Research Article Exploring the Root Cause for Chronic Kidney Disease of Unknown Etiology (CKDu) via Analysis of Metal Ion and Counterion Contaminants in Drinking Water: A Study in Sri Lanka W. P. R. T. Perera , M. D. N. R. Dayananda , and J. A. Liyanage Department of Chemistry, Faculty of Science, University of Kelaniya, Kelaniya 11600, Sri Lanka Correspondence should be addressed to W. P. R. T. Perera; 2017_perera@kln.ac.lk Received 17 July 2020; Revised 5 October 2020; Accepted 7 October 2020; Published 27 October 2020 Academic Editor: Claudio Cameselle Copyright © 2020 W. P. R. T. Perera et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. e introduction of elevated amounts of foreign ions into the blood may lead to impairment of the filtration membrane of kidneys and chronic kidney damage. In order to assess the risk of consumption of drinking water (dug well water) in chronic kidney disease of unknown etiology (CKDu), affected areas in Sri Lanka, trace metals, and other counterions in water samples obtained from dug wells were analyzed and compared with a reference area. Drinking water could be the major source that is responsible for entering nephrotoxic ion contaminants into the human body. To achieve the objective, drinking water samples were collected from dug wells in two CKDu endemic areas and a reference area where no CKDu patients were found in a dry season. In the Wewelketiya area (one of the endemic areas), Cd concentrations in 60% of water samples and Pb concentrations in 40% of water samples have exceeded the maximum limit given by Sri Lanka water quality standards. Fluoride concentrations also have exceeded the permissible limits of more than 80% of collected water samples in both CKDu endemic areas. However, none of the water samples in reference areas has reported that Cd, Pb, and fluoride are beyond their maximum permissible limits. Hence, people in the particular CKDu endemic areas are at risk of kidney tissue damage due to long-term exposure to drinking water with elevated levels of some metal ions and counterions. 1. Introduction Chronic kidney disease of unknown etiology was first dis- covered in Sri Lanka in the mid-1990s and was mostly observed among the farmers in the North Central Province (NCP) of Sri Lanka, and since then, over two decades of a period, the disease spread dramatically up to the other farming areas of the country such as Northern, North- western, Eastern, Uva, and Central Provinces [1]. Chronic kidney disease (CKD) is a noncommunicable disease that is related to risk factors such as diabetes or hypertension, past snakebites, and urinary tract infections [2–4]. Another study has defined “chronic kidney disease” as either kidney damage or decreased kidney function (decreased GFR) for three months or more [5]. Chronic kidney disease (CKD) is a global public health concern, which is attracting increased global attention because of the disease’s rapid spread. However, CKD of unknown etiology CKDu is also prevalent and is progressing rapidly in certain regions of the world, especially in Africa, Central America, and Asia [6]. e occurrence of CKDu within the same country will vary with the geographic area. An intimate relationship between water quality and the underlying geology has been recorded repeatedly in various geographical regions of the world. Since the CKDu exists in communities where groundwater is the primary source of drinking water, many risk factors are hypothesized, for example, unidentified environmental toxins leading to CKDu [7], chronic pesticide exposure and enhanced level of heavy metals in water and soil [8], high fluoride levels and potential impacts of AlFx in soil and water [9], and growth of cyanobacteria in water resources [10, 11]. Hindawi Journal of Chemistry Volume 2020, Article ID 8670974, 9 pages https://doi.org/10.1155/2020/8670974