Heavy metals exonerated in Chronic Kidney Disease in dry zone

 A Sri Lankan farmer suffering from kidney disease, lies on a bed at their house in Kebithigollewa as family members sit by his side (File Photo)

• Delving into the depths of Sri Lanka’s North Central Province, the  Chinese scientists embarked on an elaborate research mission,  collaborating with the renowned Joint Research Centre at the University  of Peradeniya, with support from the Chinese Academy of Sciences
• Water samples collected from the North Central Province revealed  shocking levels of calcium, reaching up to 200 mg per litre, and  fluoride concentrations of 2-3 mg per litre—both far exceeding  acceptable limits
• The total affected population surpasses 400,000 and the death toll exceeds 20,000

In Sri Lanka’s dry zone, a silent epidemic - Chronic Kidney Disease of Unknown Etiology (CKDu)- has plagued communities for three decades. The deadly disease has left a trail of suffering, primarily affecting those engaged in agriculture and posing a significant burden on the nation’s healthcare system. For years, experts have grappled with unraveling the enigma surrounding its cause, with the prevailing belief pointing to the toxic presence of heavy metals like cadmium and arsenic in agrochemical-contaminated groundwater. However, a groundbreaking study conducted by a team of Chinese scientists challenges this long-held perception, introducing a fresh perspective that could reshape our understanding of CKDu.  

Delving into the depths of Sri Lanka’s North Central Province, the Chinese scientists embarked on an elaborate research mission, collaborating with the renowned Joint Research Centre at the University of Peradeniya, with support from the Chinese Academy of Sciences. Their exhaustive investigations into the quality of groundwater shed light on an unexpected culprit—high concentrations of calcium and fluoride ions.  

Professor Min Yang, a prominent figure in the research team, shared exclusive insights with Daily Mirror, shedding light on their journey. Prompted by their Sri Lankan counterparts’ grave concerns about CKDu’s prevalence in the dry zone, the Chinese scientists set out on a mission in 2014, united by a shared determination to unearth the truth. Collaborative efforts paved the way for groundbreaking discoveries that have challenged the existing narrative.  

The significance of their findings cannot be understated. Water samples collected from the North Central Province revealed shocking levels of calcium, reaching up to 200 mg per litre, and fluoride concentrations of 2-3 mg per litre—both far exceeding acceptable limits

What emerged from their meticulous exploration was a compelling case linking CKDu to the hardness of water and the presence of excessive fluoride. Prof. Yang emphasized the seriousness of the issue, describing it as a “very serious problem” afflicting the dry zone’s vulnerable population. Through inter-disciplinary collaboration, the team meticulously pieced together evidence, building a robust case that elevated calcium and fluoride levels in groundwater, surpassing certain thresholds, stand as key factors contributing to this grave health hazard.  

The significance of their findings cannot be understated. Water samples collected from the North Central Province revealed shocking levels of calcium, reaching up to 200 mg per litre, and fluoride concentrations of 2-3 mg per litre—both far exceeding acceptable limits. This contrasted starkly with samples from other parts of the country, shedding light on the localized nature of the problem.  
CKDu’s impact on Sri Lanka has been staggering. Its discovery over three decades ago thrust the nation into a public health crisis, with rural farming communities in the dry zone bearing the brunt of its devastation. The government has faced an uphill battle, grappling with soaring healthcare costs and a significant loss of productivity from affected individuals who would otherwise contribute to the 
national economy.  

CKDu stands distinct from other chronic kidney diseases, with no direct correlation to common risk factors such as obesity, hypertension, diabetes, or even snake bites. This elusive nature has confounded researchers for years. However, according to the unpublished results of their research, the simultaneous presence of calcium and fluoride ions might be the main reason for the high CKDu prevalence rates from a mere two percent to an alarming 15 percent in certain areas.  

The urgency to address this crisis cannot be overstated. The World Health Organization (WHO) has issued recommendations for providing safe water to the CKDu-affected regions, aligning with Sri Lanka’s commitment to achieving the UN Sustainable Development Goals by 2030, which prioritize safe water and sanitation. 

Recognizing the limitations of the national water supply grid in reaching all affected areas, decentralized water-treatment plants have emerged as a practical solution, particularly in rural villages where centralized systems prove unsustainable.  
While concerns regarding the excessive use of agrochemicals have long dominated the discourse surrounding CKDu, Prof. Yang dismisses this notion. Drawing on his team’s research, he counters that groundwater contamination by heavy metals from industrial chemical waste does not exist in Sri Lanka as it does in other countries. Furthermore, the presence of CKDu in certain parts of Latin America is attributed to a natural chemical called ‘aristolochic acid.’ These revelations challenge the previously held assumptions, urging a re-evaluation of strategies for tackling CKDu.  

As the total affected population surpasses 400,000 and the death toll exceeds 20,000, the need for immediate action looms large. The Chinese experts advocate for the establishment of community-based water-treatment systems, incorporating a modified electro-dialysis technology to remove the hazardous ions. These solutions offer promising avenues for providing safe drinking water to small villages in the affected regions with a low cost, addressing maintenance challenges and ensuring long-term access to clean water.  

“We came to Sri Lanka in 2014 because of CKDu. Sri Lankan colleagues informed us about this serious kidney disease in the dry zone. They said it might be associated with groundwater quality. That is why we started working together with our Sri Lankan colleagues,” he said.  

CKDu’s impact on Sri Lanka has been staggering. Its discovery over three decades ago thrust the nation into a public health crisis, with rural farming communities in the dry zone bearing the brunt of its devastation

“Groundwater can be contaminated with heavy metals if there are a lot of industrial chemical wastes. In your country, we don’t find such industries. Also, agro-chemicals are used in other countries. But, this problem does not exist,” he said.   
Responding to a query about the prevalence of it in some parts of Latin America, he said it was triggered by a natural chemical. Since most areas of the dry zone are not covered by the national water supply grid of Sri Lanka, he rebuffed it saying it is triggered by a natural chemical called ‘aristolochic acid’.  

The battle against CKDu is far from over, but the findings of the Chinese research team serve as a beacon of hope in a sea of uncertainty. By challenging prevailing beliefs and shedding new light on the complex interplay of water quality and CKDu, they have opened doors to innovative approaches that hold the potential to alleviate the suffering of countless individuals and safeguard the future of Sri Lanka’s dry zone communities. As the nation strives towards its sustainable development goals, the pursuit of safe water and improved healthcare in the affected areas must remain at the forefront, guiding efforts to eradicate this debilitating disease once and for all.