Table 1 Key causes that contribute to the development of CKD-mfo
Item | Potential causative factors | References |
|---|---|---|
A | Careless use and overuse of pesticides, herbicides, and low-quality imported chemical fertilisers, which contaminate the environment with heavy metals and other toxic chemicals | |
B | Overuse of toxic agrochemicals, particularly chemical (phosphate) fertilisers as a result of continued government subsidy of these products | |
C | Ineffective control of and lack of laws regarding the selling of these toxic products (e.g. virtually anyone can buy any quantity of these potentially dangerous chemicals over the counter) | |
D | Lack of awareness by farmers of the environmental damage and human adverse effects of chronic exposure to and irresponsible and overuse of agrochemicals | [111] |
E | Farmers in developing countries who handle and spray toxic agrochemicals do not use personal protective equipment, such as masks, gloves, goggles, footwear, and clothing. Thus, they are exposed to high concentrations of toxic agrochemicals (and petrochemicals) on a daily basis, which can get into the body via absorption through the skin or inhalation | |
F | Lack of awareness leads farmers to carelessly overuse and continue to contaminate soil, water and the environment (e.g. disposing of used pesticide containers and bottles into streams) | |
G | The use of unprotected (i.e. unlined) aluminium containers for cooking, which enhances solubilisation of aluminum fluoride, and thereby, increased the absorption and potential toxic effects of fluoride | |
H | Frequent dredging of canals and reservoirs re-exposes deeply deposited toxins to water bodies and thus contaminates the food chain | |
I | Consumption of fruits, vegetables, and grains sprayed before and immediately after harvesting with chemicals and preservatives, shining or waxing agents, including harmful carbofurans and antracols, and fungicides to serve as anti-transpirants | |
J | Poor nutrition (e.g. lack of a balanced diet, which escalates chronic diseases, including CKD-mfo) promotes malnutrition | |
K | Unintended long-term adverse effects from human settlement projects and large-scale irrigation projects, such as the accelerated Mahaweli project |