Effects of Environmental Exposure to Cadmium and Lead on the Risks of Diabetes and Kidney Dysfunction.

Supabhorn Yimthiang,David A Vesey,Saruda Kuraeiad,Soisungwan Satarug,Glenda C Gobe,Paleeratana Wongrith,Tanaporn Khamphaya,Phisit Pouyfung

doi:10.3390/ijerph19042259

Abstract

Environmental exposure to cadmium (Cd) or lead (Pb) is independently associated with increased risks of type 2 diabetes, and chronic kidney disease. The aim of this study was to examine the effects of concurrent exposure to these toxic metals on the risks of diabetes and kidney functional impairment. The Cd and Pb exposure levels among study subjects were low to moderate, evident from the means for blood concentrations of Cd and Pb ([Cd]b and [Pb]b) of 0.59 µg/L and 4.67 µg/dL, respectively. Of 176 study subjects (mean age 60), 71 (40.3%) had abnormally high fasting plasma glucose levels. Based on their [Cd]b and [Pb]b, 53, 71, and 52 subjects were assigned to Cd and Pb exposure profiles 1, 2, and 3, respectively. The diagnosis of diabetes was increased by 4.2-fold in those with an exposure profile 3 (p = 0.002), and by 2.9-fold in those with the estimated glomerular filtration (eGFR) ≤ 60 mL/min/1.73 m2 (p = 0.029). The prevalence odds ratio (POR) for albuminuria was increased by 5-fold in those with plasma glucose levels above kidney threshold of 180 mg/dL (p = 0.014), and by 3.1-fold in those with low eGFR) (p = 0.050). Collectively, these findings suggest that the Cd and Pb exposure profiles equally impact kidney function and diabetes risk.

Highlights

Introduction iationsChronic environmental exposure to cadmium (Cd) has been associated with increased risks of prediabetes and diabetes in the general populations in the U.S [1,2,3,4], Korea [5], and China [6]
The aim of this study was to investigate the effects of concurrent exposure to Cd and Pb in 176 Thai subjects of which 88 were diagnosed diabetes, and 88 were apparently healthy non-diabetics. [Cd]b and [Pb]b levels were used as exposure estimates, while estimated glomerular filtration rate (GFR) and albumin-to-creatinine ratio (ACR) served as kidney functional measures
Among 176 participants, half were given type 2 diabetes diagnosis by their medical records, while 3 of 88 persons recruited as non-diabetic controls had fasting plasma glucose

Summary

Introduction

Chronic environmental exposure to cadmium (Cd) has been associated with increased risks of prediabetes and diabetes in the general populations in the U.S [1,2,3,4], Korea [5], and China [6]. Two Norwegian population studies reported exposure to Cd and lead (Pb) as potential risk factors for diabetes [7,8]. Low environmental exposure to Cd has been identified as a risk factor for chronic kidney disease (CKD) in cross-sectional studies in. The diagnosis of CKD is based on albumin-tocreatinine ratio (ACR) above 30 mg/g creatinine (albuminuria) and/or a decrease in the glomerular filtration rate (GFR) to 60 mL/min/1.73 m2 (low eGFR) that persists for at least three months [16,17,18,19]. In the Dallas lead project, an elevation of blood Pb ([Pb]b ) was associated with a marked reduction in eGFR among residents of a lead smelter community [20].

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