Myths and confusions

Chronic Kidney Disease of Multi-Factorial Origin


by Professor Sunil Wimalawansa,


In recent days, many myths and inaccurate statements have been propagated and published with reference to the chronic kidney disease (CKD) that is predominantly affecting Rajarata. Those who express views must ensure that they are based on facts, findings of research conducted by recognized and reputed scientists, and make valid suggestions that would help to ease the suffering of the affected people. These claims appear not only in the newspapers but also in paidjournals. These unfortunate viewpoints continue to confuse the public and the law makers’ alike, furtherthwarting efforts to taking appropriate actions.

Finding cause(s) as well as preventing the disease,which are priorities should be approached with unbiased feelings, broader hypothesis, and interventions based on perception of reality. In addition, consideration of what would be cost-effective and would be most helpfulin developing an action plan to ease the suffering from this deadly disease are important. Since there is no cure, prevention is utmost important. There is no reason to complicate what is needed to be done to prevent this fatal disease. [[].

Most of these Myths related to CKDmfo arises from unawareness of the disease pattern; lack of understanding of renal diseases and the big picture, ground reality, vulnerabilities andinter-relations, synergy between various toxins,correlations among disciplines of biology, environmental sciences, and medical aspects; poorly designed and inadequate statistically-powered studies; and conflict of interests and hidden agendas.

Gettingembedded with narrow minded or short sighted views and/or Myths would not get us anywhere in dealing, especiallywith the CKDmfo that has led to the current national crisis (a "chronic emergency"). To overcome this, we needto take broader, inter-disciplinary approaches. Let’s explore a few of the myths that have been getting unwarranted publicity:

Roof-based rainwater collection: Some claim that rain water harvesting should be the only option to provide water to alleviate CKDmfo in affected regions, which is anallegory. Collecting rainwater via roofs is satisfactory when there is reasonable rainfall distributed throughout the year and roofs and gutters are constantly kept clean. Neither of theseare the case inNCP and other affected regions in Sri Lanka. Moreover, many of the water collectedvia roofs arecontaminated through multiple sources;consequently, its use for drinking is questionable. Nevertheless, it is a reasonable supplementary way of providing water for home gardening and other domestic uses, and shouldbe considered asa complementary method of providing water for households (see picture A).

The current method of constructing ferro-cement rainwater storage tanks (as illustrated in the picture A), at a cost exceedingrupees 50,000 each, provides unclean water for one-family for about 6months of the year. On liter basis this is 35times more expensive than the reverse osmosis (RO) method of providing clean, potable water to people (see picture B).

In fact, on the same basis,the current roof-water collection systems are as expensive as purchasing bottled water. The latter is the most expensive way of providing clean water. Althoughroof-water collection tanks provide water for "one family" (e.g., five people) for a part of the year for several years, 20,000-liter per day capacity, one RO unit provides clean water for 3,000 people for more than 20 years. In fact, there is no comparison of the cost-effectiveness between the two. However, just like roof-water collecting systems, RO plants require a one-time,up-front significant investment andregular maintenance.

RO units do not pollute the environment:The statements made by few, that RO plants have "serious ecological implications" is perplexingbecause such facilities do not add any pollutant to the water (a blatant fable)! The levels of pollutants in the inlet water (i.e., the water coming into a RO unit) are exactly the same as what would already be in the stream water with hundreds of fold of dilution, even when the effluent water is put back to a stream.So where do thesepurported pollutants come from? In fact, from nowhere, but the same stream or well water. We sincerely hope that individuals will stop misrepresenting such to the public.

Such Myths confuse the public and the policy/decision makers. Itwould further delays the process of helping those people who are in need inRajarata and elsewhere.RO water purification units do not add chemicals or organic elements to incoming or outgoing water; making itenvironmentally safe. Therefore, contrary to false claims, the use of RO units does not violate the National Environment Protection Act No: 47 of 1980, andconsequently is not applicable to this particular drinking water purification technology in Sri Lanka.

Food produced from Rajarata are safe:With no data or scientific evidence available to support the assertion, some say that CKDmfo is caused by the consumption of rice and manioc grown in Rajarata.Same food is exported to other parts of the county. This is another unfounded conclusion that causes unnecessary alarm, and harms the country. It seems that some are propagating this Myth for their commercial gain.

On the contrary, the annual scientific reports published by the United States Food and Drug Administration on food items imported to the United States consistently show that all varieties of rice produced in Sri Lanka are safer and less contaminatedthan the rice derived from the nation’s neighbouring southeast Asian countries. There is no reason at all to abandon our traditional food sources and modified rice varieties, and rush to import polluted rice from other countries. The latter would not only drain our precious foreign exchanges, but will not reduce the incidence of CKDmfo.

Glyphosate do not cause CKDmfo: There is no credible evidence in the world scientific literature that the herbicide, glyphosate (worldwide, the most commonly used weedicide) causing CKD of any kind. Compared to other weedicides and pesticides, it is relatively harmless to human; data available to-date, do not support it causing CKDmfo. Thus, contrary to false claims, banning of this herbicide will not have any benefit on reducing the incidence of CKDmfo. []

Other Myths:There are several other widespread myths with reference to the CKDmfo. Some of these include the following:

* Females are more affected than males;

* A large number of schoolchildren are affected with CKDmfo;

* Water isnot contaminated but food is;

* The use of plants is a practical and efficient way to clean-up watersheds;

* After a few seasons of monsoon rains, the soil and reservoir waters will be clear of all toxins and excess phosphates;

* The current levels of pollutants in water in reservoirs and shallow wells, and soil contaminations can be reversed with three or four cultivation cycles;

* ‘Replacing’ the farm soil in the NCP is the solution;

* Consuming water from the domestic water filters distributed by the government and sold by some industries will prevent CKDmfo;

* The use of local rock phosphate would markedly reduce heavy metal contamination in the farm-soil;

* The excessive use of pain killers, locally grown tobacco, and illegal brewed alcohol are not associated with the disease;

* Kidney failure can be reversed in patients with severe CKDmfo (kidney disease,beyond stage IIIb) by black-magic and/or native treatments;

* The hardness of water, arsenic, lead, mercury, cadmium, glyphosate, salinity, or ionicity, as a "single" entity, is the cause of this disease.

None of these are factual or proven.

Several non-profit organizations and government entities are taking actions such as provision of clean water, but these contributions are too little. Actions from the corporate sector (e.g., CSR efforts & funding) however, is still significantly lagging behind. Thus,taking timely,decisive, and appropriate actions by the government to prevent this national crisis is essential. This is now 15 years overdue. Prevention is the only way forward. [].

To avoid inter-ministerial and departmental conflicts, and refusal to accept responsibility and accountability by the ministries, the best option for the country is to create a "CKD-Eradication Authority"by the President, to accomplish this task in a timely manner. If the cost-effective, detailed programs that proposed by the Preventive Health, Environmental Protection, and Research Organization (PHEPRO Foundation) to the president and the government are implemented in full, CKDmfo can be eradicated from Sri Lanka within 12 years. Why we are still waiting!

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