Avaliação da presença de metais pesados na água potável fornecida à população urbana de Altamira e o seu possível impacto epidemiológico sobre doenças crônicas renais

Abstract

The Xingu River is crucial for potable water supply in Altamira, but it faces risks of heavy metal pollution, especially mercury, due to illegal mining and UHBM activities. Mercury can bioaccumulate in humans and be associated with an increased risk of hypertension and kidney diseases. This study evaluated the presence of heavy metals in Altamira's drinking water and outlined the epidemiological profile of chronic kidney disease (CKD) in Altamira and the Xingu region. Concentrations of Al, As, Cr, Cd, Pb, Fe, and Hg were measured in 24 water samples collected in July 2022, using ICP/MS by the Evandro Chagas Institute, compared to Brazilian legislation and WHO limits. Mortality data from CKD, diabetes mellitus (DM), and systemic arterial hypertension (SAH) from 2000 to 2020 were analyzed using public data from DATASUS. Additionally, medical records of CKD patients treated at HRPT from 2007 to 2023 were analyzed. The concentrations of metals in the analyzed water samples were within established limits, except for aluminum (Al), which was elevated in two water samples. Mortality data obtained from DATASUS between 2000 and 2020 showed a significant increase in mortality due to SAH in Altamira (R²=0.80), while mortality from CKD (R²=0.30) and DM (R²=0.31) had a smaller impact on the mortality rate during the studied period. Considering the medical records of CKD patients treated at HRPT, it was identified that between 2007 and 2023, 174 CKD patients treated at HRPT were from Altamira, with 64.4% men and 35.6% women. Regarding age, 48.85% were over 60 years old, and 36.78% were between 41 and 60 years old. The main comorbidity associated with CKD was SAH (56.90%), followed by the association of SAH and DM (36.94%). Altamira presented an average prevalence of 8.99 cases per 100,000 inhabitants and an average incidence of 10.24 new cases per year of CKD during the analyzed period. In the Xingu region, 403 CKD cases were identified, predominantly in men (61.5%) with an average age of 60 years. The main comorbidity associated with CKD was SAH (49.88%), followed by the association of SAH and DM (37.47%). The average prevalence of CKD in the region was 6.97 cases per 100,000 inhabitants, with an average incidence of 23.70 new cases per year of CKD during the analyzed period. The levels of metals in the analyzed water samples are within the limits recommended by Brazilian legislation and WHO. The high prevalence of CKD in Altamira and the Xingu region raises concerns about public health impacts. Historical mercury contamination may be related to the high mortality from SAH and the prevalence of CKD associated with SAH. These results emphasize the need for continuous monitoring of water quality and public policies to mitigate the impacts of CKD in the region.