Arsenic, cadmium, lead, and chromium in well water, rice, and human urine in Sri Lanka in relation to chronic kidney disease of unknown etiology.

Chronic kidney disease of unknown etiology (CKDu) is spreading gradually in Sri Lanka. In the current research, 1,435 well water samples from all 25 districts of Sri Lanka, 91 rice samples, and 84 human urine samples from both CKDu-endemic and non-endemic areas in Sri Lanka were analyzed for arsenic, cadmium, lead, and chromium to detect whether toxic elements could be a cause of CKDu. The liver-type fatty acid binding protein (L-FABP) concentration and arsenic, cadmium, lead, and chromium concentrations of the urine samples were analyzed to determine the relation of L-FABP with arsenic, cadmium, lead, and chromium. High concentrations of arsenic, cadmium, lead, and chromium were not detected in the well water samples from CKDu-endemic areas. Arsenic, cadmium, and lead contents in the rice samples from both CKDu-endemic and non-endemic areas were well below the Codex standard. There were no relationships between the L-FABP concentration and concentrations of arsenic, cadmium, lead, and chromium in urine. In addition, arsenic, cadmium, lead, and chromium concentrations in human urine samples from CKDu-endemic areas were not significantly different from those from non-endemic areas. These findings indicated that arsenic, cadmium, lead, and chromium could not cause CKDu.