Environmental Contamination and Chronic Kidney Disease in Southern India

摘要

Background: In a multicenter screening project in India we reported a CKD prevalence rate of 16.5%m but with tremendous center variability. The highest prevalence of CKD (48.3%) observed in Srikakulum district in Andhra Pradesh. Media reports from this area and our interviews with villagers highlighted an "epidemic of kidney failure" from environmental contamination of the water supply. We hypothesized that environmental toxicity as the cause of kidney disease in Srikakulum. Aims: 1. Determine the prevalence of CKD in villages in Srikakuum. 2. Investigate contamination of water, food or soil in Srikakulum compared to other areas. Methods: A cross-sectional study was conducted. Domiciliary screening in 8 of 16 villages was carried out in 2011. Patients were interviewed and examined. Blood and urine was collected. Soil, food and water samples were sent for analysis. Results: 1152 participants were enrolled. 45.4% were male with a mean age of 44.6+14 (SD) years (range 18-95). Mean estimated glomerular filtration rate (GFR) was 95±57 ml/min/m2. The prevalence of proteinuria was 5.6%. Total prevalence of CKD was 14.6%. Hypertension was observed in 38.4% and 7.3% with diabetes mellitus. The highest prevalence of CKD of 26.2% and 23.8% was observed in primary health centers (PHC) of Akkupalli and Borivanka, respectively. In these PHCs, hypertension and diabetes were found to be 39% and 7.7%, respectively. Preliminary data from analysis of the water pointed to a high level of silica contamination in the water. Conclusions: A high prevalence of CKD in the villages of Srikakulam district was observed confirming our previous findings from a nationwide SEEK study. The villages of Akkupalli and Borivanka, both in the northeastern part of Srikakulum had the highest prevalence of CKD. Preliminary water analysis points to high silica levels in the water. Silica as a cause of CKD has been described previously.