Quality and sources of food and water consumed by people with chronic kidney disease of unknown etiology in Sri Lanka: a systematic review.

Background: Prevalence data indicates that chronic kidney disease (CKD) affects approximately 15% of people worldwide, and chronic kidney disease of unknown etiology (CKDu) is highly prevalent in Sri Lanka. Food and water contamination are factors that were suggested as associated with CKDu. This systematic review aimed to summarize evidence on the patterns in quality and sources of food and water consumed by people with CKDu in Sri Lanka.

Methods: MEDLINE, EMBASE, PsycINFO, and SLJOL databases were searched from inception to August 2024 for studies investigating the quality and sources of food and water consumed by the people with CKDu in Sri Lanka. Studies assessing children below 18 years, pregnant women and dialysis patients were excluded. Studies not specifically investigating CKDu were likewise excluded from the review. Two independent reviewers completed the screening, and the conflicts were resolved by consensus. Extracted data were presented as a narrative summary.

Results: Of 1067 studies, 57 were eligible for the final analysis. Commonly investigated food sources were contaminated with heavy metals, while water sources were contaminated with heavy metals, toxic anions and cations, agrochemicals, fertilizers, herbicides, glyphosate, and aminomethylphosphonic acid (AMPA).

Conclusion: Nephrotoxic heavy metals and fluoride contamination alter the quality of food and water, and pose high risks with regard to the kidney function of the people in Sri Lanka. Appropriate strategies to reduce the contamination of heavy metals, agrochemicals, and major ions that afftect the quality of water and food, should be implemented to lower the burden of CKDu in Sri Lanka.