Abstract
Heavy metals causing chronic nephrotoxicity may play a key role in the pathogenesis of chronic kidney disease (CKD). This study hypothesized that plasma folate and vitamin B12 would modify the association of CKD with total urinary arsenic and blood lead and cadmium levels. We recruited 220 patients with CKD who had an estimated glomerular filtration rate of <60 mL/min/1.73 m2 for ≥3 consecutive months and 438 sex- and age-matched controls. We performed inductively coupled plasma mass spectrometry to measure blood cadmium and lead levels. The urinary arsenic level was determined using a high-performance liquid chromatography–hydride generator–atomic absorption spectrometry. Plasma vitamin B12 and folate levels were measured through the SimulTRAC-SNB radioassay. Compared with patients with plasma vitamin B12 ≤ 6.27 pg/mL, the odds ratio (OR) and 95% confidence interval of CKD for patients with plasma vitamin B12 > 9.54 pg/mL was 2.02 (1.15–3.55). However, no association was observed between plasma folate concentration and CKD. A high level of plasma vitamin B12 combined with high levels of blood lead and cadmium level and total urinary arsenic tended to increase the OR of CKD in a dose-response manner, but the interactions were nonsignificant. This is the first study to demonstrate that patients with high plasma vitamin B12 level exhibit increased OR of CKD related to high levels of blood cadmium and lead and total urinary arsenic.
Highlights
Our recent study reported that the levels of blood lead and cadmium and total urinary arsenic are significantly associated with an increased odds ratio (OR) of chronic kidney disease (CKD), whereas the plasma selenium level significantly reduced the OR of CKD [5]
A Thai study reported that long-term exposure to cadmium and a high urinary cadmium level were associated with a significant decrease in estimated glomerular filtration rate (eGFR), resulting in CKD [6]
The present study demonstrated that the increase in plasma vitamin B12, total urinary arsenic, and blood lead and cadmium levels gradually and significantly increased the OR of CKD
Summary
In Taiwan, the CKD prevalence was 11.9% in 2008 [3], and the prevalence of end-stage renal disease was the highest in the world from a 2016 report [4]; CKD is a significant public health issue in Taiwan. Our recent study reported that the levels of blood lead and cadmium and total urinary arsenic are significantly associated with an increased odds ratio (OR) of CKD, whereas the plasma selenium level significantly reduced the OR of CKD [5]. A Thai study reported that long-term exposure to cadmium and a high urinary cadmium level were associated with a significant decrease in eGFR, resulting in CKD [6]. A Chinese follow-up study showed that the levels of plasma arsenic and lead are associated with a significant annual decline in eGFR after adjustment for demographic variables and risk factors for CKD [7]
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