RESEARCH ARTICLE The impact of aluminum, fluoride, and aluminum–fluoride complexes in drinking water on chronic kidney disease Hewa M. S. Wasana 1 & Gamage D. R. K. Perera 2 & Panduka S. De Gunawardena 3 & Jayasundera Bandara 1 Received: 26 September 2014 /Accepted: 5 March 2015 # Springer-Verlag Berlin Heidelberg 2015 Abstract It is suspected that drinking water containing fluo- ride and aluminum results in negative health effects especially on brain, liver, and kidney. In this investigation, the effect of F, Al, and AlF x complex on chronic kidney disease (CKD) was investigated. Mice were treated either with WHO recommend- ed or slightly higher F and Al levels in drinking water. Treatment solutions contained 0.05–10.0 mg/L of F, 0.08– 10.0 mg/L of Al, or 0.07–15 mg/L of AlF x , and the treatment period was 42 weeks. Blood urea level and creatinine levels were investigated as a measure of malfunction of kidneys. Histopathological evaluations of kidney tissues were carried out to assess the extent of damage that F, Al, and AlF x com- plex could cause. It was demonstrated that the treated drinking water containing F and Al with par with WHO or moderately above the WHO levels or AlF x in low level (0.07–15 mg/L) does not lead to CKD in mice. Keywords Aluminum . Fluoride toxicity . Chronic kidney disease . Water quality . Environment and public health Introduction Chronic kidney disease (CKD) is considered to be a world- wide public health problem and receiving increased global attention because of a significant increase in the prevalence of the disease. Aging, diabetes, hypertension, and nephrotoxic drug usage are found to be the primary cause of CKD risk factors while CKD of unknown etiology (CKDu) is preva- lence in some regions of the world especially in African, Central American, and Asian nations (Nahas et al., 2005; Codreanu et al., 2006). The term Bunknown etiology^ is re- ferred, because the disease is not associated with any known risk factors but suspected to be occupational and environmen- tal causes (Soderland et al. 2010). Hence, the major factors that were considered for CKD causes are as follows: environ- mental toxins (Wanigasuriyaa et al. 2011), heavy metals (e.g., Cd, Pb), (Bandara et al. 2010; Wanigasuriya et al., 2011), fluoride, aluminum, and aluminofluoride (AlF x ) complexes in water (Ileperuma et al. 2009). Though all these risk factors can be categorized into a waterborne factor, presence of Al and F was the most common problem worldwide due to pres- ence of dissolved fluoride and aluminum in drinking water. Despite the toxicity effects of F (Schiffl 2008) and Al (Sargazi et al. 2001) on CKD patients having shown, it has not been clearly demonstrated that F and Al as causative factor (s) in prevalence of CKD. In this investigation, we attempt to eluci- date the role of F, Al, and AlF x complexes in triggering of CKD. The known toxicity of F, Al, and AlF x complexes on humans and animals is briefly reviewed in the following par- agraphs. Fluoride is an essential element for human beings for development and growth. While it is beneficial at low recom- mended doses, its toxicity at higher levels has also been well established. As F gets accumulated in hard tissues of the body, endemic skeletal and teeth fluorosis are known at higher F Responsible editor: Philippe Garrigues * Jayasundera Bandara jayasundera@yahoo.com 1 Institute of Fundamental Studies, Hantana Road, Kandy 20000, Sri Lanka 2 Department of Farm animal production and health, Faculty of Veterinary Medicine, University of Peradeniya, Peradeniya, Sri Lanka 3 Department of Veterinary Pathobiology, Faculty of Veterinary Medicine, University of Peradeniya, Peradeniya, Sri Lanka Environ Sci Pollut Res DOI 10.1007/s11356-015-4324-y