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

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

[1]  Elizabeth Selvin,et al.  Lead, Cadmium, Smoking, and Increased Risk of Peripheral Arterial Disease , 2004, Circulation.

[2]  G. Gambaro,et al.  Low level exposure to cadmium increases the risk of chronic kidney disease: analysis of the NHANES 1999-2006 , 2010, BMC public health.

[3]  Josef Coresh,et al.  Chronic kidney disease , 2012, The Lancet.

[4]  D. Lison,et al.  Renal effects of low-level environmental cadmium exposure: 5-year follow-up of a subcohort from the Cadmibel study , 1999, The Lancet.

[5]  D. Mukherjee,et al.  Protective effect of aqueous garlic extract against lead-induced hepatic injury in rats. , 2011, Indian journal of experimental biology.

[6]  Bertram L Kasiske,et al.  The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. , 2011, Kidney international.

[7]  E. Lerma,et al.  Diabetes and chronic kidney disease. , 2015, Disease-a-month : DM.

[8]  R. Unwin,et al.  Heavy metal poisoning: the effects of cadmium on the kidney , 2010, BioMetals.

[9]  Carol Coupland,et al.  Predicting the risk of Chronic Kidney Disease in Men and Women in England and Wales: prospective derivation and external validation of the QKidney® Scores , 2010, BMC family practice.

[10]  C. Crainiceanu,et al.  Cadmium Exposure and Hypertension in the 1999–2004 National Health and Nutrition Examination Survey (NHANES) , 2007, Environmental health perspectives.

[11]  S. Skerfving,et al.  Tubular and Glomerular Kidney Effects in Swedish Women with Low Environmental Cadmium Exposure , 2005, Environmental health perspectives.

[12]  B. Jaar,et al.  Lead-related nephrotoxicity: a review of the epidemiologic evidence. , 2006, Kidney international.

[13]  M. Evans,et al.  Chronic renal failure from lead: myth or evidence-based fact? , 2011, Kidney international.

[14]  Lars Järup,et al.  Hazards of heavy metal contamination. , 2003, British medical bulletin.

[15]  A. Go,et al.  Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function. , 2009, Clinical journal of the American Society of Nephrology : CJASN.

[16]  E. Guallar,et al.  Associations of blood lead with estimated glomerular filtration rate using MDRD, CKD-EPI and serum cystatin C-based equations. , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[17]  M. Evans,et al.  Occupational lead exposure and severe CKD: a population-based case-control and prospective observational cohort study in Sweden. , 2010, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[18]  C. Faes,et al.  Chronic exposure of mice to environmentally relevant, low doses of cadmium leads to early renal damage, not predicted by blood or urine cadmium levels. , 2007, Toxicology.

[19]  D. Weiner,et al.  Chronic kidney disease associated with environmental toxins and exposures. , 2010, Advances in chronic kidney disease.

[20]  J. Sommar,et al.  End-stage renal disease and low level exposure to lead, cadmium and mercury; a population-based, prospective nested case-referent study in Sweden , 2013, Environmental Health.

[21]  Joshua R Edwards,et al.  The vascular endothelium as a target of cadmium toxicity. , 2006, Life sciences.

[22]  C. Zeng,et al.  Mercury-induced membranous nephropathy: clinical and pathological features. , 2010, Clinical journal of the American Society of Nephrology : CJASN.

[23]  E. Guallar,et al.  Lead Exposure and Cardiovascular Disease—A Systematic Review , 2006, Environmental health perspectives.

[24]  L. Järup Cadmium overload and toxicity. , 2002, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[25]  Howard Hu,et al.  Bone lead as a biological marker in epidemiologic studies of chronic toxicity: conceptual paradigms. , 1998, Environmental health perspectives.

[26]  O Axelson,et al.  Cadmium exposure and end-stage renal disease. , 2001, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[27]  J. Coresh,et al.  Blood lead and chronic kidney disease in the general United States population: results from NHANES III. , 2003, Kidney international.

[28]  Jer-Chia Tsai,et al.  Epidemiology, impact and preventive care of chronic kidney disease in Taiwan , 2010, Nephrology.

[29]  Joshua R Edwards,et al.  Cadmium, diabetes and chronic kidney disease. , 2009, Toxicology and applied pharmacology.

[30]  E. Guallar,et al.  Blood cadmium and lead and chronic kidney disease in US adults: a joint analysis. , 2009, American journal of epidemiology.

[31]  A. Fernando,et al.  In vivo evidence of hepato- and reno-protective effect of garlic oil against sodium nitrite-induced oxidative stress , 2009, International journal of biological sciences.

[32]  S. Skerfving,et al.  Cadmium in blood and urine--impact of sex, age, dietary intake, iron status, and former smoking--association of renal effects. , 2002, Environmental health perspectives.