Environmental Heavy Metal Exposure and Chronic Kidney Disease in the General Population

Abstract

Lead (Pb), mercury (Hg), and cadmium (Cd) are common heavy metal toxins and cause toxicological renal effects at high levels, but the relevance of low-level environmental exposures in the general population is controversial. A total of 1,797 adults who participated in the KNHANES (a cross-sectional nationally representative survey in Korea) were examined, and 128 of them (7.1%) had chronic kidney disease (CKD). Our study assessed the association between Pb, Hg, Cd exposure, and CKD. Blood Pb and Cd levels were correlated with CKD in univariate logistic regression model. However, these environmental heavy metals were not associated with CKD after adjustment for age, sex, BMI, smoking, hyperlipidemia, hypertension, diabetes, and these metals in multivariate logistic regression models. We stratified the analysis according to hypertension or diabetes. In the adults with hypertension or diabetes, CKD had a significant association with elevated blood Cd after adjustment, but no association was present with blood Pb and Hg. The corresponding odds ratio [OR] of Cd for CKD were 1.52 (95% confidence interval [CI], 1.05-2.19, P=0.026) in adults with hypertension and 1.92 (95% CI, 1.14-3.25, P=0.014) in adults with diabetes. Environmental low level of Pb, Hg, Cd exposure in the general population was not associated with CKD. However, Cd exposure was associated with CKD, especially in adults with hypertension or diabetes. This finding suggests that environmental low Cd exposure may be a contributor to the risk of CKD in adults with hypertension or diabetes.Graphical Abstract

Urinary KIM-1: a novel biomarker for evaluation of occupational exposure to lead

“…Heavy metal poisoning has been a focus of public health research4121718. As one of the most easily accumulated poisonous substances in human body, lead exposure is closely related to chronic renal injury10111920.…”

“…Kidney is one of the main target organs of lead toxicity4567. Early exposure to lead can cause renal proximal tubular dysfunction, chronic interstitial nephritis and eventually irreversible progressive chronic kidney disease that culminates in end stage renal failure8910111213.…”

The aging kidney and the nephrotoxic effects of mercury

“…Exposure of older individuals to toxic metals that are also nephrotoxicants may promote or enhance the progression of renal disease (Jarup et al 1995; 1998; Kim et al 2015b; Hellstrom et al 2001; Moriguchi et al 2005). Mercury (Hg) is a toxic metal that is of particular concern since certain forms are highly nephrotoxic while exposure to other forms may lead to significant neurotoxic effects.…”

Kidney Cadmium Toxicity, Diabetes and High Blood Pressure: The Perfect Storm

“…This prevalence exceeds the 5% acceptable disease prevalence in the general population. Likewise, Kim et al (2015) reported the prevalence of CKD in Korean population of 7.1%, while noting an increase in sensitivity to Cd toxicity in those with hypertension and/or diabetes. In a Swedish study, blood Cd level as low as 0.34 µg/L was associated with signs of kidney toxicity, especially in diabetic subjects .…”