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12-12-2023 | Original Article

Environmental fluoride exposure and implications on potential pediatric kidney health risks: an approach with urinary biomarkers

Authors: T. D. K. S. C. Gunasekara, P. Mangala C. S. De Silva, E. P. S. Chandana, Sudheera Jayasinghe, Chula Herath, Sisira Siribaddana, Nishad Jayasundara

Published in: Pediatric Nephrology | Issue 5/2024

Abstract

Background

Environmental fluoride exposure at elevated levels is potentially linked to kidney injury, and may contribute to chronic kidney disease of uncertain etiology (CKDu) as a risk factor. However, this link remains unclear, and examining the risk of kidney damage from early life fluoride exposure may provide important insights. Hence, this study aimed to investigate associations of fluoride exposure with pediatric kidney health in CKDu impacted and unimpacted communities in Sri Lanka.

Methods

Considering the geographical variations in environmental fluoride, climate, and prevalence of CKDu, four study groups were established within selected education zones in CKDu-endemic dry zone regions (D-En), and CKDu-nonendemic regions within the dry (D-NE), wet (W-NE), and intermediate (I-NE) climatic zones. The study population included 922 school students (11–18 years of age). Participants in each group were divided into four subgroups based on quartiles of respective urinary fluoride (UF) distribution for comparison of urinary kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and albumin-creatinine ratio (ACR).

Results

UF levels in participants particularly in CKDu endemic dry zone regions were significantly high compared to the other regions. Significantly high median urinary NGAL (in D-NE) and ACR (in D-EN, and W-NE) levels were observed in subgroups of higher UF quartiles. Albuminuria was not particularly identified in subjects with high UF excretion. Urinary KIM-1 showed no significant variation across the UF quartile subgroups. Linear regression identified weak associations of UF with kidney injury biomarkers.

Conclusions

Fluoride exposure is particularly high in CKDu-endemic dry zone communities. As implied by kidney injury biomarkers, a strong link between fluoride exposure and pediatric kidney health was not evident at the observed exposure levels in the study regions.

Graphical abstract

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Title: Environmental fluoride exposure and implications on potential pediatric kidney health risks: an approach with urinary biomarkers
Authors: T. D. K. S. C. Gunasekara
P. Mangala C. S. De Silva
E. P. S. Chandana
Sudheera Jayasinghe
Chula Herath
Sisira Siribaddana
Nishad Jayasundara
Publication date: 12-12-2023
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 5/2024
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-023-06218-z

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Springer Medicine

Environmental fluoride exposure and implications on potential pediatric kidney health risks: an approach with urinary biomarkers

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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