论文标题
评论“水源和肾脏功能：在一项前瞻性研究中研究未知病因的慢性肾脏疾病”，P。Vlahos等人
Comment on "Water sources and kidney function: investigating chronic kidney disease of unknown etiology in a prospective study", by P. Vlahos et al
论文作者
论文摘要
Vlahos等人，参考。 1，NPJ清水。 4，50（2021）报告说，在斯里兰卡地区的井水“单个时间点分析”中，农药污染的存在高于安全水平，而慢性病因学（CKDU）是地方性的。他们得出结论：“在稻谷和其他农业实践中的农业化学使用……斯里兰卡的绿色革命现在可能会导致健康状况不佳，疾病的快速发展和死亡率”。作者还提出“减少……斯里兰卡和其他热带国家的农业化学污染物，以减少……ckdu”。这些结论是基于它们所谓的“单个时间点分析”，与vlahos等人提出的证据所支持的鉴定CKDU病因的鉴定。他们说，即使是最简单的因果关系标准也不满足。特别是（i）在该国大部分地区，包括没有CKDU的地方，偶发地发现了类似但非持久性的农药过剩； （ii）（1）中报道的农药引起肝毒性和肾毒性；后者具有肾小球损伤，而CKDU则与没有报道的肝毒性症状有关。 （iii）检测到的农药的半衰期很短，在耕种期间短期内使用；因此，一个时间点分析是不足和误导的。 （iv）以相同方式使用农药但基本上没有CKDU的农业社区存在于CKDU的社区附近； （v）CKDU的患病率似乎与当地的地貌相关，但与农业无关，而农业在该国大部分地区实践。 。
Vlahos et al., Ref. 1, NPJ Clean water. 4, 50 (2021) have reported the presence of pesticide contamination above safe levels in a "single time-point analysis" of well water in a region in Sri Lanka where chronic kidney disease of unknown etiology (CKDu) is endemic. They conclude "that agrochemical use in paddy and other agricultural practices ... of the Green Revolution in Sri Lanka may now be contributing to ill health, rapid progression of disease, and mortality". The authors also propose "reducing ... agrochemical contaminants in Sri Lanka and other tropical countries to reduce ... CKDu". These conclusions, based on what they call a "single time-point analysis", tantamount to an identification of the etiology of CKDu are unsupported by the evidence presented by Vlahos et al. They do not satisfy, say, even the simplest of Bradford-Hill criteria for causation. In particular, (i) similar but non-persistent pesticide excesses have been detected sporadically in most parts of the country including where there is no CKDu; (ii) the pesticides reported in (1) cause both hepatotoxicity and nephrotoxicity; the latter with glomerular damage while CKDu is associated with tubulo-interstitial damage where no hepatotoxic symptoms have been reported; (iii) the pesticides detected have short half-lives and are used over short periods during farming; so the one time-point analysis is inadequate and misleading; (iv) farming communities that use pesticides in the same way but remain essentially without CKDu are found to exist adjacent to communities with CKDu; (v) the CKDu prevalence seems to correlate with local geomorphology but without correlation to agriculture which is practiced in most parts of the country. .
