A food policy approach to CKDu in Sri Lanka: : Implementing Food Policy to Address Chronic Kidney Disease of Unknown Etiology in Sri Lanka

Sammanfattning

Chronic Kidney Disease of Unknown Etiology (CKDu) has emerged as a major health issue in Sri Lanka, particularly among male agricultural workers in dry-zone districts. This study aimed to identify key environmental, occupational, and dietary risk factors contributing to the disease. A mixed-methods approach was used, combining environmental sampling, community surveys, and stakeholder interviews. Water and soil samples collected from ten CKDu-endemic sites were analysed for heavy metals. Results indicated frequent exceedance of WHO safety thresholds for arsenic, cadmium, and lead, especially in Hingurakgoda, Padaviya, and Elahera. Water and Soil Quality Index scores further confirmed degraded environmental quality linked to intensive agricultural practices. Occupational assessments revealed prolonged exposure to high temperatures and inadequate hydration among farming populations, consistent with clinical records linking heat stress to kidney damage. Dietary assessments showed heavy dependence on rice cultivated in contaminated soils and irrigated with polluted water, with limited dietary diversity contributing to chronic nephrotoxin exposure. Together, these findings demonstrate that CKDu in the study regions is associated with combined risks from agrochemical contamination, occupational heat stress, and dietary vulnerability. The results highlight the need for integrated interventions that address environmental, occupational, and nutritional drivers of CKDu to safeguard farming communities in Sri Lanka.