Further thoughts on CKDu
Posted on April 23rd, 2013
Thanks to Dr A Wijesekara for supplying information and thanks to Lankaweb for highlighting the issue.
Arsenic and Cadmium levels of healthy people living in endemic areas appear to be double (approximately) that of the control group. This suggest that people living in endemic areas are subjected to high levels of Cd and As, that are known toxins, causing kidney failure. ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â Due to this high level of exposure, some may succumb to CKD. The probability could be calculated easily if one knows the number of people who are suffering from CKDu and the population in the relevant area. On this basis, exposure to Arsenic and Cadmium could be considered high risk factors.
There are some lessons that could be learnt from the asbestos safety debate. Initially scientists said that there was a safe level of exposure, threshold limit value (TLV) for asbestos. Gradually, on the basis of evidence, they continuously brought the level down and ultimately found that there is no safe limit and even a small exposure is dangerous.. ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â It could be that the safe level for Cd and As, currently thought, ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â may be too ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â highÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â and needs to be lowered ( a lesson that could be learnt from asbestos safe levels). Further, the duration of the exposure may also have a significant impact. That is, a longer duration significantly increase ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â the risk of suffering from CKDu. It is prudent to drink clean water, when ever possible.
To borrow some ideas from Engineering, the cyclic failure of metals, not only depend on the number of cycles, but depend on environmental factors and stress levels. Again ideas could be borrowed from engineering. A lesson that could be learnt is that a combination of factors, including environmental factors ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â may cause CKDu.
Clearly exposure to ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â Cd and As are high risk factors. Introducing these toxins to the environment is harmful to humans and pollutes the environment. Clearing these toxins from the environment may be very expensive. It is far cheaper to take preventative measures to prevent these toxins entering the environment. One method is to ban products with these toxins from entering the country.
In addition to As and Cd, a combination of other factors may contribute to CKDu such as:
- The exposure level ÃƒÆ’Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œcurrent safe levels may be too high
- The duration of the exposure ÃƒÆ’Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œ Long periods of exposure may not allow the body to recover
- ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â General health of the person
- Nutrient intake of the person ÃƒÆ’Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œ Vitamin C is known to combat toxins. It could be that some lack food with vitamin C.
- Alcohol abuse
- Genetic make up of the person
- Fluid intake
- Heat stress
- Condition of the water such as fluoride content or hardness
ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â What is known for certain is that drinking clean water does not induce CKD. ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â An obvious solution is to use rain water harvesting. This is an area whereÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â various groups and overseas Sri L Nankas can help. ÃƒÆ’Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â As and Cd appear to be high risk and these two toxins should be banned to prevent deaths and environmental pollution. Organic farming to be encouraged. Research may be needed to find if improved diet help to combat CKDu.