Chronic renal failure in Sri Lanka caused by elevated dietary cadmium: Trojan horse of the green revolution

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Abstract

The endemic of chronic renal failure (CRF) emerged in 2002 in the farming provinces of Sri Lanka. An estimate of dietary cadmium intake was between 15 and 28 μg/kg body weight per week. The mean urinary cadmium in patients diagnosed with stage 5 kidney failure was 7.6 μg/g creatinine and 11.6 μg/g for asymptomatic persons. The agrochemical triple superphosphate (TSP) fertilizer containing 23.5–71.7 mg Cd/kg was the source of cadmium added to soils. Mean Cd content in cultivated vs. uncultivated soils in Anuradhapura district was 0.02 ± 0.01 vs. 0.11 ± 0.19 mg/kg while in Polonnaruwa district, it was 0.005 ± 0.004 vs. 0.016 ± 0.005 mg/kg. Prior to the Green Revolution, the amount of fertilizer used in rice cultivation in 1970 was 32,000 metric tons (Mts) rising to 74,000 Mts in 1975. Up to 68.9 Mts of Cd could have entered into the rice-cascade reservoir environment from TSP use since 1973. Diversion of the Mahaweli River in 1970–1980 further increased cadmium input. Cadmium transfer from Upper Mahaweli water to Polgolla was 72.13 kg/day. Cadmium content of the sediments from reservoirs collecting cadmium from irrigated TSP fertilized crop fields (rice and vegetables) was 1.8–2.4 mg/kg.

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Adverse Health Effects of Chronic Exposure to Low-Level Cadmium in Foodstuffs and Cigarette Smoke

Soisungwan Satarug, Michael Moore (2004)

Cadmium is a cumulative nephrotoxicant that is absorbed into the body from dietary sources and cigarette smoking. The levels of Cd in organs such as liver and kidney cortex increase with age because of the lack of an active biochemical process for its elimination coupled with renal reabsorption. Recent research has provided evidence linking Cd-related kidney dysfunction and decreases in bone mineral density in nonoccupationally exposed populations who showed no signs of nutritional deficiency. This challenges the previous view that the concurrent kidney and bone damage seen in Japanese itai-itai disease patients was the result of Cd toxicity in combination with nutritional deficiencies, notably, of zinc and calcium. Further, such Cd-linked bone and kidney toxicities were observed in people whose dietary Cd intakes were well within the provisional tolerable weekly intake (PTWI) set by the Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives of 1 μg/kg body weight/day or 70 μg/day. This evidence points to the much-needed revision of the current PTWI for Cd. Also, evidence for the carcinogenic risk of chronic Cd exposure is accumulating and Cd effects on reproductive outcomes have begun to emerge.

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Chronic renal failure among farm families in cascade irrigation systems in Sri Lanka associated with elevated dietary cadmium levels in rice and freshwater fish (Tilapia).

S Senevirathna, T. Abeysekara, J. M. R. Sarath Bandara … (2008)

Chronic renal failure (CRF), in the main agricultural region under reservoir based cascade irrigation in Sri Lanka has reached crisis proportion. Over 5,000 patients in the region are under treatment for CRF. The objective of this study is to establish the etiology of the CRF. Concentrations of nine heavy metals were determined in sediments, soils of reservoir peripheries, water and Nelumbo nucifera (lotus) grown in five major reservoirs that supply irrigation water. All five reservoirs carried higher levels of dissolved cadmium (Cd), iron (Fe) and lead (Pb). Dissolved Cd in reservoir water ranged from 0.03 to 0.06 mg/l. Sediment Cd concentration was 1.78-2.45 mg/kg. No arsenic (As) was detected. Cd content in lotus rhizomes was 253.82 mg/kg. The Provisional Tolerable Weekly Intake (PTWI) of Cd based on extreme exposure of rice is 8.702-15.927 microg/kg body weight (BW) for different age groups, 5-50 years. The PTWI of Cd due to extreme exposure of fish is 6.773-12.469 microg/kg BW. The PTWI on a rice staple with fish is 15.475-28.396 microg/kg BW. The mean urinary cadmium (UCd) concentration in CRF patients of age group 40-60 years was 7.58 microg Cd/g creatinine and in asymptomatic persons UCd was 11.62 microg Cd/g creatinine, indicating a chronic exposure to Cd. The possible source of Cd in reservoir sediments and water is Cd-contaminated agrochemicals. The CRF prevalent in north central Sri Lanka is a result of chronic dietary intake of Cd, supported by high natural levels of fluoride in drinking water, coupled with neglecting of routine de-silting of reservoirs for the past 20 years.

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Elevated levels of cadmium and zinc in paddy soils and elevated levels of cadmium in rice grain downstream of a zinc mineralized area in Thailand: implications for public health.

R K Simmons, D Saiyasitpanich, S Klinphoklap … (2005)

Prolonged consumption of rice containing elevated cadmium (Cd) levels is a significant health issue particularly in subsistence communities that are dependent on rice produced on-farm. This situation is further exacerbated in areas of known non-ferrous mineralization adjacent to rice-based agricultural systems where the opportunity for contamination of rice and its eventual entry into the food chain is high. In the current study, an assessment of the degree of soil Cd and Zn contamination and associated rice grain Cd contamination downstream of an actively mined zone of Zn mineralization in western Thailand was undertaken. Total soil Cd and Zn concentrations in the rice-based agricultural system investigated ranged from 0.5 to 284 mg kg(-1) and 100 to 8036 mg kg(-1), respectively. Further, the results indicate that the contamination is associated with suspended sediment transported to fields via the irrigation supply. Consequently, the spatial distribution of Cd and Zn is directly related to a field's proximity to primary outlets from in-field irrigation channels and inter-field irrigation flows with 60-100% of the Cd and Zn loading associated with the first three fields in irrigation sequence. Rice grain Cd concentrations in the 524 fields sampled, ranged from 0.05 to 7.7 mg kg(-1). Over 90% of the rice grain samples collected contained Cd at concentrations exceeding the Codex Committee on Food Additives and Contaminants (CCFAC) draft Maximum Permissible Level for rice grain of 0.2 mg Cd kg(-1). In addition, as a function of demographic group, estimated Weekly Intake (WI) values ranged from 20 to 82 mug Cd per kg Body. This poses a significant public health risk to local communities. The results of this study suggest that an irrigation sequence-based field classification technique in combination with strategic soil and rice grain sampling and the estimation of WI values via rice intake alone may be a useful decision support tool to rapidly evaluate potential public health risks in irrigated rice-based agricultural systems receiving Cd contaminated irrigation water. In addition, the proposed technique will facilitate the cost effective strategic targeting of detailed epidemiological studies thus focusing resources to specific 'high risk' areas.