Abstract
BackgroundEnvironmental factors have been associated with the outbreak of chronic kidney disease (CKD). We evaluated the association of Cadmium (Cd) exposure with the risk of CKD in U.S. adults who participated in the 1999-2006 National Health and Nutrition Examination Surveys (NHANES).Methods5426 subjects ≥ 20 years were stratified for values of urinary and blood Cd and a multivariate logistic regression was performed to test the association between blood and urinary Cd, CKD and albuminuria (ALB) after adjustment for age, gender, race/ethnicity, body mass index and smoking habits.ResultsSubjects with urinary Cd > 1 mcg/g and subjects with blood Cd > 1 mcg/L showed a higher association with ALB (OR 1.63, 95% CI 1.23, 2.16; P = 0.001). Subjects with blood Cd > 1 mcg/L showed a higher association with both CKD (OR 1.48, 95% CI 1.01, 2.17; P = 0.046) and ALB (OR 1.41, 95% CI 1.10, 1.82; P = 0.007). An interaction effect on ALB was found for high levels of urinary and blood Cd (P = 0.014).ConclusionsModerately high levels of urinary and blood Cd are associated with a higher proportion of CKD and ALB in the United States population.
Highlights
Environmental factors have been associated with the outbreak of chronic kidney disease (CKD)
Cadmium nephropathy is characterized by low molecular weight (LMW) proteinuria due to diminished intrarenal uptake and catabolism of filtered proteins
Cadmium nephropathy has been observed in workers exposed to high levels of Cd, recent data suggest that relatively low levels of exposure in people living in polluted industrial areas increase the risk of tubular dysfunction [1]
Summary
Environmental factors have been associated with the outbreak of chronic kidney disease (CKD). We evaluated the association of Cadmium (Cd) exposure with the risk of CKD in U.S adults who participated in the 19992006 National Health and Nutrition Examination Surveys (NHANES). Chronic exposure to Cadmium (Cd), an industrial and environmental pollutant, can cause both renal proximal tubular damage and decline in glomerular filtration rate (GFR) in humans; this has been confirmed in experimental models [1,2]. Cadmium nephropathy has been observed in workers exposed to high levels of Cd, recent data suggest that relatively low levels of exposure in people living in polluted industrial areas increase the risk of tubular dysfunction [1]. The very recent paper by Navas-Acien et al [8] has disclosed that marginally high levels of blood Cd are significantly associated with kidney dysfunction. Since the urinary excretion of Cd is assumed to mirror chronic exposition to Cd, and Navas-Acien did not investigate this topic, we have addressed whether an association exists between urinary Cd and renal dysfunction
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