Skip to main content

Advertisement

SpringerLink
Log in

The role of ions, heavy metals, fluoride, and agrochemicals: critical evaluation of potential aetiological factors of chronic kidney disease of multifactorial origin (CKDmfo/CKDu) and recommendations for its eradication

  • Review Paper
  • Published:
Environmental Geochemistry and Health Aims and scope Submit manuscript

Abstract

The pollution of water and food through human waste and anthropogenic activities, including industrial waste and agricultural runoff, is a mounting problem worldwide. Water pollution from microbes causes identifiable diarrhoeal illnesses. The consumption of water contaminated with heavy metals, fluoride, and other toxins causes insidious illnesses that lead to protracted, non-communicable diseases and death. Chronic kidney disease of unusual/uncertain/unknown aetiology is one such example, began to manifest in the mid-1960s in several dry-zonal agricultural societies in developing economies that are located around the equator. In Sri Lanka, such a disease is affecting the North Central Province, the rice bowl of the country that first appeared in the mid-1990s. Several potential causes have been postulated, including heavy metals, fluoride, cyanobacterial and algae toxins, agrochemicals, and high salinity and ionicity in water, but no specific source or causative factor has been identified for CKD of multifactorial origin (CKDmfo). Three large studies conducted in the recent past failed to find any of the postulated components (heavy metals, cyanobacterial toxins, fluoride, salinity, or agrochemicals) at levels higher than those deemed safe by the World Health Organization and the US Environmental Protection Agency. At the reported low levels in water and with the heterogeneous geographical distribution, it is unrealistic to expect any of these components individually could cause this disease. However, the additive or synergistic effects of a combination of factors and components, even at lower exposure levels, together with malnutrition and harmful behaviours, and/or a yet-unidentified (or not investigated) toxin, can cause this epidemic. Because the cause is unknown, scientists need to work on broader hypotheses, so that key causative elements are not missed. Taken together the plausibility of multiple factors in the genesis of this disease, the appropriate terminology is CKDmfo, a name that also indicates the need for multi-disciplinary research programs to facilitate identifying the cause(s) and the need for multiple approaches to eradicate it. While some potential causes remain to be investigated, existing data point to polluted water as the main source of this disease. This article evaluates pros and cons of each hypothesis and highlights the importance of among others, providing clean water to all affected and surrounding communities. Available data do not support any of the postulated agents, chemicals, heavy metals, fluoride, salinity/ionicity, or individual agrochemical components, such as phosphate or glyphosate, as causative factors for CKDmfo in Sri Lanka. However, as the CKDmfo name implies, a combination of these factors (or an unknown toxin) together with harmful behaviour and chronic dehydration may cause this disease. Irrespective of the cause, prevention is the only way forward for eradication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Amerasinghe, F. P., & Munasingha, N. B. (1988). A predevelopment mosquito survey in the Mahaweli Development Project area, Sri Lanka: immatures. Journal of Medical Entomology, 25, 286–294.

    Article  CAS  Google Scholar 

  • Anawar, H. M., Akai, J., Yoshioka, T., Konohira, E., Lee, J. Y., Fukuhara, H., et al. (2006). Mobilization of arsenic in groundwater of Bangladesh: evidence from an incubation study. Environmental Geochemistry and Health, 28, 553–565.

    Article  CAS  Google Scholar 

  • Anderson, C. R., & Cook, G. M. (2004). Isolation and characterization of arsenate-reducing bacteria from arsenic-contaminated sites in New Zealand. Current Microbiology, 48, 341–347.

    Article  CAS  Google Scholar 

  • Asians-Studies-and-Windows-in-Asia. (1998). Historical settings—Ancient hydrolic irrigation systems. http://asia.isp.msu.edu/wbwoa/south_asia/sri_lanka/history.htm. Traditional Sri Lanka. http://www.shsu.edu/~his_ncp/SriLanka.html.

  • Athuraliya, N. T., Abeysekera, T. D., Amerasinghe, P. H., Kumarasiri, R., Bandara, P., Karunaratne, U., et al. (2011). Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney International, 80, 1212–1221.

    Article  Google Scholar 

  • Bandara, J. M., Senevirathna, D. M., Dasanayake, D. M., Herath, V., Bandara, J. M., Abeysekara, T., & Rajapaksha, K. H. (2008). Chronic renal failure among farm families in cascade irrigation systems in Sri Lanka associated with elevated dietary cadmium levels in rice and freshwater fish (Tilapia). Environmental Geochemistry and Health, 30, 465–478.

    Article  CAS  Google Scholar 

  • Bandara, J. M., Wijewardena, H. V., Bandara, Y. M., Jayasooriya, R. G., & Rajapaksha, H. (2011). Pollution of River Mahaweli and farmlands under irrigation by cadmium from agricultural inputs leading to a chronic renal failure epidemic among farmers in NCP, Sri Lanka. Environmental Geochemistry and Health, 33, 439–453.

    Article  CAS  Google Scholar 

  • Bandara, J. M., Wijewardena, H. V., Liyanege, J., Upul, M. A., & Bandara, J. M. (2010a). Chronic renal failure in Sri Lanka caused by elevated dietary cadmium: Trojan horse of the green revolution. Toxicology Letters, 198, 33–39.

    Article  CAS  Google Scholar 

  • Bandara, J. M., Wijewardena, H. V., & Seneviratne, H. M. (2010b). Remediation of cadmium contaminated irrigation and drinking water: A large scale approach. Toxicology Letters, 198, 89–92.

    Article  CAS  Google Scholar 

  • Banerjee, K., Senthilkumar, B., Purvaja, R., & Ramesh, R. (2012). Sedimentation and trace metal distribution in selected locations of Sundarbans mangroves and Hooghly estuary, northeast coast of India. Environmental Geochemistry and Health, 34, 27–42.

    Article  CAS  Google Scholar 

  • Berntssen, M. H., Julshamn, K., & Lundebye, A. K. (2010). Chemical contaminants in aquafeeds and Atlantic salmon (Salmo salar) following the use of traditional-versus alternative feed ingredients. Chemosphere, 78, 637–646.

    Article  CAS  Google Scholar 

  • Bosch, T. (1996). Nephrotoxicity and fluoride from the viewpoint of the nephrologist. Anaesthesist, 45(Suppl 1), S41–S45.

    CAS  Google Scholar 

  • Brain, R. A., & Solomon, K. R. (2009). Comparison of the hazards posed to amphibians by the glyphosate spray control program versus the chemical and physical activities of coca production in Colombia. Journal of Toxicology and Environmental Health, Part A, 72, 937–948.

    Article  CAS  Google Scholar 

  • Bruchfeld, A., Carrero, J. J., Qureshi, A. R., Lindholm, B., Barany, P., Heimburger, O., et al. (2009). Elevated serum macrophage migration inhibitory factor (MIF) concentrations in chronic kidney disease (CKD) are associated with markers of oxidative stress and endothelial activation. Molecular Medicine, 15, 70–75.

    Article  CAS  Google Scholar 

  • Caldwell, K., Pan, Y., Mortensen, M. E., Makhmudov, A., Merrill, L., & Moye, J. (2013). Iodine status in pregnant women in the United States: National Children’s Study and National Health and Nutrition Examination Survey. Thyroid, 23, 927–937.

    Article  CAS  Google Scholar 

  • Carpenter, S. R. (2005). Eutrophication of aquatic ecosystems: Biostability and soil phosphorus. Proceedings of the National Academy of Sciences of the United States of America, 102, 10002–10005.

    Article  CAS  Google Scholar 

  • Chandrajith, R., Dissanayake, C. B., Ariyarathna, T., Herath, H. M., & Padmasiri, J. P. (2011a). Dose-dependent Na and Ca in fluoride-rich drinking water—Another major cause of chronic renal failure in tropical arid regions. Science of the Total Environment, 409, 671–675.

    Article  CAS  Google Scholar 

  • Chandrajith, R., Dissanayake, C. B., & Tobschall, H. J. (2005). The abundances of rarer trace elements in paddy (rice) soils of Sri Lanka. Chemosphere, 58, 1415–1420.

    Article  CAS  Google Scholar 

  • Chandrajith, R., Nanayakkara, S., Itai, K., Aturaliya, T. N., Dissanayake, C. B., Abeysekera, T., et al. (2011b). Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: Geographic distribution and environmental implications. Environmental Geochemistry and Health, 33, 267–278.

    Article  CAS  Google Scholar 

  • Charlesworth, S., De Miguel, E., & Ordonez, A. (2011). A review of the distribution of particulate trace elements in urban terrestrial environments and its application to considerations of risk. Environmental Geochemistry and Health, 33, 103–123.

    Article  CAS  Google Scholar 

  • Chen, W., Krage, N., Wu, L., Pan, G., Khosrivafard, M., & Chang, A. C. (2008). Arsenic, cadmium, and lead in California cropland soils: Role of phosphate and micronutrient fertilizers. Journal of Environmental Quality, 37, 689–695.

    Article  CAS  Google Scholar 

  • Chen, S., Xu, M., Ma, Y., & Yang, J. (2007). Evaluation of different phosphate amendments on availability of metals in contaminated soil. Ecotoxicology and Environmental Safety, 67, 278–285.

    Article  CAS  Google Scholar 

  • Chiu, H. F., & Yang, C. Y. (2005). Decreasing trend in renal disease mortality after cessation from arsenic exposure in a previous arseniasis-endemic area in southwestern Taiwan. Journal of Toxicology and Environmental Health, Part A, 68, 319–327.

    Article  CAS  Google Scholar 

  • Clair, E., Linn, L., Travert, C., Amiel, C., Seralini, G. E., & Panoff, J. M. (2012). Effects of Roundup((R)) and glyphosate on three food microorganisms: Geotrichum candidum, Lactococcus lactis subsp. cremoris and Lactobacillus delbrueckii subsp. bulgaricus. Current Microbiology, 64, 486–491.

    Article  CAS  Google Scholar 

  • Cobbett, C., & Goldsbrough, P. (2002). Phytochelatins and metallothioneins: Roles in heavy metal detoxification and homeostasis. Annual Review of Plant Biology, 53, 159–182.

    Article  CAS  Google Scholar 

  • Company, R., Serafim, A., Lopes, B., Cravo, A., Shepherd, T. J., Pearson, G., & Bebianno, M. J. (2008). Using biochemical and isotope geochemistry to understand the environmental and public health implications of lead pollution in the lower Guadiana River, Iberia: A freshwater bivalve study. Science of the Total Environment, 405, 109–119.

    Article  CAS  Google Scholar 

  • Dani, S. U. (2010). Gold, coal and oil. Medical Hypotheses, 74, 534–541.

    Article  CAS  Google Scholar 

  • Daston, G. P., Rehnberg, B. F., Carver, B., & Kavlock, R. J. (1985). Toxicity of sodium fluoride to the postnatally developing rat kidney. Environmental Research, 37, 461–474.

    Article  CAS  Google Scholar 

  • de Burbure, C., Buchet, J. P., Leroyer, A., Nisse, C., Haguenoer, J. M., Mutti, A., et al. (2006). Renal and neurologic effects of cadmium, lead, mercury, and arsenic in children: Evidence of early effects and multiple interactions at environmental exposure levels. Environmental Health Perspectives, 114, 584–590.

    Article  CAS  Google Scholar 

  • Department of Health, UK (1998). Report of the subgroup on bone health, working group on the nutritional status of the population of the Committee on Medical Aspects of Food and Nutrition Policy. In Nutrition and bone health. London.

  • Desalegn, B., Nanayakkara, S., Harada, K. H., Hitomi, T., Chandrajith, R., Karunaratne, U., et al. (2011). Mycotoxin detection in urine samples from patients with chronic kidney disease of uncertain etiology in Sri Lanka. Bulletin of Environment Contamination and Toxicology, 87, 6–10.

    Article  CAS  Google Scholar 

  • Dharmagunawardhane, H. A., & Dissanayake, C. B. (1993). Fluoride problems in Sri Lanka. Environmental Management and Health, 4, 9–16.

    Article  Google Scholar 

  • Dharmawardana, M. W., Amarasiri, S. L., Dharmawardene, N., & Panabokke, C. R. (2014). Chronic kidney disease of unknown aetiology and ground-water ionicity: Study based on Sri Lanka. Environmental Geochemistry and Health, 37, 221–231.

    Article  CAS  Google Scholar 

  • Dissanayake, C. B. (1996). Water quality and dental health in the Dry Zone of Sri Lanka. Geological Society, London, Special Publications, 113, 131–140.

    Article  CAS  Google Scholar 

  • Dissanayake, C. (2005a). Water quality in the dry Zone of Sri Lanka—Some interesting health aspects. Journal of National Science Foundation Sri Lanka, 33, 161–168.

    Google Scholar 

  • Dissanayake, C. B. (2005b). Global voices of science of stones and health: medical geology in Sri Lanka. Science, 309, 883–885.

    Article  CAS  Google Scholar 

  • Dissanayake, C. B., & Chandrajith, R. (2007). Medical geology in tropical countries with special reference to Sri Lanka. Environmental Geochemistry and Health, 29, 155–162.

    Article  CAS  Google Scholar 

  • Dori, O., Humbert, A., Burnier, M., & Teta, D. (2014). Renal risks of dietary complements: A forgotten cause. Revue Medicale Suisse, 10, 498–503.

    Google Scholar 

  • Douard, V., Asgerally, A., Sabbagh, Y., Sugiura, S., Shapses, S. A., Casirola, D., & Ferraris, R. P. (2010). Dietary fructose inhibits intestinal calcium absorption and induces vitamin D insufficiency in CKD. Journal of the American Society of Nephrology, 21, 261–271.

    Article  CAS  Google Scholar 

  • Ece, A., Gurkan, F., Kervancioglu, M., Kocamaz, H., Gunes, A., Atamer, Y., & Selek, S. (2006). Oxidative stress, inflammation and early cardiovascular damage in children with chronic renal failure. Pediatric Nephrology(Berlin, Germany), 21, 545–552.

    Article  Google Scholar 

  • Ellison, C. A., Tian, Y., Knaak, J. B., Kostyniak, P. J., & Olson, J. R. (2012). Human hepatic cytochrome P450-specific metabolism of the organophosphorus pesticides methyl parathion and diazinon. Drug Metabolism and Disposition, 40, 1–5.

    Article  CAS  Google Scholar 

  • Eqani, S. A., Malik, R. N., & Mohammad, A. (2011). The level and distribution of selected organochlorine pesticides in sediments from River Chenab, Pakistan. Environmental Geochemistry and Health, 33, 33–47.

    Article  CAS  Google Scholar 

  • Fatima, S., & Mahmood, R. (2007). Vitamin C attenuates potassium dichromate-induced nephrotoxicity and alterations in renal brush border membrane enzymes and phosphate transport in rats. Clinica Chimica Acta, 386, 94–99.

    Article  CAS  Google Scholar 

  • Ferraro, P. M., Costanzi, S., Naticchia, A., Sturniolo, A., & Gambaro, G. (2010). Low level exposure to cadmium increases the risk of chronic kidney disease: analysis of the NHANES 1999-2006. BMC Public Health, 10, 304.

    Article  CAS  Google Scholar 

  • Fleshner, N., Gomella, L. G., Cookson, M. S., Finelli, A., Evans, A., Taneja, S. S., et al. (2007). Delay in the progression of low-risk prostate cancer: rationale and design of the Reduction by Dutasteride of Clinical Progression Events in Expectant Management (REDEEM) trial. Contemporary Clinical Trials, 28, 763–769.

    Article  CAS  Google Scholar 

  • Food and Drug Administration, U.S.A. (2013). Arsenic in rice and rice products. http://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm319948.htm. 08/04/2014.

  • Ginsberg, G. L. (2012). Cadmium risk assessment in relation to background risk of chronic kidney disease. Journal of Toxicology and Environmental Health, Part A, 75, 374–390.

    Article  CAS  Google Scholar 

  • Grollman, A. P., & Jelakovic, B. (2007). Role of environmental toxins in endemic (Balkan) nephropathy. October 2006, Zagreb, Croatia. Journal of the American Society of Nephrology, 18, 2817–2823.

    Article  CAS  Google Scholar 

  • Gutiérrez, R. L., Rubio-Arias, H., Quintana, R., Ortega, J. A., & Gutierrez, M. (2008). Heavy metals in water of the San Pedro River in Chihuahua, Mexico and its potential health risk. International Journal of Environmental Research and Public Health, 5, 91–98.

    Article  Google Scholar 

  • Heffernan, J. B., Liebowitz, D. M., Frazer, T. K., Evans, J. M., & Cohen, M. J. (2010). Algal blooms and the nitrogen-enrichment hypothesis in Florida springs: evidence, alternatives, and adaptive management. Ecological Applications, 20, 816–829.

    Article  Google Scholar 

  • Heiri, C., Wolf, A., Rohrer, L., & Bugmann, H. (2009). Forty years of natural dynamics in Swiss beech forests: Structure, composition, and the influence of former management. Ecological Applications, 19, 1920–1934.

    Article  CAS  Google Scholar 

  • Hills, L. M., & Johansen, V.C. (2007). Hexavalent chromium in cement manufacturing: Literature review. In edited by SN2983, 16. Skokie, IL: Portland Cement Association.

  • Hippisley-Cox, J., & Coupland, C. (2010). Predicting the risk of chronic kidney disease in men and women in England and Wales: Prospective derivation and external validation of the QKidney Scores. BMC Family Practice, 11, 49.

    Article  Google Scholar 

  • Hirayama, C., Kishimoto, Y., Wakushima, T., & Murawaki, Y. (1983). Mechanism of the protective action of thiol compounds in ethanol-induced liver injury. Biochemical Pharmacology, 32, 321–325.

    Article  CAS  Google Scholar 

  • House, E., Esiri, M., Forster, G., Ince, P. G., & Exley, C. (2012). Aluminium, iron and copper in human brain tissues donated to the Medical Research Council’s Cognitive Function and Ageing Study. Metallomics, 4, 56–65.

    Article  CAS  Google Scholar 

  • Hu, P., Huang, J., Ouyang, Y., Wu, L., Song, J., Wang, S., et al. (2013). Water management affects arsenic and cadmium accumulation in different rice cultivars. Environmental Geochemistry and Health, 35, 767–778.

    Article  CAS  Google Scholar 

  • Hung, C. L., So, M. K., Connell, D. W., Fung, C. N., Lam, M. H., Nicholson, S., et al. (2004). A preliminary risk assessment of trace elements accumulated in fish to the Indo-Pacific Humpback dolphin (Sousa chinensis) in the northwestern waters of Hong Kong. Chemosphere, 56, 643–651.

    Article  CAS  Google Scholar 

  • Hutson, D. H., & Wright, A. S. (1980). The effect of hepatic microsomal monooxygenase induction on the metabolism and toxicity of the organophosphorus insecticide chlorfenvinphos. Chemico-Biological Interactions, 31, 93–101.

    Article  CAS  Google Scholar 

  • Ileperuma, O. A., Dharmagunawardhane, H. A., & Herath, K. P. R. P. (2009). Dissolution of aluminium from sub-standard utensils under high fluoride stress: a possible risk factor for chronic renal failure in the North-Central Province. Journal of National Science Foundation Sri Lanka, 37, 219–222.

    Article  CAS  Google Scholar 

  • Ishaque, A. B., Johnson, L., Gerald, T., Boucaud, D., Okoh, J., & Tchounwou, P. B. (2006). Assessment of individual and combined toxicities of four non-essential metals (As, Cd, Hg and Pb) in the microtox assay. International Journal of Environmental Research and Public Health, 3, 118–120.

    Article  CAS  Google Scholar 

  • Jackson, R. E., & Reddy, K. J. (2007). Trace element chemistry of coal bed natural gas produced water in the Powder River Basin, Wyoming. Environmental Science and Technology, 41, 5953–5959.

    Article  CAS  Google Scholar 

  • Jarup, L. (2003). Hazards of heavy metal contamination. British Medical Bulletin, 68, 167–182.

    Article  Google Scholar 

  • Jarvie, H. P., Sharpley, A. N., Withers, P. J., Scott, J. T., Haggard, B. E., & Neal, C. (2013). Phosphorus mitigation to control river eutrophication: Murky waters, inconvenient truths, and “postnormal” science. Journal of Environmental Quality, 42, 295–304.

    Article  CAS  Google Scholar 

  • Jayasekara, J. M., Dissanayake, D. M., Adhikari, S. B., & Bandara, P. (2013). Geographical distribution of chronic kidney disease of unknown origin in North Central Region of Sri Lanka. Ceylon Medical Journal, 58, 6–10.

    Article  CAS  Google Scholar 

  • Jayasekara, R. S., & Schultz, T. (2007). Health status, trends, and issues in Sri Lanka. Nursing & Health Sciences, 9, 228–233.

    Article  Google Scholar 

  • Jayasekera, J. M. K. B., Dissnayake, D. M., Ratnayake P., Wikramasinghe, W., Radella, Y. A., & Palugaswewa, W. B. (2012). The effects from concentrated water on reservoirs of high prevalence areas on CKD of unknown origin in Sri Lanka on mice (Abst.). Sri Lanka Medical Association annual scientific sessions, 2012.

  • Jayasinghe, S. (2014). Chronic kidney disease of unknown etiology should be renamed chronic agrochemical nephropathy. MEDICC Review, 16, 72–74.

    Google Scholar 

  • Jayasumana, C., Gunatilake, S., & Senanayake, P. (2014). Glyphosate, hard water and nephrotoxic metals: are they the culprits behind the epidemic of chronic kidney disease of unknown etiology in Sri Lanka? International Journal of Environmental Research and Public Health, 11, 2125–2147.

    Article  Google Scholar 

  • Jayasumana, C., Gunatilake, S., & Siribaddana, S. (2015). Simultaneous exposure to multiple heavy metals and glyphosate may contribute to Sri Lankan agricultural nephropathy. BMC Nephrology, 16, 103.

    Article  CAS  Google Scholar 

  • Jayasumana, M. A. C. S., Paranagama, P. A., Amarasinghe, M. D., Wijewardane, K. M. R. C., Dahanayake, K. S., Fonseka, S. I., et al. (2013). Possible link of chronic arsenic toxicity with chronic kidney disease of unknown etiology in Sri Lanka. Journal of Natural Sciences Research, 3, 64–73.

    Google Scholar 

  • Jayathilaka, N., Maheepala, P., Mendis, S., Mehta, F. R., Dissanayake, L. J., & Janakan, N. (2013). WHO-CKDu-final report. WHO Sri Lanka CKDu report: Chronic kidney disease of unknown aetiology (CKDu): A new threat to health. http://dh-web.org/place.names/posts/index.html#ckdu. http://www.lankaweb.com/news/items12/WHO%20final%20report%20on%20CKDu%20SL.pdf. World Health Organization. http://dh-web.org/place.names/posts/index.html#ckdu.

  • Jayatilake, N., Mendis, S., Maheepala, P., & Mehta, F. R. (2013). Chronic kidney disease of uncertain aetiology: prevalence and causative factors in a developing country. BMC Nephrology, 14, 180.

    Article  Google Scholar 

  • Jia, H., Cheng, S., Ding, J., & Li, J. (2001). Relationship between eutrophication control and reservoir operation. Huan Jing Ke Xue, 22, 104–107.

    CAS  Google Scholar 

  • Jimenez, Carlos A., Roncal, Takuji Ishimoto, Lanaspa, Miguel A., Rivard, Christopher J., Takahiko Nakagawa, A., Ejaz, Ahsan, et al. (2014). Fructokinase activity mediates dehydration-induced renal injury. Kidney International, 86, 294–302.

    Article  CAS  Google Scholar 

  • Komarnicki, G. J. (2005). Lead and cadmium in indoor air and the urban environment. Environmental Pollution, 136, 47–61.

    Article  CAS  Google Scholar 

  • Krasnici, N., Dragun, Z., Erk, M., & Raspor, B. (2013). Distribution of selected essential (Co, Cu, Fe, Mn, Mo, Se, and Zn) and nonessential (Cd, Pb) trace elements among protein fractions from hepatic cytosol of European chub (Squalius cephalus L.). Environmental Science and Pollution Research International, 20, 2340–2351.

    Article  CAS  Google Scholar 

  • Langston, C. E., & Heuter, K. J. (2003). ‘Leptospirosis. A re-emerging zoonotic disease’, Vet Clin North Am Small Anim Pract, 33, 791–807.

    Article  Google Scholar 

  • Lantz, O., Jouvin, M. H., De Vernejoul, M. C., & Druet, P. (1987). Fluoride-induced chronic renal failure. American Journal of Kidney Diseases, 10, 136–139.

    Article  CAS  Google Scholar 

  • Larsen, K., Najle, R., Lifschitz, A., & Virkel, G. (2012). Effects of sub-lethal exposure of rats to the herbicide glyphosate in drinking water: glutathione transferase enzyme activities, levels of reduced glutathione and lipid peroxidation in liver, kidneys and small intestine. Environmental Toxicology and Pharmacology, 34, 811–818.

    Article  CAS  Google Scholar 

  • Lawley, S. D., Cinderella, M., Hall, M. N., Gamble, M. V., Nijhout, H. F., & Reed, M. C. (2011). Mathematical model insights into arsenic detoxification. Theoretical Biology and Medical Modelling, 8, 31.

    Article  CAS  Google Scholar 

  • Lee, C. (2012). Arsenic exposure, metabolism and health effects. University of Alberta. http://www.ualberta.ca/~xcle/publications.html.

  • Levine, R., Hirayama, B., & Wright, E. M. (1984). Sensitivity of renal brush-border Na + -cotransport systems to anions. Biochimica et Biophysica Acta, 769, 508–510.

    Article  CAS  Google Scholar 

  • Li, Y., Cao, W., Su, C., & Hong, H. (2011a). Nutrient sources and composition of recent algal blooms and eutrophication in the northern Jiulong River, Southeast China. Marine Pollution Bulletin, 63, 249–254.

    Article  CAS  Google Scholar 

  • Li, C., Kang, S., Zhang, Q., Gao, S., & Sharma, C. M. (2011b). Heavy metals in sediments of the Yarlung Tsangbo and its connection with the arsenic problem in the Ganges-Brahmaputra Basin. Environmental Geochemistry and Health, 33, 23–32.

    Article  CAS  Google Scholar 

  • Lorgelly, P. K., Lawson, K. D., Fenwick, E. A., & Briggs, A. H. (2010). Outcome measurement in economic evaluations of public health interventions: A role for the capability approach? International Journal of Environmental Research and Public Health, 7, 2274–2289.

    Article  Google Scholar 

  • Madden, E. F., & Fowler, B. A. (2000). Mechanisms of nephrotoxicity from metal combinations: A review. Drug and Chemical Toxicology, 23, 1–12.

    Article  CAS  Google Scholar 

  • Mahathir, M. (1998). Crises in national leadership? Integration, 57, 18–20.

    Google Scholar 

  • Malluche, H. H. (2002). Aluminium and bone disease in chronic renal failure. Nephrology, Dialysis, Transplantation, 17(Suppl 2), 21–24.

    Article  CAS  Google Scholar 

  • Masubuchi, Y., Nakayama, J., & Sadakata, Y. (2011). Protective effects of exogenous glutathione and related thiol compounds against drug-induced liver injury. Biological & Pharmaceutical Bulletin, 34, 366–370.

    Article  CAS  Google Scholar 

  • McBride, A. J., Athanazio, D. A., Reis, M. G., & Ko, A. I. (2005). Leptospirosis. Current Opinion in Infectious Diseases, 18, 376–386.

    Article  Google Scholar 

  • Meharg, A. A., & Rahman, M. M. (2003). Arsenic contamination of Bangladesh paddy field soils: Implications for rice contribution to arsenic consumption. Environmental Science and Technology, 37, 229–234.

    Article  CAS  Google Scholar 

  • Mendis, D. L. O. (2002). Water heritage of Sri Lanka. Colombo: Sri Lanka Pugwash Group.

    Google Scholar 

  • Mesnage, R., Bernay, B., & Seralini, G. E. (2013). Ethoxylated adjuvants of glyphosate-based herbicides are active principles of human cell toxicity. Toxicology, 313, 122–128.

    Article  CAS  Google Scholar 

  • Mijal, R. S., & Holzman, C. B. (2010). Blood cadmium levels in women of childbearing age vary by race/ethnicity. Environmental Research, 110, 505–512.

    Article  CAS  Google Scholar 

  • Mitra, A. K., Haque, A., Islam, M., & Bashar, S. A. (2009). Lead poisoning: An alarming public health problem in Bangladesh. International Journal of Environmental Research and Public Health, 6, 84–95.

    Article  CAS  Google Scholar 

  • Mizumura, A., Watanabe, T., Kobayashi, Y., & Hirano, S. (2010). Identification of arsenite-and arsenic diglutathione-binding proteins in human hepatocarcinoma cells. Toxicology and Applied Pharmacology, 242, 119–125.

    Article  CAS  Google Scholar 

  • Morgan, W. K., Reger, R. B., & Tucker, D. M. (1997). Health effects of diesel emissions. Annals of Occupational Hygiene, 41, 643–658.

    Article  CAS  Google Scholar 

  • Mortensen, M. E., Wong, L. Y., & Osterloh, J. D. (2011). Smoking status and urine cadmium above levels associated with subclinical renal effects in U.S. adults without chronic kidney disease. International Journal of Hygiene and Environmental Health, 214, 305–310.

    Article  CAS  Google Scholar 

  • Nagarajah, S., Emerson, B. N., Abeykoon, V., & Yogalingam, S. (1988). Water quality of some wells in Jaffna and Kilinochchi with special reference to nitrate pollution. Tropical Agriculturist, 144, 61–78.

    Google Scholar 

  • Nair, P. K. (2011). Agroforestry systems and environmental quality: Introduction. Journal of Environmental Quality, 40, 784–790.

    Article  CAS  Google Scholar 

  • Nanayakkara, S., Komiya, T., Ratnatunga, N., Senevirathna, S. T., Harada, K. H., Hitomi, T., et al. (2012a). Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farmers in North Central Province of Sri Lanka. Environmental Health and Preventive Medicine, 17, 213–221.

    Article  Google Scholar 

  • Nanayakkara, S., Senevirathna, S. T., Abeysekera, T., Chandrajith, R., Ratnatunga, N., Gunarathne, E. D., et al. (2014a). An integrative study of the genetic, social and environmental determinants of chronic kidney disease characterized by tubulointerstitial damages in the North Central Region of Sri Lanka. Journal of Occupational Health, 56, 28–38.

    Article  CAS  Google Scholar 

  • Nanayakkara, S., Senevirathna, S. T., Abeysekera, T., Chandrajith, R., Ratnatunga, N., Gunarathne, E. D., et al. (2014b). An integrative study of the genetic, social and environmental determinants of chronic kidney disease characterized by tubulointerstitial damages in the North Central Region of Sri Lanka. J Occup Health, 56, 28–38.

    Article  CAS  Google Scholar 

  • Nanayakkara, S., Senevirathna, S. T., Karunaratne, U., Chandrajith, R., Harada, K. H., Hitomi, T., et al. (2012b). Evidence of tubular damage in the very early stage of chronic kidney disease of uncertain etiology in the North Central Province of Sri Lanka: A cross-sectional study. Environmental Health and Preventive Medicine, 17, 109–117.

    Article  Google Scholar 

  • Nogue, S., Sanz-Gallen, P., Torras, A., & Boluda, F. (2004). Chronic overexposure to cadmium fumes associated with IgA mesangial glomerulonephritis. Occupational Medicine (London), 54, 265–267.

    Article  Google Scholar 

  • Norville, W. (2005). Spatial distribution of heavy metals in sediments from the Gulf of Paria, Trinidad. Revista de Biologia Tropical, 53(Suppl 1), 33–40.

    Google Scholar 

  • Noyes, P. D., McElwee, M. K., Miller, H. D., Clark, B. W., Van Tiem, L. A., Walcott, K. C., et al. (2009). The toxicology of climate change: Environmental contaminants in a warming world. Environment International, 35, 971–986.

    Article  CAS  Google Scholar 

  • Null, S. E., Medellin-Azuara, J., Escriva-Bou, A., Lent, M., & Lund, J. R. (2014). Optimizing the dammed: water supply losses and fish habitat gains from dam removal in California. Journal of Environmental Management, 136, 121–131.

    Article  Google Scholar 

  • Orisakwe, O. E., Njan, A. A., Afonne, O. J., Akumka, D. D., Orish, V. N., & Udemezue, O. O. (2004). Investigation into the nephrotoxicity of Nigerian bonny light crude oil in albino rats. International Journal of Environmental Research and Public Health, 1, 106–110.

    Article  CAS  Google Scholar 

  • Paerl, H. W., & Otten, T. G. (2013). Harmful cyanobacterial blooms: Causes, consequences, and controls. Microbial Ecology, 65, 995–1010.

    Article  CAS  Google Scholar 

  • Palaneeswari, M. S., Rajan, P. M., Silambanan, S., & Jothimalar, (2013). Blood arsenic and cadmium concentrations in end-stage renal disease patients who were on maintenance haemodialysis. Journal of Clinical and Diagnostic Research, 7, 809–813.

    Google Scholar 

  • Park, S. H., Lee, Y. J., Lim, M. J., Kim, E. J., Lee, J. H., & Han, H. J. (2004). High glucose inhibits fructose uptake in renal proximal tubule cells: Involvement of cAMP, PLC/PKC, p44/42 MAPK, and cPLA2. Journal of Cellular Physiology, 200, 407–416.

    Article  CAS  Google Scholar 

  • Partanen, S. (2002). Inhibition of human renal acid phosphatases by nephrotoxic micromolar concentrations of fluoride. Experimental and Toxicologic Pathology, 54, 231–237.

    Article  CAS  Google Scholar 

  • Payne, K. B., & Abdel-Fattah, T. M. (2005). Adsorption of arsenate and arsenite by iron-treated activated carbon and zeolites: effects of pH, temperature, and ionic strength. Journal of Environmental Science and Health, 40, 723–749.

    Article  CAS  Google Scholar 

  • Peiris-John, R. J., Wanigasuriya, J. K., Wickremasinghe, A. R., Dissanayake, W. P., & Hittarage, A. (2006). Exposure to acetylcholinesterase-inhibiting pesticides and chronic renal failure. Ceylon Medical Journal, 51, 42–43.

    CAS  Google Scholar 

  • Radcliffe, D., & Cabrera, M. (2006). Modeling phosphorus in the environment. Boca Raton: CRC Press.

    Book  Google Scholar 

  • Rahman, M. M., Chowdhury, U. K., Mukherjee, S. C., Mondal, B. K., Paul, K., Lodh, D., et al. (2001). Chronic arsenic toxicity in Bangladesh and West Bengal, India—a review and commentary. Journal of Toxicology - Clinical Toxicology, 39, 683–700.

    Article  CAS  Google Scholar 

  • Redmon, J. H., Elledge, M. F., Womack, D. S., Wickremashinghe, R., Wanigasuriya, K. P., Peiris-John, R. J., et al. (2014). Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka–lessons learned from the WHO CKDu population prevalence study. BMC Nephrology, 15, 125.

    Article  Google Scholar 

  • Roman, R. J., Carter, J. R., North, W. C., & Kauker, M. L. (1977). Renal tubular site of action of fluoride in Fischer 344 rats. Anesthesiology, 46, 260–264.

    Article  CAS  Google Scholar 

  • Rush, G. F., & Willis, L. R. (1982). Renal tubular effects of sodium fluoride. Journal of Pharmacology and Experimental Therapeutics, 223, 275–279.

    CAS  Google Scholar 

  • Rychetnik, L., Frommer, M., Hawe, P., & Shiell, A. (2002). Criteria for evaluating evidence on public health interventions. Journal of Epidemiology and Community Health, 56, 119–127.

    Article  CAS  Google Scholar 

  • Sabath, E., & Robles-Osorio, M. L. (2012). Renal health and the environment: Heavy metal nephrotoxicity. Nefrologia, 32, 279–286.

    Google Scholar 

  • Sabolic, I. (2006). Common mechanisms in nephropathy induced by toxic metals. Nephron Physiology, 104, 107–114.

    Article  CAS  Google Scholar 

  • Senevirathna, L., Abeysekera, T., Nanayakkara, S., Chandrajith, R., Ratnatunga, N., Harada, K. H., et al. (2012). Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka. Environmental Health and Preventive Medicine, 17, 191–198.

    Article  Google Scholar 

  • Sexton, K., & Hattis, D. (2007). Assessing cumulative health risks from exposure to environmental mixtures—Three fundamental questions. Environmental Health Perspectives, 115, 825–832.

    Article  CAS  Google Scholar 

  • Shasha, S. M. (2005). Medicine in the concentration camps of the Third Reich. Harefuah, 144(291–5), 301.

    Google Scholar 

  • Siriwardhana, E. A., Perera, P. A., Sivakanesan, R., Abeysekara, T., Nugegoda, D. B., & Weerakoon, K. G. (2014). Is the staple diet eaten in Medawachchiya, Sri Lanka, a predisposing factor in the development of chronic kidney disease of unknown etiology? A comparison based on urinary beta2-microglobulin measurements. BMC Nephrology, 15, 103.

    Article  CAS  Google Scholar 

  • Siscar, R., Koenig, S., Torreblanca, A., & Sole, M. (2014). The role of metallothionein and selenium in metal detoxification in the liver of deep-sea fish from the NW Mediterranean Sea. Science of the Total Environment, 466–467, 898–905.

    Article  CAS  Google Scholar 

  • Smith, V. H., Tilman, G. D., & Nekola, J. C. (1999). Eutrophication: impacts of excess nutrient inputs on freshwater, marine, and terrestrial ecosystems. Environmental Pollution, 100, 179–196.

    Article  CAS  Google Scholar 

  • Sommar, J. N., Svensson, M. K., Bjor, B. M., Elmstahl, S. I., Hallmans, G., Lundh, T., et al. (2013). End-stage renal disease and low level exposure to lead, cadmium and mercury; a population-based, prospective nested case-referent study in Sweden. Environ Health, 12, 9.

    Article  CAS  Google Scholar 

  • Stefanovic, V., Cukuranovic, R., Miljkovic, S., Marinkovic, D., & Toncheva, D. (2009). Fifty years of Balkan endemic nephropathy: Challenges of study using epidemiological method. Renal Failure, 31, 409–418.

    Article  Google Scholar 

  • Stroud, J. L., Norton, G. J., Islam, M. R., Dasgupta, T., White, R. P., Price, A. H., et al. (2011). The dynamics of arsenic in four paddy fields in the Bengal delta. Environmental Pollution, 159, 947–953.

    Article  CAS  Google Scholar 

  • Sun, G., & Sheng, L. (2001). Ecological engineering for eutrophication control in lake. Ying Yong Sheng Tai Xue Bao, 12, 590–592.

    CAS  Google Scholar 

  • Talukder, A. S., Meisner, C. A., Sarkar, M. A., Islam, M. S., Sayre, K. D., Duxbury, J. M., & Lauren, J. G. (2012). ‘Effect of water management, arsenic and phosphorus levels on rice in a high-arsenic soil–water system: II. Arsenic uptake. Ecotoxicology and Environmental Safety, 80, 145–151.

    Article  CAS  Google Scholar 

  • Teuten, E. L., Saquing, J. M., Knappe, D. R., Barlaz, M. A., Jonsson, S., Bjorn, A., et al. (2009). Transport and release of chemicals from plastics to the environment and to wildlife. Philosophical Transactions of the Royal Society of London. Series B, Biological sciences, 364, 2027–2045.

    Article  CAS  Google Scholar 

  • Thawornchaisit, U., & Polprasert, C. (2009). Evaluation of phosphate fertilizers for the stabilization of cadmium in highly contaminated soils. Journal of Hazardous Materials, 165, 1109–1113.

    Article  CAS  Google Scholar 

  • Thomas, L. D., Elinder, C. G., Wolk, A., & Akesson, A. (2014). Dietary cadmium exposure and chronic kidney disease: A population-based prospective cohort study of men and women. International Journal of Hygiene and Environmental Health, 217, 720–725.

    Article  CAS  Google Scholar 

  • Thomas, P., & Wofford, H. W. (1984). Effects of metals and organic compounds on hepatic glutathione, cysteine, and acid-soluble thiol levels in mullet (Mugil cephalus L.). Toxicology and Applied Pharmacology, 76, 172–182.

    Article  CAS  Google Scholar 

  • Thompson, R. C., Moore, C. J., vom Saal, F. S., & Swan, S. H. (2009). Plastics, the environment and human health: Current consensus and future trends. Philosophical Transactions of the Royal Society of London. Series B, Biological sciences, 364, 2153–2166.

    Article  CAS  Google Scholar 

  • Tracy, D., & Backer, B. (2003). Heavy metals in fertilisers used in organic production.

  • Tracy, D., & Baker, B. (2008). Heavy metals in fertilizers.

  • Valverde, J. L., Lobato, J., Fernandez, I., Marijuan, L., Periz-Mohedano, S., & Talero, R. (2005). Ferrous sulphate mono and heptahydrate reduction of hexavalent chromium in cement: Effectiveness and storability. Materiales de Construction, 279(55), 39–52.

    Article  Google Scholar 

  • Wahlqvist, M. L., & Kuo, K. N. (2009). Securing health through food systems: An initiative of the nutrition consortium of the National Health Research Institutes in Taiwan and Asia Pacific regional partners as a network. Asia Pacific Journal of Clinical Nutrition, 18, 472–479.

    Google Scholar 

  • Wang, X., Li, T., Xu, A., & He, W. (2001). ‘Study of the distribution of non-point source pollution in the watershed of the Miyun Reservoir, Beijing, China. Water Science and Technology, 44, 35–40.

    CAS  Google Scholar 

  • Wanigasuriya, K. P. (2012). Aetiological factors of chronic kidney disease in the north central province of Sri Lanka: A review of evidence to-date. J College Community Physicians Sri Lanka, 17, 15–20.

    Article  Google Scholar 

  • Wanigasuriya, K. (2014). Update on uncertain etiology of chronic kidney disease in Sri Lanka’s north-central dry zone. MEDICC Rev, 16, 61–65.

    Google Scholar 

  • Wanigasuriya, K. P., Peiris, H., Ileperuma, N., Peiris-John, R. J., & Wickremasinghe, R. (2008). Could ochratoxin A in food commodities be the cause of chronic kidney disease in Sri Lanka? Transactions of the Royal Society of Tropical Medicine and Hygiene, 102, 726–728.

    Article  Google Scholar 

  • Wanigasuriya, K. P., Peiris-John, R. J., & Wickremasinghe, R. (2011). Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause? BMC Nephrology, 12, 32.

    Article  Google Scholar 

  • Wanigasuriya, K. P., Peiris-John, R. J., Wickremasinghe, R., & Hittarage, A. (2007). Chronic renal failure in North Central Province of Sri Lanka: An environmentally induced disease. Transactions of the Royal Society of Tropical Medicine and Hygiene, 101, 1013–1017.

    Article  Google Scholar 

  • Weber, R., Watson, A., Forter, M., & Oliaei, F. (2011). Review article: Persistent organic pollutants and landfills—A review of past experiences and future challenges. Waste Management and Research, 29, 107–121.

    Article  CAS  Google Scholar 

  • Wedeen, R. P., & Qian, L. F. (1991). Chromium-induced kidney disease. Environmental Health Perspectives, 92, 71–74.

    Article  CAS  Google Scholar 

  • Whitford, G. M., Pashley, D. H., & Stringer, G. I. (1976). Fluoride renal clearance: A pH-dependent event. American Journal of Physiology, 230, 527–532.

    CAS  Google Scholar 

  • Wickremasinghe, A. R., Peiris-John, R. J., & Wanigasuriya, K. P. (2011). Chronic kidney disease of unknown aetiology in the North Central Province of Sri Lanka: Trying to unravel the mystery. Ceylon Medical Journal, 56, 143–146.

    CAS  Google Scholar 

  • Wijetunge, S., Ratnatunga, N. V., Abeysekera, D. T., Wazil, A. W., Selvarajah, M., & Ratnatunga, C. N. (2013). Retrospective analysis of renal histology in asymptomatic patients with probable chronic kidney disease of unknown aetiology in Sri Lanka. Ceylon Medical Journal, 58, 142–147.

    Article  CAS  Google Scholar 

  • Wijewickrama, E. S., Weerasinghe, D., Sumathipala, P. S., Horadagoda, C., Lanarolle, R. D., & Sheriff, R. M. (2011). Epidemiology of chronic kidney disease in a Sri Lankan population: Experience of a tertiary care center. Saudi Journal of Kidney Diseases and Transplantation, 22, 1289–1293.

    Google Scholar 

  • Wimalawansa, S. J. (2013a). Knocking the kidney killer. Daily News. http://www.dailynews.lk/features/knocking-kidney-killer.

  • Wimalawansa, S. J. (2013b). Olcott Oration-2013: https://wimalawansa.org/sites/all/files/Olcott_Oration_2013_b.pdf, https://Wimalawansa.org.

  • Wimalawansa, S. J. (2013c). Purification of contaminated water with reverse osmosis: Effective solution of providing clean water for human needs in developing countries. Journal of Emerging Technology and Advanced Engineering, 3, 75–89.

    Google Scholar 

  • Wimalawansa, S. J. (2013d). Water pollution-associated ill health: Special emphasis on chronic kidney disease in Sri Lanka. In Olcott memorial oration (pp. 1–12). Colombo, Sri Lanka: Ananda Collage. https://wimalawansa.org/sites/all/files/Olcott_Oration_2013_b.pdf; http://www.anandacollege.net/document/14011809Olcott%20Oration%20Book.pdf.

  • Wimalawansa, S. J. (2014a). Escalating chronic kidney diseases in Sri Lanka: Causes, solutions and recommendations. Environmental Health and Preventive Medicine, 19, 375–394.

    Article  Google Scholar 

  • Wimalawansa, S. J. (2014b). Prevention of CKD of multi-factorial origin (CKD-mfo): Issues, gravity, & the importance of early diagnosis. In R. Dissanayake (Ed.), 5th International conference on sustainable built environment; “Environment pollution of prevention of CKD-mfo in Sri Lanka” (pp. 22–26). Kandy, Sri Lanka: ICSBE.

  • Wimalawansa, S. J. (2015a). Agrochemicals and chronic kidney disease of multifactorial origin: Environmentally induced occupational exposure disease. International Journal of Nephrology and Kidney Failure, 1, 1–9.

    Google Scholar 

  • Wimalawansa, S. J. (2015b). Escalating chronic kidney diseases of multi-factorial origin (CKD-mfo) in Sri Lanka: Causes, solutions, and recommendations-update and responses. Environmental Health and Preventive Medicine, 20, 152–157.

    Article  Google Scholar 

  • Wimalawansa, S. J. (2015c). Obesity and type 2 diabetes: Preventing complications. Journal of Diabetes, Metabolic Disorders & Control, 2, 47–50.

    Google Scholar 

  • Wimalawansa, S. A., & Wimalawansa, S. J. (2014a). Impact of changing agricultural practices on human health: Chronic kidney disease of multi-factorial origin in Sri Lanka. Wudpecker: Journal of Agricultural Research, 3, 110–124.

    Google Scholar 

  • Wimalawansa, S. A., & Wimalawansa, S. J. (2014b). Agrochemical-related environmental pollution: Effects on human health. Global Journal of Biology, Agriculture and Health Sciences, 3, 72–83.

    Google Scholar 

  • Wimalawansa, S. A., & Wimalawansa, S. J. (2014c). Water pollution associated occupational diseases: Special emphasis on chronic kidney disease of multifactorial origin (CKDmfo/CKDu). Jacob Journal of Environmental Science (submitted).

  • Wimalawansa, S. A., & Wimalawansa, S. J. (2015a). Clean water, healthy environment, and preservation of watersheds: Correct, enforceable policies are essential. Jacobs Journal of Hydrology, 1, 3–15.

    Google Scholar 

  • Wimalawansa, S. A., & Wimalawansa, S. J. (2015b). Protection of watersheds and control of fertilisers to prevent phosphate eutrophication of reservoirs in Sri Lanka. International Journal of Research in Environmental Science, 1, 1–17.

    Google Scholar 

  • Wimalawansa, S. J., & Wimalawansa, S. A. (2015c). Chronic kidney disease of multifactorial origin (CKDmfo) in Sri Lanka: Escalating incidence and long-term survival estimates. Agricultural Science and Research Journal (submitted).

  • World Health Organization. (2011). World Health Organization Guidelines for drinking-water quality. Geneva: World Health Organization.

    Google Scholar 

  • World Health Organization. (2013). Water sanitation health: Chemical hazards in drinking-water. WHO, Geneva. http://www.who.int/water_sanitation_health/dwq/chemicals/en/index.html.

  • World Bank. (2013). Fertilizer consumption (kilograms per hectare of arable land). [http://data.worldbank.org/indicator/AG.CON.FERT.ZS]’.

  • Woskie, S. R., Kalil, A., Bello, D., & Virji, M. A. (2002). Exposures to quartz, diesel, dust, and welding fumes during heavy and highway construction. AIHA Journal (Fairfax, VA), 63, 447–457.

    Article  CAS  Google Scholar 

  • WritingGroup. (1992). Environmental problems and developing countries. Finance and Development, 29, 22–23.

    Google Scholar 

  • Wyne, K., & Wimalawansa, S. J. (2014). Screening and diagnosis of chronic tubular kidney disease of multi-factorial origin. In R. Dissanayake (Ed.), 5th International conference on sustainable built environment; environment pollution of prevention of CKD-mfo in Sri Lanka (pp. 11–13). Kandy, Sri Lanka: ICSBE.

  • Yaghi, B., & Abdul-Wahab, S. A. (2003). Assessment of lead, zinc, copper, nickel and chromium in total suspended particulate matter from the workplace in Al-Rusayl Industrial Estate, Oman. Journal of Environmental Monitoring, 5, 950–952.

    Article  CAS  Google Scholar 

  • Yamanouchi, T., Shinohara, T., Ogata, N., Tachibana, Y., Akaoka, I., & Miyashita, H. (1996). Common reabsorption system of 1,5-anhydro-d-glucitol, fructose, and mannose in rat renal tubule. Biochimica et Biophysica Acta, 1291, 89–95.

    Article  Google Scholar 

  • Zhang, X., Izaurralde, R. C., Arnold, J. G., Williams, J. R., & Srinivasan, R. (2013). Modifying the soil and water assessment tool to simulate cropland carbon flux: model development and initial evaluation. Science of the Total Environment, 463–464, 810–822.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

I am grateful to the constructive suggestions made by Drs. Manjula Bandara and Douglas Olcott, and Ms. Chamandika Warusavitharana in early versions of this manuscript. For the past 17 years, author has been studying issues related to water contamination, escalating chronic diseases, the prevention of environmental pollution, and the provision of education and clean water to prevent the propagation of CKDmfo and other non-communicable diseases in Sri Lanka.

Author information

Authors and Affiliations

  1. Cardio-Metabolic Institute, Somerset, NJ, 08873, USA

    Sunil J. Wimalawansa

Authors
  1. Sunil J. Wimalawansa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sunil J. Wimalawansa.

Ethics declarations

Conflict of interest

The author has no conflicts of interest. There is no funding associated with this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wimalawansa, S.J. The role of ions, heavy metals, fluoride, and agrochemicals: critical evaluation of potential aetiological factors of chronic kidney disease of multifactorial origin (CKDmfo/CKDu) and recommendations for its eradication. Environ Geochem Health 38, 639–678 (2016). https://doi.org/10.1007/s10653-015-9768-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10653-015-9768-y

Keywords

Search

Navigation