Efficacy of Reverse Osmosis in Reducing Chronic Kidney Disease of Unknown Etiology in Sri Lanka: A Narrative Review

There has been an epidemic of Chronic Kidney Disease of Unknown Etiology (CKDu) affecting the agricultural communities in Sri Lanka, spanning three decades. The main pathological finding has been chronic interstitial nephritis. This narrative review focuses on the efficacy of Reverse Osmosis (RO) technology in purifying water and its impact in reducing CKDu. PubMed, Cochrane and Google Scholar were used to search for peer-reviewed articles from 2000 to 2023. The themes that emerged from the literature review were validated through the opinions of key informants and subject matter experts.There were anecdotal, as well as some research evidence to indicate that RO-treated water is efficacious in preventing and slowing down the progression of CKDu. This relationship needs further investigation with well-designed prospective studies. The literature review also revealed many social, technical and environmental issues related to the use of RO machines. Despite the potential benefits of RO machines, these issues must be resolved in order to prevent serious problems in the future.In conclusion, this review underscores the need for further research, interventions and regulatory measures related to the use of RO machines to reshape the CKDu trajectory in Sri Lanka.