Abstract
BackgroundMalnutrition is associated with an increased risk of cardiovascular death and may cause protein-energy wasting in individuals with chronic kidney disease. A previous study demonstrated that blood cadmium levels (BCLs) were associated with malnutrition in maintenance hemodialysis (MHD) patients. However, the correlation between cadmium exposure and malnutrition remains unclear in chronic peritoneal dialysis (CPD) patients. This study examined the possible adverse effects of environmental cadmium exposure in CPD patients.MethodsA total of 301 CPD patients were enrolled and divided into 3 study groups based on the following BCL tertiles: low (<0.19 μg/L), middle (0.19–0.39 μg/L), and high (>0.39 μg/L). Demographic, hematological, biochemical, and dialysis-related data were obtained for analysis. The analysis also included values of nutritional and inflammatory markers.ResultsThe BCLs of CPD patients were lower than those of MHD patients. At baseline, patients in the high BCL group were older and had a higher prevalence of diabetes mellitus but lower serum albumin, creatinine, and phosphate levels than the patients in the other 2 groups. After adjusting for potential variables, stepwise backward multiple linear regression analysis revealed that age and alanine aminotransferase levels were positively associated with logarithmic transformation of BCLs (log BCLs), while serum albumin levels were negatively associated with log BCLs in CPD patients. The log BCLs were a significant determinant (beta coefficient ± standard error = -0.185 ± 0.074; P = 0.013) of nutritional status and significantly associated with the presence of malnutrition (odds ratio = 2.64; 95% confidence interval: 1.07–6.48; P = 0.035) in CPD patients after adjustment for related variables.ConclusionsBCL is significantly associated with nutritional status and malnutrition in CPD patients. Therefore, it is important for CPD patients to avoid environmental exposure to cadmium such as through smoking and consumption of cadmium-rich foods.
Highlights
Malnutrition is associated with an increased risk of cardiovascular death and may cause protein-energy wasting in individuals with chronic kidney disease
The 3 groups did not differ in terms of erythropoietin dose, total Kt/V, residual renal weekly creatinine clearance (Ccr), standard weekly total Ccr, normalized protein nitrogen appearance (nPNA), hemoglobin, alanine aminotransferase (ALT), transferrin saturation, ferritin, serum corrected-calcium, intact parathyroid hormone (iPTH), cholesterol, triglyceride, and high-sensitivity Creactive protein (Hs-CRP) levels, as well as the presence of viral hepatitis B antigen and viral hepatitis C antibody
The results of our study indicate that chronic environmental low-level cadmium exposure may play a role in the increased malnutrition of chronic peritoneal dialysis (CPD) patients. This is the first study to demonstrate that blood cadmium levels (BCLs) are related to age, serum albumin levels, and Alanine aminotransferase (ALT) levels in CPD patients
Summary
Malnutrition is associated with an increased risk of cardiovascular death and may cause protein-energy wasting in individuals with chronic kidney disease. A previous study demonstrated that blood cadmium levels (BCLs) were associated with malnutrition in maintenance hemodialysis (MHD) patients. The correlation between cadmium exposure and malnutrition remains unclear in chronic peritoneal dialysis (CPD) patients. This study examined the possible adverse effects of environmental cadmium exposure in CPD patients. Occupational studies have shown that cadmium exposure is associated with increased all-cause and cancer-related mortality [2]. Cadmium has been shown to accumulate in the bones of patients with end-stage renal disease (ESRD), and increased blood cadmium levels (BCLs) have been observed in maintenance hemodialysis (MHD) patients [7,8,9]. The clinical significance of BCLs in chronic peritoneal dialysis (CPD) patients remains unknown, and the possible adverse effects of environmental cadmium exposure in CPD patients were not identified
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