HEAVY METAL CONTAMINATION IN DRINKING WATER: CONNECTION TO CHRONIC KIDNEY DISEASE RISK
DOI:
https://doi.org/10.71000/wp0xsd08Keywords:
Chronic kidney disease, Drinking water, Arsenic, Cadmium, Environmental Exposure, Lead, MercuryAbstract
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.
References
Yang J, Lo K, Yang A. Trends in Urinary and Blood Cadmium Levels in U.S. Adults with or without Comorbidities, 1999-2018. Nutrients. 2022;14(4).
Danziger J. Synergistic susceptibility to environmental lead toxicity in chronic kidney disease. Curr Opin Nephrol Hypertens. 2024;33(5):543-50.
Nigra AE, Navas-Acien A. Racial Inequalities in Drinking Water Lead Exposure: A Wake-Up Call to Protect Patients with End Stage Kidney Disease. J Am Soc Nephrol. 2021;32(10):2419-21.
Lin CJ, Shih HM, Wu PC, Pan CF, Lin YH, Wu CJ. Plasma selenium and zinc alter associations between nephrotoxic metals and chronic kidney disease: Results from NHANES database 2011-2018. Ann Acad Med Singap. 2023;52(8):398-410.
Mishra M, Nichols L, Dave AA, Pittman EH, Cheek JP, Caroland AJV, et al. Molecular Mechanisms of Cellular Injury and Role of Toxic Heavy Metals in Chronic Kidney Disease. Int J Mol Sci. 2022;23(19).
Danziger J, Willetts J, Larkin J, Chaudhuri S, Mukamal KJ, Usvyat LA, et al. Household Water Lead and Hematologic Toxic Effects in Chronic Kidney Disease. JAMA Intern Med. 2024;184(7):788-96.
Yin G, Xin M, Zhao S, Zhao M, Xu J, Chen X, et al. Heavy metals and elderly kidney health: A multidimensional study through Enviro-target Mendelian Randomization. Ecotoxicol Environ Saf. 2024;281:116659.
Win-Thu M, Myint-Thein O, Win-Shwe TT, Mar O. Environmental cadmium exposure induces kidney tubular and glomerular dysfunction in the Myanmar adults. J Toxicol Sci. 2021;46(7):319-28.
Farkhondeh T, Naseri K, Esform A, Aramjoo H, Naghizadeh A. Drinking water heavy metal toxicity and chronic kidney diseases: a systematic review. Rev Environ Health. 2021;36(3):359-66.
Satarug S, Vesey DA, Gobe GC. Dose-Response Analysis of the Tubular and Glomerular Effects of Chronic Exposure to Environmental Cadmium. Int J Environ Res Public Health. 2022;19(17).
Smereczański NM, Brzóska MM. Current Levels of Environmental Exposure to Cadmium in Industrialized Countries as a Risk Factor for Kidney Damage in the General Population: A Comprehensive Review of Available Data. Int J Mol Sci. 2023;24(9).
Yin G, Zhao S, Zhao M, Xu J, Ge X, Wu J, et al. Complex interplay of heavy metals and renal injury: New perspectives from longitudinal epidemiological evidence. Ecotoxicol Environ Saf. 2024;278:116424.
Medgyesi DN, Mohan S, Bangia K, Spielfogel ES, Spaur M, Fisher JA, et al. Community Water Trihalomethanes and Chronic Kidney Disease. JAMA Netw Open. 2025;8(7):e2518513.
Gao H, Zhu N, Deng S, Du C, Tang Y, Tang P, et al. Combination Effect of Microcystins and Arsenic Exposures on CKD: A Case-Control Study in China. Toxins (Basel). 2023;15(2).
Shi X, Wang X, Zhang J, Dang Y, Ouyang C, Pan J, et al. Associations of mixed metal exposure with chronic kidney disease from NHANES 2011-2018. Sci Rep. 2024;14(1):13062.
Kuo PF, Huang YT, Chuang MH, Jiang MY. Association of low-level heavy metal exposure with risk of chronic kidney disease and long-term mortality. PLoS One. 2024;19(12):e0315688.
Wei Y, Lyu Y, Cao Z, Zhao F, Liu Y, Chen C, et al. Association of low cadmium and mercury exposure with chronic kidney disease among Chinese adults aged ≥80 years: A cross-sectional study. Chin Med J (Engl). 2022;135(24):2976-83.
Haruna I, Obeng-Gyasi E. Association of Combined Per- and Polyfluoroalkyl Substances and Metals with Chronic Kidney Disease. Int J Environ Res Public Health. 2024;21(4).
Doccioli C, Sera F, Francavilla A, Cupisti A, Biggeri A. Association of cadmium environmental exposure with chronic kidney disease: A systematic review and meta-analysis. Sci Total Environ. 2024;906:167165.
Aaseth J, Alexander J, Alehagen U, Tinkov A, Skalny A, Larsson A, et al. The Aging Kidney-As Influenced by Heavy Metal Exposure and Selenium Supplementation. Biomolecules. 2021;11(8).
CANPOLAT Ö. THE GLOBAL PROBLEM: WATER POLLUTION AND HEAVY METALS-A. Research And Evaluations In Agriculture, Forestry And Aquaculture. 2023 Dec:119.
Talema A. Causes, negative effects, and preventive methods of water pollution in Ethiopia. Quality Assurance and Safety of Crops & Foods. 2023 Apr 1;15(2):129-39.
Tsai HJ, Hung CH, Wang CW, Tu HP, Li CH, Tsai CC, Lin WY, Chen SC, Kuo CH. Associations among heavy metals and proteinuria and chronic kidney disease. Diagnostics. 2021 Feb 11;11(2):282.
Danziger J, Willetts J, Larkin J, Chaudhuri S, Mukamal KJ, Usvyat LA, Kossmann R. Household Water Lead and Hematologic Toxic Effects in Chronic Kidney Disease. JAMA Intern Med. 2024 Jul 1;184(7):788-796.
Gao Z, Wu N, Du X, Li H, Mei X, Song Y. Toxic Nephropathy Secondary to Chronic Mercury Poisoning: Clinical Characteristics and Outcomes. Kidney Int Rep. 2022 Mar 18;7(6):1189-1197.
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Copyright (c) 2025 Kirsh Kumar, Sajan Sarang, Hina Qasim Memon, Anchal Kumari, Hira Jamil, Abdul Razzaque Nohri (Author)
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