title: Chronic kidney disease of unknown aetiology and ground-water ionicity: study based on Sri Lanka.
abstract: High incidence of chronic kidney disease of unknown aetiology (CKDU) in Sri Lanka is shown to correlate with the presence of irrigation works and rivers that bring-in 'nonpoint source' fertilizer runoff from intensely agricultural regions. We review previous attempts to link CKDU with As, Cd and other standard toxins. Those studies (e.g. the WHO-sponsored study), while providing a wealth of data, are inconclusive in regard to aetiology. Here, we present new proposals based on increased ionicity of drinking water due to fertilizer runoff into the river system, redox processes in the soil and features of 'tank'-cascades and aquifers. The consequent chronic exposure to high ionicity in drinking water is proposed to debilitate the kidney via a Hofmeister-type (i.e. protein-denaturing) mechanism.
authors.affiliation: National Research Council, Ottawa, ON, K1A 0R6, Canada, chandre.dharma-wardana@nrc-cnrc.gc.ca.
authors.forename: M W C
authors.initials: MW
authors.lastname: Dharma-Wardana
authors.forename: Sarath L
authors.initials: SL
authors.lastname: Amarasiri
authors.forename: Nande
authors.initials: N
authors.lastname: Dharmawardene
authors.forename: C R
authors.initials: CR
authors.lastname: Panabokke
mesh_terms: D060766:Drinking Water / Q000737:chemistry*; D005308:Fertilizers / Q000633:toxicity; D060587:Groundwater / Q000737:chemistry*; D006801:Humans; D007477:Ions; D010084:Oxidation-Reduction; D011485:Protein Binding; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced* / Q000453:epidemiology; D012307:Risk Factors; D045483:Rivers / Q000737:chemistry; D012987:Soil / Q000737:chemistry; D013188:Sri Lanka / Q000453:epidemiology; D014874:Water Pollutants, Chemical / Q000032:analysis* / Q000633:toxicity; D014877:Water Pollution, Chemical
chemical_list: D060766:Drinking Water; D005308:Fertilizers; D007477:Ions; D012987:Soil; D014874:Water Pollutants, Chemical