Heavy Metal Contamination in Drinking Water: Connection to Chronic Kidney Disease Risk

Background: Heavy metal contamination in drinking water is a growing global public health concern, especially in rural and resource-limited regions. Chronic exposure to nephrotoxic metals such as lead, cadmium, and arsenic is increasingly recognized as a significant environmental risk factor for chronic kidney disease (CKD). In areas lacking proper water regulation and infrastructure, such exposures can lead to serious long-term health consequences and increased disease burden in vulnerable populations. Objective: To evaluate the concentration of heavy metals in drinking water and investigate their association with CKD among adults living in rural regions of Pakistan. Methods: A cross-sectional quantitative study was conducted involving 250 adult participants (52% male, 48% female; mean age 45.8 ± 13.4 years) from rural communities with known environmental exposure. Water samples from participants’ households were collected and analyzed for lead, cadmium, arsenic, and mercury using inductively coupled plasma mass spectrometry (ICP-MS). Renal function was assessed using serum creatinine, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (UACR). Clinical and demographic data, including smoking status and comorbidities, were collected through structured interviews and medical records. Logistic regression analysis was performed to determine associations between heavy metal levels and CKD, adjusting for age, gender, smoking, and existing health conditions. Results: Lead levels exceeded WHO limits in 87% of water samples (mean: 0.72 mg/L), cadmium in 75% (0.15 mg/L), arsenic in 81% (0.098 mg/L), and mercury in 64% (0.006 mg/L). A total of 23 participants (9.2%) met clinical criteria for CKD. Lead exposure showed the strongest association with CKD (AOR: 2.85; 95% CI: 1.75–4.61; p<0.001), followed by cadmium (AOR: 2.40; p=0.002) and arsenic (AOR: 1.92; p=0.018). Mercury exposure was not statistically significant (AOR: 1.45; p=0.168). Conclusion: High levels of lead, cadmium, and arsenic in rural drinking water are significantly associated with increased risk of CKD. These findings highlight the urgent need for water safety regulation and environmental health interventions in affected regions.