residues, pathogens, and bacterial toxins in the groundwaters of the CKDu-endemic region. It was comprehensively discussed why each of these constituents was considered a risk factor of CKDu, how could they possibly trigger the pathogenesis of the disease, what was the evidence that supported or failed each hypothesis, and whether providing safe drinking water had been effective at mitigating the progression of the disease. Although plenty of circumstantial evidence supported an etiology related to groundwater for CKDu, it was impossible to elucidate the cause–effect relationships between drinking impaired groundwater and the occurrence of the disease. Future research should be effectively designed to clarify the role of groundwater in the onset of CKDu by taking into account the gaps in past research. HIGHLIGHTS Most updated review on the underlying topic to cover all relevant original studies up to 2020.; An intensive discussion focusing on groundwater as a potential cause of CKDu.; Useful for identifying the gaps in previous research and seeking new methods to elucidate the cause of CKDu.; Highly relatable to those who are interested in exploring health implications of drinking water.;Sachithra ImbulanaKumiko OgumaIWA Publishingarticlechronic kidney disease of unknown etiologydrinking watergroundwaterwater qualityPublic aspects of medicineRA1-1270ENJournal of Water and Health, Vol 19, Iss 3, Pp 393-410 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	chronic kidney disease of unknown etiology drinking water groundwater water quality Public aspects of medicine RA1-1270
spellingShingle	chronic kidney disease of unknown etiology drinking water groundwater water quality Public aspects of medicine RA1-1270 Sachithra Imbulana Kumiko Oguma Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review
description	The cause of Chronic Kidney Disease of unknown etiology (CKDu) in the rural dry zone of Sri Lanka remains unidentified, despite vast research efforts that brought about an extensive list of potential risk factors. Among these, the long-term exposure to various nephrotoxic elements through drinking groundwater was widely suspected owing to the unique geographical distribution of the disease. This review focuses on such well-known hypotheses suspecting the relations with fluoride, hardness, major ions, heavy metals, metalloids, organic matter, agrochemical residues, pathogens, and bacterial toxins in the groundwaters of the CKDu-endemic region. It was comprehensively discussed why each of these constituents was considered a risk factor of CKDu, how could they possibly trigger the pathogenesis of the disease, what was the evidence that supported or failed each hypothesis, and whether providing safe drinking water had been effective at mitigating the progression of the disease. Although plenty of circumstantial evidence supported an etiology related to groundwater for CKDu, it was impossible to elucidate the cause–effect relationships between drinking impaired groundwater and the occurrence of the disease. Future research should be effectively designed to clarify the role of groundwater in the onset of CKDu by taking into account the gaps in past research. HIGHLIGHTS Most updated review on the underlying topic to cover all relevant original studies up to 2020.; An intensive discussion focusing on groundwater as a potential cause of CKDu.; Useful for identifying the gaps in previous research and seeking new methods to elucidate the cause of CKDu.; Highly relatable to those who are interested in exploring health implications of drinking water.;
format	article
author	Sachithra Imbulana Kumiko Oguma
author_facet	Sachithra Imbulana Kumiko Oguma
author_sort	Sachithra Imbulana
title	Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review
title_short	Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review
title_full	Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review
title_fullStr	Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review
title_full_unstemmed	Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review
title_sort	groundwater as a potential cause of chronic kidney disease of unknown etiology (ckdu) in sri lanka: a review
publisher	IWA Publishing
publishDate	2021
url	https://doaj.org/article/9f679b81e12c4251a69ace5f721c58e4
work_keys_str_mv	AT sachithraimbulana groundwaterasapotentialcauseofchronickidneydiseaseofunknownetiologyckduinsrilankaareview AT kumikooguma groundwaterasapotentialcauseofchronickidneydiseaseofunknownetiologyckduinsrilankaareview
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Groundwater as a potential cause of Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka: a review

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