Case-control study of water and agricultural exposures among women in CKDu-endemic Sri Lanka

Chronic kidney disease of unknown etiology (CKDu) disproportionately affects men in agricultural regions; few studies parse exposures among affected and unaffected women. We conducted a case–control study among women in Sri Lanka, identifying 15 cases, who experienced progressive kidney disease in a prospective study in a CKDu-endemic region. We selected age-matched controls from the same endemic and neighboring non-endemic region. We then assessed differences in self-reported exposures, and analyzed water samples for inorganic and organic chemicals. Women who reported heat exhaustion (OR = 19.3; p = 0.017) and pesticide handling (OR = 12.6; p = 0.011) were more likely cases. Women who used natural fertilizer in home gardens were more likely controls (OR = 0.05; p = 0.008). Cases' water had higher fluoride, sulfate, calcium, and vanadium, and more often contained pesticides at >1 ppb, particularly diazinon, compared with controls from endemic and non-endemic regions. Our study supports prior data linking heat exposure to CKDu and identifies differences in home gardening, pesticide use, and water content among CKDu-affected women.