‘A Religious Response to Chronic Kidney Disease in NCP’

This refers to an article that appeared in  on 31.12.2018 on the above title written by Rev. Father Emmanuel Fernando OMI. As a scientist deeply interested in the subject of  Chronic Kidney Disease of Uncertain Aetiology (CKDu) that is plaguing the people of  Rajarata and some neighbouring areas, I wish to express my sincere appreciation of the assistance provided by the good father in collaboration with the Regional Religious Unit (RRU) and other associates to CKDu patients. At the same time, Prof. Channa Jayasumana’s (CJ) input too should be appreciated in helping the activities of RRU. 

Water quality and CKDu 
However, CJ’s contention expressed by the Rev. Father that “medical research has proved that the disease is caused by excessive use of chemical fertilizers and pesticides” is incorrect. There is no scientific evidence to date to implicate any agrochemicals in the causation of CKDu. This is the clear message emanating from authentic research published to date. On the other hand, CJ is right in saying that “non-availability of safe drinking water” is a problem affecting the people of  Rajarata. In fact, it is now established with a high degree of certainty that the disease is associated with the quality of drinking water. Research in the last several years has established that whereas people drinking dug well water in the upland areas of Rajarata contaminate the disease those drinking surface water from reservoirs or streams do not. For example, city dwellers of Anuradhapura and Polonnaruwa who consume pipe-borne water from reservoirs do not contaminate the disease but the villagers/farmers in the peripheral areas who drink water from certain wells do. 

That the source of potable water is the cause has been established dramatically by a simple experiment conducted in the village  of Ginnoruwa, Girandurukotte, a hot bed of CKDu. In Ginnoruwa, there are two small villages; Badulupura and Sarabhumi. The latter village is situated in a plain close to a reservoir and the people consume water from the reservoir or a stream or from wells dug close to the reservoir. By contrast, Badulupura is situated on high ground and the dwellers consume water from sunk wells. Both eat the same rice and vegetables cultivated in the lowlands in Sarabhumi. Whereas Badulupura people are afflicted with CKDu, no CKDu cases have been reported from Sarabhumi. Plastic water tanks were provided to Badulupura households for harvesting of rainwater some three years ago and the indication is that there are now no new cases of  CKDu reported therefrom. Moreover, there is clear evidence according to the medical officer of the area that as a consequence of people now being educated about the role of water in CKDu, the incidence of the disease in terms of new patient numbers has declined. Also, according to a leading nephrologist dealing with CKDu, hospital records reveal declining numbers of new patients from high incidence CKDu areas such as Medawachchiya, Padaviya (NCP) and Girandurukotte (UvaProvince). 

CJ’s contention expressed by the Rev. Father that “medical research has proved that the disease is caused by excessive use of chemical fertilizers and pesticides” is incorrect

It is now the consensus among the majority of scientists that fluoride and hard water are a cause for CKDu. The water in wells on high ground generally has high levels of fluoride especially in the dry periods, and there is scientific evidence indicative of fluoride in conjunction with magnesium from the hard water causing CKDu. Recent research at the University  of Peradeniya has provided evidence to this effect in trials with mice. 

The RRU is reported to have installed a water purifying filter with a capacity of 500 litres per day at the Mihintale Hospital. While this is undoubtedly a commendable deed, given the fact that the filters often need servicing and other running repairs, an alternative and far cheaper approach should be to provide access to surface water or rain water for drinking and cooking. 

CKDu and agrochemicals 
Whilst research has not proved that agrochemicals are the cause of CKDu, their role cannot be totally ruled out in that disease may be multi-factorial as adverted to by many. The 2013 WHO report indicated that cadmium may play a role in CKDu and several nephrotoxic pesticides are also above reference limits in the urine of CKDu subjects. However, that study, though it had analysed pesticide residues in both the CKDu and control (non-CKDu) subjects, the data for the latter group from a non-CKDu area (Hambantota) were not published for some unknown reason. Subsequent analysis of raw data obtained from the National Science Foundation was shocking in that the incidence of above reference limit pesticide residue subjects were far greater in the control group than the CKDu group. Interestingly, the number of subjects with the above reference Glyphosate limit was double (7%) in the control group compared to the CKDu group (3.5%). A subsequent International Expert Consultation Meeting in 2017 also concluded that there was no tangible evidence to implicate any agrochemical in CKDu causation. 

The agrochemical saga however has taken a heavy toll on the agriculture of this country consequent on the ban of Glyphosate, the most widely used weed killer in the world, apparently based on a hypothesis that Glyphosate complexing with some toxic heavy metals was responsible for causation of CKDu. The hypothesis propounded by CJ and two other authors and published in an open access, fee-levying journal was however heavily criticised as being faulty in terms of the chemistry. Further there has been no other research evidence or publications to support it.

However, it was able to hoodwink two presidents of this country leading initially, in 2013, to the ban of the weed killer in the CKDu areas and later in 2015 in the entire country. The consequent economic loss for the tea industry alone has been estimated by the Tea Research Institute to be of the order of Rs.19 billion per annum. Fortunately, the ban has been now lifted for tea and rubber, again a highly short sighted decision by the government in that coconut needs Glyphosate far more than rubber, and so do the arable crops. The government must as a matter of urgency totally lift the ban. 

CKDu or not there is no argument that excessive use of agrochemicals should be stopped, as they can be harmful to health. In this regard, the government should take more effective preventive action through comprehensive farmer education programmes on judicious agrochemical use.