Hardness, Arsenic and Prevalence of CKDu Prof. Priyani Paranagama - PowerPoint PPT Presentation

Potential Link between Ground Water Hardness, Arsenic and Prevalence of CKDu Prof. Priyani Paranagama Senior Professor & Chair of Chemistry University of Kelaniya Kelaniya

Members of the research team • Prof. Priyani Paranagama -Chemistry - Uni. of Kelaniya • Prof. Mala Amarasinghe- Botany - Univ. of Kelaniya • Mr. Saranga Fonseka – Faculty of Science, University of Kelaniya • Dr. Channa Jayasumana - Faculty of Medicine, Rajarata University • Ashwin Fernando , Collage of Chemical Science, Institute of Chemistry, Celon. • Ms. Kumudika Jayalath , University of Kelaniya Team of medical doctors • Dr. Chinthaka Wijewardhane - Former MOIC-Padavi Sripura Hospital • Dr. Kumudu Dahanayake - Former JMO-Monaragala DGH • Dr. Dananjaya Samarasinghe - Karawanella Base Hospital • Dr. Panduka Mahamithawa - Faculty of Medicine,Rajarata University • Dr. Lakshitha Rajakaruna - Faculty of Medicine, Rajarata University • University of Ruhuna • Dr. Mangala de Silva, Department of Zoology

Why? 1) unique geographical distribution of the CKDu 2) there was no CKDu 20-25 years back

Initiated in December 2010 • With the concurrence of Ethics Committee of the Faculty of Medicine and Allied Sciences of Rajarata University of Sri Lanka. • Written informed consent was obtained from all the individuals who have participated in the study. • Literature Search on Causative Factors for CKDu

Objectives of the present study • To investigate the link between water hardness and prevalence of CKDu • To determine the prevalence of clinical features and analysis the arsenic content in biological and environmental samples • To investigate the sources of arsenic contamination in the environment and biological samples

Clinical assessments of our Study Study areas; Endemic areas : Padavi-Sripura, Anuradhapura urban area, Polpithigama, Nikawewa, Mahawa-Siyambangamuwa, Medawachchiya, Matale, Kebithigollawa (Gonameriyawa) Nonendemic areas: Gampaha and Pasgoda

Endemic areas

Nonendemic areas: Gampaha and Pasgoda

Clinical assessments • Total no. of participants in the study (n) = 1293 • Endemic areas: CKDu cases - 801 & Controls – 346 • Non endemic areas : 146 • A door-to-door survey to gather background information on CKDu patients among the villagers • Questionnaire form was used for the survey • All subjects were interviewed • Urine ACR were obtained and recorded • Socio - demographic variables and Anthropometric characteristic, blood pressure and pulse recording of all subjects were obtained

Statistical analysis • MINITAB 14 statistical software • Data obtained from CKDu cases in endemic area, controls in endemic and nonendemic area ; age, sex, education, occupation, type of agriculture, source of drinking water, use of agrochemicals were statistically analyzed . • Linear regression analysis and correlation of water hardness and number of CKDu patients were statistically analyzed • p values less than 0.05 were considered statistically significant.

• At the beginning of the study, all selected house holds were mapped using Global Positioning System (GPS) Moragollagama Nikawewa

Siyabakangamuwa

Socio - demographic variables of CKDu cases • Gender – Male 85 % – Female 15 % 15% male female 85%

Age breakdown of the CKDu patients 250 CKDu primarily affects middle-aged 200 farmers. 150 No. of CKDu Cases 100 50 0 15 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 50 51 - 60 61 -70 71 - 80 80-90 Age category

Level of education of CKDu cases – Grade 1 to grade 5 21. 4 % – Grade 6 to Grade 10 46. 2 % – Up to O/L 18.3 % – Up to A/L 13.5 % – Degree or above 0.6 %

Employment status Farmers 77.5 % House wives 14.2 % Office employee 08.3 % (farmers) Marital status Single 38.4 % Married 61.6 %

Source of Drinking water Well water - 92 % Tube wells – 08 % Type of agriculture - Use of Agrochemicals 100 % The farming communities are predominantly affected; of which more than 90% live in rural areas Kristina Jakobsson & Channa Jayasuman (2013) Chronic Kidney Disease of Unknown origin in Sri Lanka, Proceedings of the First International Research Workshop on Mesoamerican Nephrophathy, Central American Institute for Studies on Toxic Substances (IRET-UNA) and Program on Work, Environment and Health in Central America (SALTRA), Editors: Catharina Wesseling, Jennifer Crowe, Christer Hogstedt, Kristina Jakobsson, Rebekah Lucas and David Wegman, 28-30 November, Costa Rica, pp 53.

Hardness of water from endemic area and nonendemic area Collection of water samples Endemic area (n = 381) Non endemic area (n = 232) Methodology Total hardness was measured using EPA 130.2 method EPA methods were used for detection of anions in hardwater.

Number of District Sampling locations samples 10 Kebithigollewa Spring 40 Medawachchiya Anuradhapura 36 Padaviya 45 Anuradhapura city 60 Polpithigama, Nikawewa Kurunegala 20 Mahawa-Siyambalangamuwa Mathale 49 Mathale Ampara 83 Padiyathalawa, Dehiaththakandiya Kadawatha, Ja - ela, Katunayaka, Biyagama, Gampaha 212 Kaduwela, Gampaha Monaragala 38 Monaragala Mathara 20 Pasgoda

Endemic area Minimum and Avg. Total Median Number Sampling Number Maximum District Hardness hardness of CKDu of samples Hardness locations (mg/L -1 ) (mg/L -1 ) patients (mg/L -1 ) Kebithigollewa 10 9.2 9.1 - 9.3 9.2 0 Spring 160.2 - 40 Medawachchiya 376.2 384.6 2783 685.2 Anuradhapura 270.0 - 36 Padaviya 323. 8 340 2378 820.0 Anuradhapura 108.2 – 45 112.4 122.5 5 312.5 city Polpithigama, 60 352.5 90.0 - 615.0 307.5 2654 Nikawewa Kurunegala Mahawa- 20 253 60.0 - 410.0 240 72 Siyambalangamuwa M.A.C.S. Jayasumana, P.A. Paranagama, M.D. Amarasinghe, S.I. Fonseka, Sri Lankan Agricultural Nephropathy and high ground water hardness Possible link, Proceedings of the First International Research Workshop on Mesoamerican Nephrophathy, Central American Institute for Studies on toxic Substances (IRET-UNA) and Program on Work, Environment and Health in Central America (SALTRA), Editors: Catharina Wesseling, Jennifer Crowe, Christer Hogstedt, Kristina Jakobsson, Rebekah Lucas and David Wegman, 28-30 November, Costa Rica, pp 195.

Endemic area Minimum and Avg. Total Median Number Maximum Number District Sampling locations Hardness hardness of CKDu of samples Hardness (mg/L -1 ) (mg/L -1 ) patients (mg/L -1 ) Polpithigama, 60 352.5 90.0 - 615.0 307.5 2654 Nikawewa Kurunegala Mahawa- 20 253 60.0 - 410.0 240 72 Siyambalangamuwa 49 Mathale Mathale 228 60.0 - 460 252.5 55 Padiyathalawa, 83 Ampara 259.4 18.9 - 943 260 977 Dehiaththakandiya M.A.C.S. Jayasumana, P.A. Paranagama, M.D. Amarasinghe, S.I. Fonseka, Sri Lankan Agricultural Nephropathy and high ground water hardness Possible link, Proceedings of the First International Research Workshop on Mesoamerican Nephrophathy, Central American Institute for Studies on toxic Substances (IRET-UNA) and Program on Work, Environment and Health in Central America (SALTRA), Editors: Catharina Wesseling, Jennifer Crowe, Christer Hogstedt, Kristina Jakobsson, Rebekah Lucas and David Wegman, 28-30 November, Costa Rica, pp 195.

nonendemic area Minimum and Avg. Total Median Number Number Maximum District Sampling locations Hardness hardness of CKDu of samples Hardness (mg/L -1 ) (mg/L -1 ) patients (mg/L -1 ) Kadawatha, Kelaniya, Ja - 9.4 - ela, Katunayaka, 212 94.6 140.0 67.3 0 Gampaha Biyagama, Kaduwela, Gampaha 28.4- 20 30.6 33.7 0 Mathara Pasgoda 54.6 M.A.C.S. Jayasumana, P.A. Paranagama, M.D. Amarasinghe, S.I. Fonseka, Sri Lankan Agricultural Nephropathy and high ground water hardness Possible link, Proceedings of the First International Research Workshop on Mesoamerican Nephrophathy, Central American Institute for Studies on toxic Substances (IRET-UNA) and Program on Work, Environment and Health in Central America (SALTRA), Editors: Catharina Wesseling, Jennifer Crowe, Christer Hogstedt, Kristina Jakobsson, Rebekah Lucas and David Wegman, 28-30 November, Costa Rica, pp 195.

Relationship between water hardness and number of CKDu patients in sampling areas M.A.C.S. Jayasumana, P.A. Paranagama, M.D. Amarasinghe, S.I. Fonseka, Sri Lankan Agricultural Nephropathy and high ground water hardness Possible link, Proceedings of the First International Research Workshop on Mesoamerican Nephrophathy, Central American Institute for Studies on toxic Substances (IRET-UNA) and Program on Work, Environment and Health in Central America (SALTRA), Editors: Catharina Wesseling, Jennifer Crowe, Christer Hogstedt, Kristina Jakobsson, Rebekah Lucas and David Wegman, 28-30 November, Costa Rica, pp 195.

Hardness of water in reservoirs in the endemic area

Hardness of water in reservoirs in the endemic area Avg. Hardness Location of the Reservoir (ppm) Padaviya 115 - 135 Tissa wewa 120 - 135 Bulankulama 130 - 140 Olugolla 105 - 125 Nikawewa 140 - 155 Siyambalangamuwa 100 - 120 Medawachchiya 130 - 145 Measured in three occasion of the year as Values may vary due to different climetic conditions.

Distribution of hardwater in Sri Lanka Distribution and prevalence of (Technical data for groundwater CKDu in Sri Lanka hardness in Sri Lanka, Water Resources Board, Colombo 7)