World Health Organization (WHO) report on Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka
Posted on August 15th, 2012

Mission report , 6-8thJune 2011, Dr.Shanthi Mendis , Senior advisor and coordinator,Chronic disease prevention and management, WHO, Geneva, Switzerland

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 Results of the phase 01 of this research programme reveal that in the north central andUva provinces a minimum of 15% of people in the age group 15-70 years are affected byCKDu.
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 Man over the age of 40 years who are engaged in farming for more than 10 years are athigher risk of developing this disease. In addition exposure to agrochemicals alsoincreases the risk of developing CKDu.
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 The majority of men and women suffering from this disease excrete raised levels of arsenic and/or cadmium in the urine.
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 Exposure to a combination of factors that are toxic to the kidney seems to cause thiskidney disease. Toxic factors identified up to now include arsenic, cadmium andnephrotoxic agrochemicals.
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 Recommend to develop a regulatory frame work to improve the quality control of imported fertilizer particularly with regard to nephrotoxic agents such as arsenic andcadmium.
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 It is imperative that the steps are taken as soon as possible. Delaying action will causefurther accumulation of toxic agents in the environment and result in cumulativedamage to the health of the people living in these areas.
02. Mission report, 5-7 October 2011
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 Cumulative nature of heavy metal exposure and progressive natural history of CKDu forwhich there is no known cure, demand urgent action to improve safe use and qualitycontrol of agrochemicals and quality control of fertilizer.
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 As advised by the Honorable minister of Health, a multisectoral strategic plan need tobe developed jointly with relevant ministries with short, medium and long termmeasures by the end of 2011 and implemented as early as possible in 2012 to minimizethe growing public health risks to the population.
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 It is essential that steps are taken as soon as possible. Delaying action will cause furtheraccumulation of toxic agents in the environment and result in cumulative damage to thehealth of the people living in these areas and with time also affects younger age groups.In the long term there will also be severe social and economic consequences that willnegatively impact the on going development and poverty alleviation efforts of theregion.
03. Progress report 13 Feb 2012
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 In the urine analysis of 496 cases of CKDu 56% had a urine cadmium excretion over 1ug/g creratinine. Data from recent studies show that changes of early kidney damageoccurs at cadmium excretion levels of even 0.6-1 ug/g creratinine. About 63% of CKDupatients had urine arsenic levels above 21 ug/g Ceratinine. Urine arsenic levels above 21ug/g creatinine have been shown to cause changes in kidney tissue that lead to chronickidney disease.
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 Approximately 88% of CKDu patients had urine arsenic >21 ug/g and/or urine cadmium>0.6 ug/g
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 Arsenic was also analyzed in hair and nails of people living in NCP including CKDupatients. In about 90% arsenic levels in hair were higher than those observed indeveloped countries (0.02 ug/g).In about 94% arsenic levels in nails were higher thanthose observed in developed countries (>0.03 ug/g)
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 Our analysis did not find high levels of cadmium exposure as reported in previousstudies. The mean exposure for adults is at borderline of Recommended Total Weeklyintake (TWI) of 2.5ug/kg body weight.
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 Water from 98 water sources used by patients with CKDu was analyzed for hardness.99% are hard to very hard. Hardness of water is known to affect heavy metal toxicitythrough antagonistic mechanisms and this may play a role in renal toxicity caused byheavy metals in the north central province.
Recommendations
01.
 Implement the recommendations in previous reports.02.
Strengthening the institutional arrangements for the implementation inter sectoralcoordination, monitoring and evaluation of control of pesticides and fertilizer.03.
Increasing the public awareness of the adverse health effects of agrochemicals. Thegeneral public should be made aware of the actions taken to control agrochemicals and the importance of applying safety and control measures. Health education programmesshould focus on high risk populations including farmers, vendors and also expanded toinvolve school children and the public at large.04.
Strengthen water purification schemes in north central region. Recommendations havebeen made for the maximum and minimum levels of calcium and magnesium in drinking water and total hardness.05.
As there are 66 ayurvedic prescriptions that contain aristolochia, increase awareness of ayurvedic practitioners and public of renal toxicity of aristolochia species.

2 Responses to “World Health Organization (WHO) report on Chronic Kidney Disease of unknown etiology (CKDu) in Sri Lanka”

  1. Nalliah Thayabharan Says:

    Arsenic and its metabolites are excreted via kidney which is the primary site of bio transformation of arsenic. Kidneys of persons exposed to high levels of Arsenic have accumulated high amounts of Arsenic in their kidneys.

    Arsenic is not easily detectable in hard water since Arsenic forms strong bond with Calcium. The use of Arsenic containing insecticides, herbicides and fungicides on the increase in Sri Lanka in recent years. Also the use of pesticides containing high amount of cyanide and mercury are on the increase in Sri Lanka.

    In Padaviya about 5% of the population suffer from Arsenic poisoning and 40% of the death are due to Arsenic poisoning.

    All agro chemicals are poisonous to animals, plants, microbes, insects and humans. Chemical pesticides leads to breeding of more pesticide resistant pests and creates pest epidemics.

    Since tons of pesticides containing Arsenic,Mercury, Cyanide have been used in Sri Lanka for the last 20-25 years, in them may potentially be the cause for rapidly increasing prevalence of heart disease, diabetes and cancer in Sri Lanka, curing for which the Sri Lankan Government spends millions annually.

    Drinking Arsenic contaminated water and rice caused a severe Arsenic poisoning crisis in Bangladesh where more than 70 million people are subjected to chronic arsenic poisoning caused by low quality agro chemicals which have been imported for last 30 years.

  2. Fran Diaz Says:

    Herewith two websites on the use of Alternative Medicines for Heavy Metal Poisoning :

    http://www.altmd.com/Articles/Heavy-Metal-Poisoning–Encyclopedia-of-Alternative

    http://www.herbs2000.com/disorders/toxic_metal3.htm

    Sri Lanka should start producing her own organic fertilisers. Constant use of agro chemicals such as urea will only deplete the soil in the long run.

    There are natural ways to remove common crop pests too (refer internet).

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