Status of metals in serum and urine samples of chronic kidney disease patients in a rural area of Bangladesh: An observational study

Choudhury, Tasrina Rabia; Zaman, Sk. Zubaer; Chowdhury, Tanzina Iveen; Begum, Bilkis A.; Islam, Md. Anwarul; Rahman, Mostafizur

doi:10.1016/j.heliyon.2021.e08382

Cited by 13 publications

(9 citation statements)

References 22 publications

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“…In that study, compared to the controls, CKD patients exhibited signi cantly higher levels of Pb, Cd and Cr levels in their urine samples. This signi es a potential association between heavy metal exposure and CKD [34]. As CKDu is an endemic disease, the results our study suggest an association of heavy metals with CKDu in the Indian population, and so the generalizability of the result should be used with caution.…”

Section: Discussionmentioning

confidence: 56%

Heavy metal association with chronic kidney disease of unknown cause in central India-results from a case control study

Atlani

Kumar

Ahirwar

et al. 2023

Preprint

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Background Chronic Kidney Disease of unknown cause (CKDu) a disease of exclusion, and remains unexplained in various parts of world including India. Previous studies have reported mixed findings about the role of heavy metals or agrochemicals in CKDu. These studies compared CKDu with healthy controls, but lacked subjects with CKD as controls. The purpose of this study was to test hypothesis whether heavy metals i.e. Arsenic (As), Cadmium (Cd), Lead (Pb) and Chromium (Cr) are associated with CKDu, in central India.Methods The study was conducted in case-control manner at a tertiary care hospital. CKDu cases (n = 60) were compared with CKD (n = 62) and healthy subjects (n = 54). Blood and urine levels of As, Cd, Pb and Cr were measured by Inductively Coupled Plasma- Optical Emission Spectrometry. Pesticides use, pain killers, smoking and alcohol addiction were also evaluated. The median levels of blood and urine metals were compared among the groups by Kruskal-Wallis rank sum test.Result CKDu had significantly higher pesticide use. Blood As levels (median, IQR) were significantly higher in CKDu 91.97 (1.3-132.7) µg/L compared to CKD 4.5 (0.0-58.8) µg/L and healthy subjects 39.01 (4.8–67.4) µg/L (p < 0.001). Urine Cd was higher in CKD 1.0 (0.3–1.7) µg/L compared to CKDu 0.5 (0.0-1.5) µg/L with a trend (p-0.06) of significance. Blood and urinary Pb and Cr were higher in CKD compared to CKDu (P = 0.5). Urinary Cd, Pb and Cr were undetectable in healthy subjects and were significantly higher in CKDu and CKD compared to healthy subjects (P = < 0.001).Conclusion The study showed a significant association of As with CKDu and a trend of association of Cd with CKD in this Indian cohort. Subjects with renal dysfunction (CKDu and CKD) have significantly higher metal burden of Pb, Cd, As, Cr as comparedto healthy controls.

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Section: Discussionmentioning

confidence: 56%

Heavy metal association with chronic kidney disease of unknown cause in central India-results from a case control study

Atlani

Kumar

Ahirwar

et al. 2023

Preprint

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“…In that study, compared to the controls, CKD patients exhibited significantly higher levels of Pb, Cd, and Cr levels in their urine samples. This signifies a potential association between heavy metal co-exposure and CKD [ 29 ]. In the current study a significant correlation between blood Cd, Pb, and Cr and urine Cd, Pb, and Cr were found in CKDu and CKD subjects compared to healthy subjects.…”

Section: Discussionmentioning

confidence: 99%

Heavy metal association with chronic kidney disease of unknown cause in central India-results from a case-control study

Atlani,

Kumar,

Ahirwar

et al. 2024

BMC Nephrol

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Background Chronic Kidney Disease of unknown cause (CKDu) a disease of exclusion, and remains unexplained in various parts of the world, including India. Previous studies have reported mixed findings about the role of heavy metals or agrochemicals in CKDu. These studies compared CKDu with healthy controls but lacked subjects with CKD as controls. The purpose of this study was to test the hypothesis whether heavy metals, i.e. Arsenic (As), Cadmium (Cd), Lead (Pb), and Chromium (Cr) are associated with CKDu, in central India. Methods The study was conducted in a case-control manner at a tertiary care hospital. CKDu cases (n = 60) were compared with CKD (n = 62) and healthy subjects (n = 54). Blood and urine levels of As, Cd, Pb, and Cr were measured by Inductively Coupled Plasma- Optical Emission Spectrometry. Pesticide use, painkillers, smoking, and alcohol addiction were also evaluated. The median blood and urine metal levels were compared among the groups by the Kruskal-Wallis rank sum test. Results CKDu had significantly higher pesticide and surface water usage as a source of drinking water. Blood As levels (median, IQR) were significantly higher in CKDu 91.97 (1.3–132.7) µg/L compared to CKD 4.5 (0.0–58.8) µg/L and healthy subjects 39.01 (4.8–67.4) µg/L (p < 0.001) On multinominal regression age and sex adjusted blood As was independently associated with CKDu[ OR 1.013 (95%CI 1.003–1.024) P < .05].Blood and urinary Cd, Pb, and Cr were higher in CKD compared to CKDu (p > .05). Urinary Cd, Pb and Cr were undetectable in healthy subjects and were significantly higher in CKDu and CKD compared to healthy subjects (P = < 0.001). There was a significant correlation of Cd, Pb and Cr in blood and urine with each other in CKDu and CKD subjects as compared to healthy subjects. Surface water use also associated with CKDu [OR 3.178 (95%CI 1.029–9.818) p < .05). Conclusion The study showed an independent association of age and sex adjusted blood As with CKDu in this Indian cohort. Subjects with renal dysfunction (CKDu and CKD) were found to have significantly higher metal burden of Pb, Cd, As, and Cr as compared to healthy controls. CKDu subjects had significantly higher pesticide and surface water usage, which may be the source of differential As exposure in these subjects.

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“…Cadmium(Cd) exposure, in particular, has been associated with severe kidney damage through the downregulation of specific microRNAs, thereby promoting apoptosis induced by cadmium and other heavy metals ( 7 ). Studies in Bangladesh have reported higher levels of lead (Pb), cadmium and chromium (Cr) in the urine of CKD patients compared to controls, suggesting a potential link between heavy metal exposure and CKD ( 8 ). However, existing research often fails to address combined exposure to multiple metals, overlooks covariance between them, and does not clarify the correlation between metal exposure and renal function parameters.…”

Section: Introductionmentioning

confidence: 99%

Comparative mathematical modeling of causal association between metal exposure and development of chronic kidney disease

Wu,

Hou,

Qin

et al. 2024

Front. Endocrinol.

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BackgroundPrevious studies have identified several genetic and environmental risk factors for chronic kidney disease (CKD). However, little is known about the relationship between serum metals and CKD risk.MethodsWe investigated associations between serum metals levels and CKD risk among 100 medical examiners and 443 CKD patients in the medical center of the First Hospital Affiliated to China Medical University. Serum metal concentrations were measured using inductively coupled plasma mass spectrometry (ICP-MS). We analyzed factors influencing CKD, including abnormalities in Creatine and Cystatin C, using univariate and multiple analysis such as Lasso and Logistic regression. Metal levels among CKD patients at different stages were also explored. The study utilized machine learning and Bayesian Kernel Machine Regression (BKMR) to assess associations and predict CKD risk based on serum metals. A chained mediation model was applied to investigate how interventions with different heavy metals influence renal function indicators (creatinine and cystatin C) and their impact on diagnosing and treating renal impairment.ResultsSerum potassium (K), sodium (Na), and calcium (Ca) showed positive trends with CKD, while selenium (Se) and molybdenum (Mo) showed negative trends. Metal mixtures had a significant negative effect on CKD when concentrations were all from 30th to 45th percentiles compared to the median, but the opposite was observed for the 55th to 60th percentiles. For example, a change in serum K concentration from the 25th to the 75th percentile was associated with a significant increase in CKD risk of 5.15(1.77,8.53), 13.62(8.91,18.33) and 31.81(14.03,49.58) when other metals were fixed at the 25th, 50th and 75th percentiles, respectively.ConclusionsCumulative metal exposures, especially double-exposure to serum K and Se may impact CKD risk. Machine learning methods validated the external relevance of the metal factors. Our study highlights the importance of employing diverse methodologies to evaluate health effects of metal mixtures.

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Status of metals in serum and urine samples of chronic kidney disease patients in a rural area of Bangladesh: An observational study

Cited by 13 publications

References 22 publications

Heavy metal association with chronic kidney disease of unknown cause in central India-results from a case control study

Heavy metal association with chronic kidney disease of unknown cause in central India-results from a case control study

Heavy metal association with chronic kidney disease of unknown cause in central India-results from a case-control study

Comparative mathematical modeling of causal association between metal exposure and development of chronic kidney disease

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