Poor groundwater quality in household wells is hypothesized as being a potential contributor to chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. However, the influencing factors of groundwater quality in Sri Lanka are rarely investigated at a national scale. Here, the spatial characteristics of groundwater geochemistry in Sri Lanka were described. The relationships of groundwater quality parameters with environmental factors, including lithology, land use, and climatic conditions, were further examined to identify the natural and anthropogenic controlling factors of groundwater quality in Sri Lanka. The results showed that groundwater geochemistry in Sri Lanka exhibited significant spatial heterogeneity. The high concentrations of NO₃⁻ were found in the districts that have a higher percentage of agricultural lands, especially in the regions in the coastal zone. Higher hardness and fluoride in groundwater were mainly observed in the dry zone. The concentrations of trace elements such as Cd, Pb, Cu, and Cr of all the samples were lower than the World Health Organization guideline values, while some the samples had higher As and Al concentrations above the guideline values. Principal component analysis identified four components that explained 73.2% of the total data variance, and the first component with high loadings of NO₃⁻, hardness, As, and Cr suggested the effects of agricultural activities, while other components were primarily attributed to natural sources and processes. Further analyses found that water hardness, fluoride and As concentration had positive correlations with precipitation and negative correlations with air temperature. The concentration of NO₃⁻ and water hardness were positively correlated with agricultural lands, while As concentration was positively correlated with unconsolidated sediments. The environmental factors can account for 58% of the spatial variation in the overall groundwater geochemistry indicated by the results of redundancy analysis. The groundwater quality data in this study cannot identify whether groundwater quality is related to the occurrence of CKDu. However, these findings identify the coupled controls of lithology, land use, and climate on groundwater quality in Sri Lanka. Future research should be effectively designed to clarify the synergistic effect of different chemical constituents on CKDu.

Chronic kidney disease with uncertain etiology (CKDu) is an emerging health problem in Sri Lanka, particularly among the dry-zone farming communities that use groundwater for drinking. We investigated the quality of groundwater in an area where both high- and low-prevalence clusters of CKDu have been recorded. Eighty-four groundwater and five surface water samples, covering the selected region, were collected and analyzed for both major anions and cations. The groundwater in the region is mainly of the Ca-Mg-HCO₃ type, probably due to the long residence time in fractured hard rock aquifers in this region. Irrespective of the CKDu prevalence, over 50% of samples exceeded the recommended limits for EC/TDS, alkalinity, hardness, and Mg²⁺ content in groundwater. Water hardness in CKDu clusters was dominated by Mg²⁺. High fluoride content up to 4.0 mg/L was also found in most groundwater samples from the region. The water quality index (WQI) values indicated that 42% of the groundwater samples in regions with no or low CKDu prevalence and 49% of the samples in regions with high prevalence were poor in quality. The spatial distribution of WQI and fluoride concentration overlapped, indicating the direct influence of fluoride on the groundwater quality in the study region. In addition, regions with higher WQI values overlapped with the CKDu hotspots, indicating the direct impact of groundwater quality on the disease prevalence in the studied river basin. The WQI can be used to effectively demarcate areas with possible groundwater-related health effects in the dry-zone regions of Sri Lanka.

The prevalence of chronic kidney disease of uncertain etiology (CKDu) in the Uva Province (UP) of Sri Lanka has received much attention over the past two decades. Many scientists assumed that prolonged consumption of drinking water with high levels of contaminants may be the causative factor. Thus, the prime objective of this study is to develop a binary logistic regression model based on water quality parameters and the prevalence of CKDu to find out the geochemical risk factors that affect the CKDu. For this, 260 groundwater samples were collected following a stratified random sampling method and analyzed for its major cations, anions, and selected trace element contents. In the model, the dichotomous dependent variable defines the availability of CKDu patients, and explanatory variables define groundwater quality parameters. According to the best-fit model, F⁻ and PO43- levels of the groundwater were found to be the geochemical risk factors that were significantly associated with the progression of CKDu in the study area. Furthermore, it was shown that geochemical processes such as dissolution of bedrocks are the causative phenomenon of the enhancement of F⁻ levels in the groundwater sources. It has also been observed that the PO43- concentrations of the groundwater possibly increase because of the intensive application of agrochemicals in addition to geogenic sources. The results of this study can be used by the government authorities in groundwater management and the management of the prevalence of CKDu disease in the study area. Furthermore, the findings of this study will contribute to the policy-makers in Sri Lanka for providing safe drinking water to meet the sustainable development goals (SDGs).