Chronic Kidney Disease of Unknown Etiology (CKDu) has been a major concern in Sri Lanka, especially in the North Central Province as well as some other parts of the dry zone, claiming lives of hundreds of locals over the past few decades. Many researches conducted so far in the country to find out actual causes for CKDu, has not been able to reach a common conclusion or consensus regarding the CKDu. Meanwhile, President Gotabaya Rajapaksa tweeted that chemical fertilizers were contributing a lot to the CKDu. We fact checked this claim to find out what factors can be held responsible for CKDu and how much the use of chemical fertilizers has to do with it.
Tweet by the President:
In his official Twitter handle, President Gotabaya Rajapaksa stated that “For decades, chronic kidney disease has been a serious issue in Sri Lanka. Overuse of chemical fertilizers has contributed significantly to this. It is in this context that my gvt took firm steps to reduce imports of chemical fertilizer, & strongly encourage organic agriculture.”
There have been mixed reactions on this tweet as seen below
Due to the serious nature of President Rajapaksa`s claim, we decided to do an investigation over this.
What is CKDu?
Central America and Sri Lanka are two major locations in which CKDu has been reported over the past few years. In these countries, CKDu has become one of the major public health issues and new hotspots of disease are emerging daily as endemic communities suffer heavily because of this disease and burden it puts on their health and finances.
In certain countries of Latin America, like El Salvador it has become a major cause for hospitalization. Initial surveys conducted in Central American countries show that 20-30% people of endemic communities suffer from deteriorated kidney functioning.
However, the possible risk factors in South America and Sri Lanka/Asia are different. In South America, many researches focus on heat stress and dehydration, however in Asia, researchers focus on drinking water quality and chemical exposure. More details about this can be read here.Archived.
Research on CKDu in Sri Lanka
We decided to go through research papers related to CKDu, which mostly affects North and Central provinces as well as some other areas of dry zone in Sri Lanka.
We were able to find a research paper, done by Dr.Channa Jayasumana, currently the State Minister of Production, Supply and Regulation of Pharmaceuticals. He was formerly a researcher and professor at Rajarata University of Sri Lanka. According to the research carried out by Prof. Jayasumana and team, Arsenic was included in fertilizers and pesticides, what are collectively called as agrochemicals. The research paper was published in 2015 at Springer. So, according to their research, the Triple Super Phosphate fertilizers included the highest concentration of Arsenic. The research paper can be reached via this link.
From the above-mentioned research paper, Professor Jayasumana and his team suggested that agrochemicals especially phosphate fertilizers are a major source of inorganic arsenic in CKDu endemic areas in Sri Lanka. Hence, it’s suggested that farmers should be encouraged to move into organic fertilizers and reduce the usage of chemical fertilizers.
We tried to contact Professor Channa Jayasumana to get his current views regarding the effects of chemical fertilizer on CKDu however we were not able to contact him.
But when we directed our attention towards some other research their findings were different from the above study.
We directed our attention towards the National Research Council, and it`s funded research led by Professor Rohana Chandrajith at the University of Peradeniya. The research carried out between year 2015 and 2019, found out that there was no association between the CKDu and toxic trace elements like Arsenic, Cadmium, Lead and Uranium. And they also found that these toxic elements were very low in the soil and water in the areas in North Central province/dry zone and in some places the concentrations of these elements were lower than the other areas of the country, where there was no epidemic of kidney disease. According to the study, the high fluoride concentration of the water as well as high Magnesium concentration of the water and excessive heat of the daytime of area may contribute to prevailing CKDu epidemic condition in those areas. The research team suggests providing purified drinking water to the people who are living in CKDu endemic areas, North Central province.
We were able to contact professor.Rohana Chandrajith who commented that, “there is no connection between the chemical fertilizers and the CKDu, according to the research his team had carried out so far”. He pointed out the fact that there had not been any scientific evidence that water sources of the affected area of CKDu had heavy metals/toxic elements like Lead, Cadmium, and Arsenic above the safe levels. “There has been no evidence to say that ground water of North Central Province, polluted from toxic elements like Cd, As and etc. Also there is no evidence to show that heavy metals are adding to the rice harvest”, he said. Professor.Rohana Chandrajith further added that the fluoride concentration of the water at some places of North Central Province is very high and hardness of the water is also high in some places. “When the two factors, hardness of water and fluoride concentration of the water is high, we observed high number of CKDu patients there”, he added. The hardness of water and the Fluoride concentration of water are natural factors and chemical fertilizers have nothing to do with those factors, he added.
Meanwhile, Professor.Sunil J.Wimalawansa ,the professor of medicine who has decades long experiences in North Central Province, said in a research paper that CKDu issue should be addressed through taking multiple steps and CKDu is not a result of only a one reason/cause and it`s a result of multiple causes. He suggests making some tangible changes in people’s lifestyles including providing clean water, behavioral and lifestyle changes, alleviating malnutrition, reducing irresponsible and overuse of agrochemicals, and cost-effective treatment options.
We contacted to M.C.Jayasinghe, chairman of the Agriculture Graduates` Association of the Sri Lanka Agricultural Service to get their views regarding the connection between chemical fertilizers and the CKDu as well. He stated that there is no sufficient scientific evidence to prove the fact that chemical fertilizers contribute to the CKDu in Sri Lanka. He said that according to the well-known research, the main contributing factors for disease are Fluoride and Magnesium concentration in groundwater (The high level of magnesium and Fluoride of the ground water is due to the natural causes and chemical fertilizers or etc. not contribute to it.)And heat stress. As a sustainable solution for the issue, he suggested providing purified drinking water to the people living in the North Central Province/Dry Zone of the country.
The World Health Organization, WHO, also didn’t agree with the view that Cadmium (Cd) Or Arsenic (As) alone are contributing to the CKDu issues in Sri Lanka. In a report of their international consultation, 2016, they said that clinically characterized CKDu symptoms related to Cd (Cadmium) are different when comparing it with the CKDu prevailing in Sri Lanka. They add that there is no connection between As (Arsenic) level and nephrotoxicity of humans and as alone, it cannot contribute to the CKDu epidemic in Sri Lanka.
In the WHO consultation report, they also claim that hardness of the water and the Fluoride concentration of water are the facts that we should concern about.
Note: The main aim in this investigation was to educate the readers on currently available literature and research findings on chemical fertilizer and its impact on CKDu in Sri Lanka.