Arsenic, fluoride in water linked to higher kidney disease risk in India, warns nephrologist

While diabetes and hypertension have long been the primary suspects in India’s rising Chronic Kidney Disease (CKD) rates, a more insidious culprit is emerging from the depths: contaminated drinking water. Nephrologists and public health experts said that for the 600 million Indians reliant on groundwater, the very source of life may be a hidden vector for organ failure.

Beyond the reach of traditional lifestyle risks, a "silent epidemic" is taking hold in rural and urban corridors alike, driven by tasteless, odorless toxins that bypass the senses but devastate the body’s filtration system.

According to Dr. Shriniwas Ambike, Consulting Nephrologist at NephroPlus, long-term exposure to polluted groundwater can gradually impair kidney function, often without obvious symptoms for many years. This is particularly worrying in India, where a large share of the population relies on groundwater for drinking and daily household use.

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"India depends heavily on groundwater resources, with estimates suggesting that more than 600 million people use it for drinking and domestic purposes. However, multiple national assessments have highlighted widespread contamination of groundwater across many districts. Pollutants such as nitrates, fluoride, arsenic and other heavy metals have been detected in significant concentrations in various regions," he said.

Dr Ambike further said "Arsenic contamination alone has been reported in more than 230 districts across the country, while fluoride affects nearly 469 districts. In several areas, nitrate levels have also been found to exceed recommended safety limits. Because these contaminants are typically colourless, tasteless and odourless, households may consume polluted water for years without being aware of the risk."

The kidneys play a critical role in filtering toxins from the body, processing roughly 180 litres of blood every day. When contaminants repeatedly enter the bloodstream through drinking water, the kidneys must work harder to eliminate these harmful substances. Over time, this increased workload can damage kidney tissue.

Heavy metals such as cadmium, arsenic, lead and uranium are particularly harmful, said Dr Ambike, adding that ong-term exposure, even in relatively small amounts, has been associated with chronic kidney injury and declining kidney function. High concentrations of fluoride can also contribute to kidney damage, especially in regions already affected by fluorosis and environmental exposure.

Environmental changes are further complicating the situation. Over-extraction of groundwater, industrial discharge, agricultural runoff and inadequate waste management are increasing contamination levels in water sources. In some regions, falling groundwater tables lead to higher concentrations of minerals and heavy metals in the remaining water supply, he added.

Climate and occupational factors may also heighten the risk. Prolonged exposure to heat, dehydration and physically demanding labour — common in agricultural communities — can increase vulnerability to kidney injury caused by toxins present in drinking water.

One of the most concerning aspects of water-related CKD is that it often develops silently. Early stages typically show no noticeable symptoms. By the time warning signs such as fatigue, swelling, reduced urine output or breathing difficulties appear, significant kidney damage may already have occurred. This challenge is especially acute in rural areas where access to routine medical screening and awareness of water contamination risks remains limited.

Addressing the problem requires coordinated public health measures, Dr Ambike stressed the importance of regular groundwater monitoring, transparent reporting of water quality data and expanding safe piped drinking water systems. Community-level filtration systems in affected regions can also help reduce exposure to harmful contaminants.

At the individual level, testing local water sources, using certified purification systems capable of removing heavy metals and maintaining adequate hydration are practical steps that may help lower risks, he said.

While lifestyle-related diseases remain major contributors to kidney problems, contaminated drinking water is increasingly being recognised as a preventable environmental risk. Strengthening groundwater protection and ensuring safe water supplies could play a crucial role in reducing the growing burden of chronic kidney disease in India.