Abstract
Background: There is a scarcity of epidemiological studies evaluating the association of arsenic exposure on kidney diseases. The aim of this study was to examine the association of chronic arsenic exposure from drinking water and end-stage renal disease (ESRD) in highly-exposed areas in Taiwan by long-term perspective study. Methods: The southwestern (SW) cohort was recruited from blackfoot disease endemic townships with high arsenic levels of 350–1140μg/L (median: 780μg/L) in their well water. The arsenic concentration in the wells was measured using the mercuric bromide stain method. The status of ESRD for study subjects was ascertained through linkage with the computerized Taiwan National Health Insurance (NHI) database from 1998 to 2009. Cox regression analysis was used to determine the hazard ratios (HRs) for developing ESRD. Results: A total of 98 ESRD patients were observed, corresponding to 465.6 per 100,000 person-years. Significant dose-response relationship between arsenic exposure indices and ESRD was observed after adjustment with potential confounding factors. The HRs were 1.00 (referent), 1.20 (0.54-2.69), 1.41 (0.69-2.89) and 2.25(1.14-4.45) in relation to lifetime cumulative arsenic exposure of
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