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

• Prof. Priyani Paranagama

Senior Professor & Chair of Chemistry University of Kelaniya Kelaniya

Potential Link between Ground Water Hardness, Arsenic and Prevalence of CKDu

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

• Literature Search on Causative Factors

for CKDu

Initiated in December 2010

• With the concurrence of Ethics Committee of the Faculty
• f 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.

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 %

male female

85%

15%

50 100 150 200 250 15 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 50 51 - 60 61 -70 71 - 80 80-90

Age breakdown of the CKDu patients

• No. of CKDu

Cases Age category

CKDu primarily affects middle-aged farmers.

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.

District

Sampling locations Number of samples Anuradhapura

Kebithigollewa Spring

10

Medawachchiya

40

Padaviya

36

Anuradhapura city

45

Kurunegala

Polpithigama, Nikawewa

60

Mahawa-Siyambalangamuwa

20

Mathale

Mathale

49

Ampara

Padiyathalawa, Dehiaththakandiya

83

Gampaha

Kadawatha, Ja - ela, Katunayaka, Biyagama, Kaduwela, Gampaha

212

Monaragala

Monaragala

38

Mathara

Pasgoda

20

District

Sampling locations

Number

• f samples
• Avg. Total

Hardness (mg/L-1) Minimum and Maximum Hardness (mg/L-1) Median hardness (mg/L-1) Number

• f CKDu

patients

Anuradhapura

Kebithigollewa Spring

10

9.2 9.1 - 9.3 9.2

Medawachchiya

40

376.2 160.2 - 685.2 384.6 2783

Padaviya

36

• 323. 8

270.0 - 820.0 340 2378

Anuradhapura city

45

112.4 108.2 – 312.5 122.5 5

Kurunegala

Polpithigama, Nikawewa

60

352.5 90.0 - 615.0 307.5 2654

Mahawa-

Siyambalangamuwa

20

253 60.0 - 410.0 240 72

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

District

Sampling locations Number

• f samples
• Avg. Total

Hardness (mg/L-1) Minimum and Maximum Hardness (mg/L-1) Median hardness (mg/L-1) Number

• f CKDu

patients

Kurunegala

Polpithigama, Nikawewa

60

352.5 90.0 - 615.0 307.5 2654

Mahawa-

Siyambalangamuwa

20

253 60.0 - 410.0 240 72

Mathale

Mathale

49

228 60.0 - 460 252.5 55

Ampara

Padiyathalawa, Dehiaththakandiya

83

259.4 18.9 - 943 260 977

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

District

Sampling locations Number

• f samples
• Avg. Total

Hardness (mg/L-1) Minimum and Maximum Hardness (mg/L-1) Median hardness (mg/L-1) Number

• f CKDu

patients

Gampaha

Kadawatha, Kelaniya, Ja - ela, Katunayaka, Biyagama, Kaduwela, Gampaha

212 94.6 9.4 - 140.0 67.3

Mathara

Pasgoda

20 30.6 28.4- 54.6 33.7

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

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

Location of the Reservoir

• Avg. Hardness

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

Average values of total hardness and other ions in water samples of sampling areas

Location

Avg. Hardness mg/L Avg. PO43- mg/L Avg. SO42- mg/L Avg. NO3- mg/L Avg. CO32- mg/L

• Avg. F

mg/L Avg. Fe mg/L

Pasgoda

30.60 0.14 2.40 0.21 60.82 0.20 0.22

Gampaha

94.60 0.93 25.10 1.02 82.38 0.20 0.28

Anuradhapura city

112.40 0.51 16.93 0.45 186.17 1.04 0.02

Monaragala

142.90 0.60 20.31 1.60 110.80 1.80 0.10

Mathale

228.00 0.37 9.57 0.41 294.27 0.72 0.09

Mahawa - Siyambalangamuwa

253.00 10.41 63.79 3.07 178.58 1.40 0.24

Ampara

259.40 9.60 54.58 1.25 346.00 1.02 0.11

Padaviya

323.80 12.63 76.80 3.72 324.20 1.20 0.26

Polpithigama

352.50 11.21 72.89 4.07 192.77 1.20 0.36

Medawachchiya

376.20 12.80 80.10 4.86 366.75 1.50 0.60

Fonseka, S.I., Amarasinghe, M.D., Paranagama, P.A. (2013) Nitrate, phosphate and sulfate concentrations of well water in CKDu endemic areas and non endemic areas and their relation to water hardness, Proceedings of the 69

the Advancement of Science, Sri Lanka will be held on 2nd – 6th Dec. 2013, pp 271.

Fonseka, S.I., Amarasinghe, M.D., Paranagama, P.A. (2013) Nitrate, phosphate and sulfate concentrations of well water in CKDu endemic areas and non endemic areas and their relation to water hardness, Proceedings of the 69th annual sessions of Sri Lanka Association for the Advancement of Science, Sri Lanka will be held on 2nd – 6th Dec. 2013, pp. 271.

• To determine the prevalence of clinical

features and analysis the arsenic content in urine and hair samples

• Abnormal spotty pigmentation observed in

palms and soles of CKDu patients during clinical examinations of CKDu patients

• Different from Chronic Arsenic Toxicity present

in Bangladesh

IN BANGLADESH

Endemic area

• Jayasumana, M.A.C.S., Paranagama, P.A., Amarasinghe, M.D., Wijewardane, K.M.R.C., Dahanayake, K.S., Fonseka, S.I.,

Rajakaruna, K.D.L.M.P., Mahamithawa, A.M.P., Samarasinghe, U.D., Senanayake, V.K. (2013) Possible link of Chronic arsenic toxicity with Chronic Kidney Disease of unknown etiology in Sri Lanka, Journal of Natural Sciences Research, 3(1), 64-73.

Percentage dermal manifestation observed in the CKDu cases and control groups

Subjects from non-endemic area did not show hyperpigmentations or kerotosis

• f palms and soles

Collection of biological samples

• Urine samples were collected

CKDu patients (n = 125) controls from endemic area (n = 180) controls from nonendemic area (n = 43)

• Hair samples were collected

CKDu patients (n = 125) controls from endemic area (n = 180) controls from nonendemic area (n = 43)

Measurement of Arsenic content in urine and hair samples

• GBC 932 plus Atomic Absorption Spectrometer-

AAS (Australia) equipped with a hydride generation system (GBC 3000) and Graphite Furnace (GF 3000) with the background corrector Analysis of arsenic content

Atomic Absorption Spectrometer and Mercury Vapour Generator at Water Resources Board Colombo 07 -Sri Lanka

Digestion of samples

–EPA 7060 A method

• Digestion of samples was carried out with concentrated nitric

acid (70% AR) (Sigma Aldrich Pvt. Ltd),

• concentrated sulfuric acid (98% AR) (Sigma Aldrich Pvt. Ltd),
• perchloric acid (70% AR) (Sigma Aldrich Pvt. Ltd), HCl (37% AR)

(Sigma Aldrich Pvt. Ltd),

• and high purity hydrogen peroxide (35.5%) (Sigma Aldrich Pvt.

Ltd),

• Laboratory glassware was kept overnight in 10% (v/v) nitric
• acid. Before use, the glassware were rinsed with de-ionized

water and dried in a dust free environment.

• Spike samples were used in order to calculate the %

recovery of biological samples

Urinary arsenic contents of CKDu patients and individuals of the control groups

• Jayasumana MACS, Dahanayake KS, Paranagama PA, Amarasinghe, MD, Wijewardena C, Rajakaruna

L, Mahamithawa AMP, Samarasinghe UDS, Fonseka SI, Senanayake KV,Wijekoon, DVK (2012) Toxic levels of arsenic in hair and urine samples of patients of chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka, Proceedings of the research symposium on Chronic Kidney Disease of unknown aetiology , Sri Lanka Medical Association, Sri Lanka, 11

th

March 2012, pp12.

Toxic excretory level for arsenic in urine for south Asian population is 35μg/L. (http://www.mayomedicallaboratories.com).

Urinary arsenic Concentration (µg/L) CKDu patients (%) (n=125)

Controls 1 (%)

(n=180)

Controls 2 (%)

(n=43) 0-10 4.0 10.0 11.6 10-20 4.8 13.3 16.3 20-30 6.4 26.6 27.9 30-40 12.0 21.2 23.3 40-50 32.0 14.4 9.3 50-60 25.6 10.0 6.9 >60 15.2 4.5 4.6

Controls 1 – controls from endemic area control 2 – controls from nonendemic area

Arsenic content in hair samples of CKDu patients and individuals of the control groups

• Jayasumana MACS, Dahanayake KS, Paranagama PA, Amarasinghe, MD, Wijewardena C, Rajakaruna

L, Mahamithawa AMP, Samarasinghe UDS, Fonseka SI, Senanayake KV,Wijekoon, DVK (2012) Toxic levels of arsenic in hair and urine samples of patients of chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka, Proceedings of the research symposium on Chronic Kidney Disease of unknown aetiology , Sri Lanka Medical Association, Sri Lanka, 11th March 2012, pp12.

Hair samples Arsenic -mg/kg Mean-Normal (Muzumdar 2000) 0.46 Control group 1 0.22 to 4.58 Control group 2 0.15 to 2.59 CKDu patients 1.27 to 7.03

Controls 1 – controls from endemic area control 2 – controls from nonendemic area

Arsenic content in Plants, Rice, Hard water and Soil

Plant species As (µg/Kg)

Calotropis gigantean (Wara) 80.5±2.1 Asteracantha longifolia (Ikiriya) 5.55±0.1 Calotropis gigantean (Wara) 157.6±1.4 Eichhornia crassipes 553.5±2.4 Marsilea hirsuta 80±1.0 Syzygium cumini ( (Dan) Root 17.85±0.6 Cynodon dectylon (A grass) 84.05±1.1 Terminalia arjuna Bark 115±2.4 Tamarindus indica (Siyambala) bark 45.05±1.0 Gliricidia sepium (Gliricidia) root 38.45±0.7 Schleichera oleosa (Kon) root 160.1±2.8 Diospyros ebenum (Kaluwara) leaves 53.2±1.0 Bauhinia racemosa (Maila) leaves 87.0±1.3 Memecylon sp. (Kuratiya) 40.5±1.1 Pephrosia purpurea (Pila) root ND Schleichera oleosa (Kon) bark ND Bauhinia racemosa (Maila) bark ND Dichrostachys cinerea (Andara) root ND Ocimum sanctum (Maduruthala) ND Azadirachta indica (Kohomba) Bark high Terminalia arjuna Root high

Amarasinghe, MD, Fonseka SI, Jayalath, K, Senanayake KV, Paranagama PA, Jayasumana MACS (2012) Preliminary investigations on presence of arsenic in soils and plants from two CKDu prevalent areas in Sri Lanka, (2012) Proceedings of the 10th Annual Academic S essions of the College of Forensic Pathologists of Sri Lanka, 25th February 2012, Sri Lanka Medical Association, Sri Lanka, pp 15.

Arsenic in rice

Sample name As g/L

• CRM 1

253.73

• CRM 2

256.94

• CRM 3

262.07

• CRM 4

257.31

• Dr. Mangala C De Silva, University of Ruhuna

Analyzed by Prof. Andrew A. Meharg, Institute for Global Food Security , Queen’s University Belfast, David Keir Building, Malone Road, Belfast, BT9 5BN, Northern Ireland, U.K.

(ICPMS)

Sample name As ug/L

• SPIKE 1

8.17

• SPIKE 2

8.07

• SPIKE 3

8.12

• SPIKE 4

7.99 Mean 8.09 Recovery 80.87 %

• Dr. Mangala C De Silva, University of Ruhuna

Analyzed by Prof. Andrew A. Meharg, Institute for Global Food Security , Queen’s University Belfast, David Keir Building, Malone Road, Belfast, BT9 5BN, Northern Ireland, U.K.

Sample As g/kg

1 101.5 2 183.0 3 115.9 4 100.6 6 179.2 7 87.9 8 55.9 9 122.9 10 68.2 14 114.5 14 77.4 15 108.8 16 71.3 110.4 17 18 51.2 19 79.5 20 106.3 21 51.9 22 67.7 23 92.7 24 76.1 25 51.9 26 64.3

Arsenic content in Rice samples collected from endemic and nonendemic area

(n= 75)

• Dr. Mangala de Silva,

University of Ruhuna

Andrew A. Meharg, Gareth Norton, Claire Deacon,‡ Paul Williams, Eureka E. Adomako, Adam Price, Yongguan Zhu, Gang Li, Fang-Jie Zhao, Steve McGrath, Antia Villada Alessia Sommella, P. Mangala C. S. De Silva, Hugh Brammer, Tapash Dasgupta and M. Rafiqul Islam (2013) Variation in Rice Cadmium Related to Human Exposure, Environmental Science and Technology, in press.

• Dr. Mangala de Silva,

University of Ruhuna

Drinking water analysis for arsenic

• Levels of arsenic in dug wells used by CKDu ranged from 0.1 - 12.3 μg L-1
• In most of the water samples below 10 µg/L Arsenic was detected.

Concentration of Arsenic in different water sources in endemic and non endemic areas DW(EN) = Dug wells in endemic areas; TW(EN) = Tube wells in endemic areas; PF(EN) = Paddy field water in endemic areas; DW(nEN) = Dug wells in non endemic areas; PF(nEN) = Paddy field water in non endemic areas (Reference limit for As: 10 µg/L)

Fonseka, S., Paranagama, P.A., Jayalath, K, Amarasinghe, M., Senanayeke, K., Jayasumana, C., Mahamithawa, P., Wijewardhane, C., Samarasinghe, D ., Dahanayake, K. Preliminary investigations on the presence of arsenic in groundwater surface water and soils around Siyambalangamuwa and Moragolla in the Kurunegala district, Proceedings of the International Conference on Chemical Sciences, Sri Lanka Foundation Institute, Colombo 07, Sri Lanka, 20 – 22 June, 144.

Location As (ppb) PF(nEN) DW(nEN) PF(EN) TW(EN) DW(EN) Reservoir 18 16 14 12 10 8 6 4 2

Arsenic content in soli (Endemic area)

500 1000 1500 2000 2500 1 2 3 4 5 6 7 8

As Content μg/ kg

Depth (feet)

"C Yaya" Paddy field

200 400 600 800 1000 1200 1400 1 2 3 4 5 6 7 8 9 10 11 12 13

As Content μg/ kg

Depth (feet)

Padaviya lake

n= 10

Amarasinghe, MD, Fonseka SI, Jayalath, K, Senanayake KV, Paranagama PA, Jayasumana MACS (2012) Preliminary investigations on presence of arsenic in soils and plants from two CKDu prevalent areas in Sri Lanka, (2012) Proceedings of the 10th Annual Academic Sessions of the College of Forensic Pathologists of Sri Lanka, 25th February 2012, Sri Lanka Medical Association, Sri Lanka, pp 15.

Gampaha paddy field

Arsenic content in soli (nonendemic area)

Amarasinghe, MD, Fonseka SI, Jayalath, K, Senanayake KV, Paranagama PA, Jayasumana MACS (2012) Preliminary investigations on presence of ars enic in soils and plants from two CKDu prevalent areas in Sri Lanka, (2012) Proceedings of the 10th Annual Academic Sessions of the College of Forensic Pathologists of Sri Lanka, 25th February 2012, Sri Lanka Medical Association, Sri Lanka, pp 15.

n= 10

500 1000 1500 2000 2500 1 2 3 4 5 6 7 8 9 10 11 12

Pasgoda paddy field

• As content in soil profiles from the study area indicated that the As loads in

soil show gradual decline with depth.

• Although these data provide evidence that As is added to the soil from the

surface, more data will be collected for its confirmation.

Place Feets pH N (mg/Kg) P (mg/Kg) SO4 (mg/Kg) Cd (mg/Kg) As (mg/Kg) Fe (mg/Kg) 1 1 7.3 48.447 78.90 237.43 0.005 0.034 802.66 2 7.3 21.895 78.11 237.00 0.005 0.017 960.28 3 7.1 16.421 76.61 232.00 0.002 0.008 940.45 4 7.1 7.974 65.20 218.86 ND 0.004 864.14 5 6.9 5.158 40.24 206.86 ND ND 702.53 6 6.7 3.053 38.74 180.43 ND ND 806.74 7 6.6 2.132 30.42 163.22 ND ND 795.49 8 6.6 0.204 30.37 132.54 ND ND 743.31

Soil profile from Nikawewa area

• The results suggested that arsenic is

not present naturally in the soils of the study area

• No reported work is available as to the

presence of arsenic in the bedrocks

• Anthropogenic activities

Analysis of agrochemicals

• Number of pesticides samples = 472
• Number of fertilizer samples = 74

Jayasumana MACS, Paranagama PA, Fernando A, Jayalath K, Fons eka SI, Amarasinghe MD, Presence of ars enic in fertilizers and its association with the agricultural kidney disease in Sri Lanka, (2013) The Journal of Toxicology and Health

• EPA – 3050B Method was used to determine the Arseic in

fertilizer available in Sri Lanka

• Digested samples were filtered and used to detect arsenic

by Hydride generation atomic absorption spectrometry (HGAAS)

• Spike samples were used in order to calculate the % recovery of

agrochemical samples

Arsenic content in pesticides

No. Active ingredient company Arsenic content (µg/kg) 1

Carbofuran

A A A B B 331 ±12 2458 ±78 554 ±16 854 ±21 1654 ±35 2

Imidacloprid

A A 180 ±14 359 ±12 3

Methoxyfenozide

A A 911 ±24 872 ±18 4

Tubuconazole

A A 288 ±23 680 ±14 5

Etofenprox

C C 757 ±18 2584 ±28 7

Diazinon

C C 625 ±42 995 ±21

Jayasumana MACS, Paranagama PA, Fernando A, Jayalath K, Fons eka SI, Amarasinghe MD, Presence of ars enic in fertilizers and its association with the agricultural kidney disease in Sri Lanka, (2013) The Journal of Toxicology and Health

Approximately 50 % contaminated with Arsenic

8

Fenoxaprop-p-ethyl +Ethoxysulfuron

C C 1254 ±26 2578 ±39 9

Diazinon

C C 625 ±42 995 ±21 10

Quinalphos

C C 928 ±08 1893 ±15 11

Thiamethoxam

D E 542 ±19 1024 ±25 12

Penthoate

E E E 698 ±36 565 ±31 1258 ±44 13

Dimethoate

B B 965 ±25 2457 ±59 14

Profenofos

A A C C C 1452 ±45 865 ±21 458 ±12 569 ±22 987 ±32

Jayasumana MACS, Paranagama PA, Fernando A, Jayalath K, Fons eka SI, Amarasinghe MD, Presence of ars enic in fertilizers and its association with the agricultural kidney disease in Sri Lanka, (2013) The Journal of Toxicology and Health

15 Oxyfluorofen D 788 ±32 16 Ispyribac Na E E 721 ±21 1458 ±36 17 Methomyl F F 1112 ±29 1458 ±35 18 Chlophyriphos B B C C 1365 ±42 654 ±09 865 ±31 1008 ±24 19 MCPA A A C C D D D 858 ±15 458 ±12 895 ±11 478 ±13 1258 ±18 1496 ±24 789 ±20 20 Carbendazim A C 1458 ±23 1163 ±25

Jayasumana MACS, Paranagama PA, Fernando A, Jayalath K, Fons eka SI, Amarasinghe MD, Presence of ars enic in fertilizers and its association with the agricultural kidney disease in Sri Lanka, (2013) The Journal of Toxicology and Health

Arsenic content in synthetic fertilizer

Sample Arsenic content (mg/kg) Triple super phosphate1 43.25+2.5 Triple super phosphate 2 25.49+4.3 Triple super phosphate 3 33.58+7.6 Single super phosphate 26.75 + 4.12 Eppawala rock phosphate 15.25 + 3.67 Urea 0.88 + 0.32 Muriate Of Potash 1.2 + 0.19 Vegetable fertilizer 1 14.75+1.04 Flower fertilizer 1 16.46+5.2 Flower fertilizer 2 11.28+7.9 Dolomite 30.46 + 5.82 Calcium carbide 16.30 + 3.08

N = 39

Arsenic content in Natural fertilizer

Sample Arsenic content (µg/kg) Compost mixture 1 2.32 + 0.43 Compost mixture 2 ND Chicken manure 1.77 + 0.41 Cow dung mixture 1.48 + 071 Natural flower fertilizer mixture ND Wood charcoal 3.54 + 0.58 Paddy husk charcoal 1.23 + 0.34

N = 35

3 ppt

Bioaccumulation  biomagnification

Risk factors for CKDu

• Hardness of water
• Agrochemicals
• Arsenic
• Cadmium

Jayasumana, M.A.C.S., Paranagama, P.A., Amarasinghe, M. D., Wijewardane, K.M.R.C., Dahanayake, K.S., Fonseka, S.I., Rajakaruna, K.D.L.M.P., Mahamithawa, A.M.P., Samarasinghe, U.D., Senanayake, V.K. (2013) Possible link of Chronic arsenic toxicity with Chronic Kidney Disease of unknown etiology in Sri Lanka, Journal of Natural Sciences Research, 3(1), 64-73.