Blood Cadmium and Lead and Chronic Kidney Disease in US Adults: A Joint Analysis

Navas‐Acien, Ana; Téllez-Plaza, María; Güallar, Eliseo; Muntner, Paul; Silbergeld, Ellen K.; Jaar, Bernard G.; Weaver, Virginia M.

doi:10.1093/aje/kwp248

Cited by 324 publications

(228 citation statements)

References 48 publications

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“…Studies have shown that urinary Cd levels in unexposed populations are normally below 0.5µg/g creatinine which is similar to that of the CKDu and non-farmer control groups in our study [23]. The critical urinary Cd concentration that is associated with the onset of renal injury has been found to be approximately 2 to 10µg/g creatinine, which corresponds to a renal cortical Cd concentration of approximately 150 to 200µg/g tissue [24]. In more recent studies conducted in the general population, urinary Cd levels below the accepted threshold of 2µg/g creatinine have been shown to be associated with kidney disease and albuminuria [25].…”

Section: Discussionsupporting

confidence: 82%

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

et al. 2017

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Introduction Chronic kidney disease of unknown etiology (CKDu) has emerged as a significant public health problem in Sri Lanka. The role of environmental exposure to cadmium and arsenic in the aetiology of CKDu is still unclear. Identification of a panel of novel urinary biomarkers would be invaluable in the study of toxin mediated damage postulated to be the aetiology of CKDu.Objectives The aims of this study were to evaluate the profile of novel urinary biomarkers in CKDu patients and identify any association with environmental exposure to heavy metals.Methods Thirty seven randomly selected CKDu patients attending a renal clinic in the North Central Province and two control groups namely a farmer group (n=39) and a non-farmer group (n=40) from a non-endemic area were included in this comparative cross sectional study. Urine samples were analyzed for heavy metals and five urinary biomarkers.Results CKDu patients had significantly elevated urinary levels of fibrinogen (198.2 ng/mg creatinine p<0.001), clusterin (3479 ng/mg creatinine p<0.001), cystatin-C (5124.8 ng/mg creatinine p<0.001) and β2-microglobulin (9913.4 ng/mg creatinine p<0.001) compared to the control groups. Fibrinogen and β2-microglobulin were the best to discriminate CKDu patients from normal individuals with the receiver operator areas under the curve being 0.867 and 0.853, respectively. Urinary fibrinogen and KIM-1 levels correlated positively with urinary arsenic levels. KIM-1 levels correlated positively with urinary mercury and lead levels but no correlation was seen with urinary cadmium levels.Conclusions Fibrinogen and β2-microglobulin have the potential of being a screening tool for detection of CKDu and may aid the early diagnosis of toxin mediated tubular injury in CKDu. Their usefulness need to be further validated in a larger epidemiological study of patients with early stages of CKDu. IntroductionChronic kidney disease of unknown aetiology (CKDu), which emerged at the beginning of this century, has reached epidemic proportions in the North Central Dry Zone of Sri Lanka [1,2]. The disease burden is most prominent in the North Central Province and has extended to two adjacent provinces, namely, Uva and North Western provinces. The disease is not due to conventional risk factors such as diabetes, hypertension, chronic glomerulonephritis. The diagnosis of CKDu is based on exclusion of known aetiological factors of chronic kidney disease and presence of tubulo-interstitial pathology on renal biopsy [3,4].The population in the North Central Province is around 2.5 million according to the last census conducted in 2012 and farming is the main livelihood of the majority. CKDu mainly affects farming communities with poor socioeconomic background [5]. The estimated prevalence of CKDu in a community based study was reported as 16.9% in women and 12.9% in men, but the severe stages were seen more frequently in men, leading to a higher mortality and morbidity in men [5,6].Based on CKDu's clinical profile and risk factors, it was postulate...

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Section: Discussionsupporting

confidence: 82%

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

et al. 2017

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“…A chronic exposure to cadmium can cause accumulated renal damage [36]. Navas-Acien et al, reported in the large 1999-2006 NHANES adult population, which was a representative sample of the general US adult population, the existence of an association between renal dysfunction and the blood cadmium levels [37].…”

Section: Resultsmentioning

confidence: 99%

Blood Arsenic and Cadmium Concentrations in End-Stage Renal Disease Patients who were on Maintenance Haemodialysis

Palaneeswari

Pm²,

Silambanan³

et al. 2013

JCDR

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Background: In India, there is a rising burden of chronic diseases like hypertension and diabetes. It has been estimated that 25-40% of these patients are likely to develop chronic kidney disease (CKD), with a significant percentage requiring renal replacement therapy. Haemodialysis is the most common method which is used to treat advanced and permanent kidney failure. Derangements in the metabolism of several toxic and trace elements such as antimony, arsenic cadmium, molybdenum, nickel, and selenium have been reported for several decades in patients with chronically reduced renal functions. Overall, the available literature suggests that the blood levels of some elements such as cadmium, chromium, fluorine, iodine, lead, or vanadium are high in end-stage renal disease (ESRD). Aim and Objectives:Our aim was to study the levels of blood arsenic and cadmium in ESRD patients who were on maintenance haemodialysis (MHD), and to study whether there was any relationship between their concentrations and the duration of the MHD. Methods:The blood lead levels were determined in 50 healthy subjects with normal renal functions and in 50 patients with ESRD, who were on MHD. None of them had any history of smoking or any industrial exposure. Results:The results of the study revealed that the blood arsenic and cadmium concentrations were higher in the ESRD patients who were on MHD than in the healthy adults. The blood arsenic and cadmium concentrations were found to increase with the duration of the MHD. Conclusion:The mild increase in the blood arsenic and cadmium concentrations, with an increase in the duration of the MHD in the study population, may be viewed in the wider context, that a prolonged exposure to arsenic and cadmium, even at low levels, may result in renal damage and/or progression of an already existing CKD.

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“…An additional underlying mechanism for the revealed associations of cadmium and lead with auditory impairment is that exposures to together of them reduced bone mineral densitometry (BMD) [37,38] and disturb chronic kidney disease [39,40] that consequently might have intermediary adverse outcomes on hearing impairment. This suggestion is supported by many bone disease study that has stated a relationship concerning BMD in cochlear capsule beside sensorineural auditory impairment [41,42], and previous studies about the renal system that indicated an association between decreased glomerular filtration rate and neurosensory hearing impairment [43].…”

Section: Al-khfajy Et Almentioning

confidence: 99%

Environmental Exposures to Low Level of Cadmium and Lead and Hearing Impairment in Iraqi Patients

Al-khfajy

Baiee²,

Arif

2018

Asian J Pharm Clin Res

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Objectives: We examined the relations between blood cadmium and lead exposure and hearing impairments in the Iraqi people. Methods:We analyzed data from 51 individual 13-75 ages who had been randomly dispensed to the audiometry examination center at Al-Hilla Teaching Hospital (Babel) for each Iraqi civilian who said, "I suffering from the hearing problem." Pure-tone average (PTA) of auditory thresholds at frequencies of 0.5, 1, 2, and 4 kHz was calculated, and hearing impairment was described as a PTA >25 dB in either ear. Results:All patients who suffer from hearing impairment have serum lead level (23.14±1.76 µg/dL), which is a significantly elevated in comparison to control group (21.20±2.08 µg/dL). In addition to lead, the blood level of cadmium in people with hearing impairment was showed a significant elevation (0.28±0.05 µg/dL) in comparison to normal people (0.22±0.03 µg/dL). In general, this elevation remains within normal reference for the blood level of cadmium (0.5 µg/dL). Conclusions:The present study revealed that the environmental and occupational cadmium and lead coexposures lead to a significant elevation in the blood level of these metals and could have an essential part in the progression of hearing loss.

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Blood Cadmium and Lead and Chronic Kidney Disease in US Adults: A Joint Analysis

Cited by 324 publications

References 48 publications

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study

Blood Arsenic and Cadmium Concentrations in End-Stage Renal Disease Patients who were on Maintenance Haemodialysis

Environmental Exposures to Low Level of Cadmium and Lead and Hearing Impairment in Iraqi Patients

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