J Korean Med Sci.  2015 Mar;30(3):272-277. 10.3346/jkms.2015.30.3.272.

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

• Kim NH
• Hyun YY
• Lee KB
• Chang Y
• Rhu S
• Oh KH
• Ahn C

• KMID: 2133304
• DOI: http://doi.org/10.3346/jkms.2015.30.3.272

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.

Keyword

Renal Insufficiency; Environmental Low Exposure; Lead; Mercury; Cadmium

MeSH Terms

Adult
Cadmium/blood/*toxicity
Cross-Sectional Studies
Diabetes Mellitus/chemically induced/epidemiology
*Environmental Exposure
Female
Humans
Hypertension/chemically induced/epidemiology
Kidney/drug effects/pathology
Lead/blood/*toxicity
Male
Mercury/blood/*toxicity
Metals, Heavy/*poisoning
Middle Aged
Nutrition Surveys
Poisoning/*epidemiology
Renal Insufficiency, Chronic/*epidemiology
Republic of Korea
Surveys and Questionnaires
Young Adult
Cadmium
Lead
Metals, Heavy
Mercury

Reference

1. Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012; 379:165–180.

2. Järup L. Cadmium overload and toxicity. Nephrol Dial Transplant. 2002; 17:35–39.

3. Järup L. Hazards of heavy metal contamination. Br Med Bull. 2003; 68:167–182.

4. Ekong EB, Jaar BG, Weaver VM. Lead-related nephrotoxicity: a review of the epidemiologic evidence. Kidney Int. 2006; 70:2074–2084.

5. Johri N, Jacquillet G, Unwin R. Heavy metal poisoning: the effects of cadmium on the kidney. Biometals. 2010; 23:783–792.

6. Soderland P, Lovekar S, Weiner DE, Brooks DR, Kaufman JS. Chronic kidney disease associated with environmental toxins and exposures. Adv Chronic Kidney Dis. 2010; 17:254–264.

7. Evans M, Elinder CG. Chronic renal failure from lead: myth or evidence-based fact? Kidney Int. 2011; 79:272–279.

8. Prozialeck WC, Edwards JR, Woods JM. The vascular endothelium as a target of cadmium toxicity. Life Sci. 2006; 79:1493–1506.

9. Thijssen S, Maringwa J, Faes C, Lambrichts I, Van Kerkhove E. Chronic exposure of mice to environmentally relevant, low doses of cadmium leads to early renal damage, not predicted by blood or urine cadmium levels. Toxicology. 2007; 229:145–156.

10. Edwards JR, Prozialeck WC. Cadmium, diabetes and chronic kidney disease. Toxicol Appl Pharmacol. 2009; 238:289–293.

11. Li SJ, Zhang SH, Chen HP, Zeng CH, Zheng CX, Li LS, Liu ZH. Mercury-induced membranous nephropathy: clinical and pathological features. Clin J Am Soc Nephrol. 2010; 5:439–444.

12. Navas-Acien A, Tellez-Plaza M, Guallar E, Muntner P, Silbergeld E, Jaar B, Weaver V. Blood cadmium and lead and chronic kidney disease in US adults: a joint analysis. Am J Epidemiol. 2009; 170:1156–1164.

13. Olsson IM, Bensryd I, Lundh T, Ottosson H, Skerfving S, Oskarsson A. Cadmium in blood and urine--impact of sex, age, dietary intake, iron status, and former smoking--association of renal effects. Environ Health Perspect. 2002; 110:1185–1190.

14. Muntner P, He J, Vupputuri S, Coresh J, Batuman V. Blood lead and chronic kidney disease in the general United States population: results from NHANES III. Kidney Int. 2003; 63:1044–1050.

15. Ferraro PM, Costanzi S, Naticchia A, Sturniolo A, Gambaro G. Low level exposure to cadmium increases the risk of chronic kidney disease: analysis of the NHANES 1999-2006. BMC Public Health. 2010; 10:304.

16. Spector JT, Navas-Acien A, Fadrowski J, Guallar E, Jaar B, Weaver VM. Associations of blood lead with estimated glomerular filtration rate using MDRD, CKD-EPI and serum cystatin C-based equations. Nephrol Dial Transplant. 2011; 26:2786–2792.

17. Hellstrom L, Elinder CG, Dahlberg B, Lundberg M, Järup L, Persson B, Axelson O. Cadmium exposure and end-stage renal disease. Am J Kidney Dis. 2001; 38:1001–1008.

18. Sommar JN, Svensson MK, Björ BM, Elmståhl S, Hallmans G, Lundh T, Schön SM, Skerfving S, Bergdahl IA. End-stage renal disease and low level exposure to lead, cadmium and mercury; a population-based, prospective nested case-referent study in Sweden. Environ Health. 2013; 12:9.

19. Hotz P, Buchet JP, Bernard A, Lison D, Lauwerys R. Renal effects of low-level environmental cadmium exposure: 5-year follow-up of a subcohort from the Cadmibel study. Lancet. 1999; 354:1508–1513.

20. Navas-Acien A, Guallar E, Silbergeld EK, Rothenberg SJ. Lead exposure and cardiovascular disease--a systematic review. Environ Health Perspect. 2007; 115:472–482.

21. Tellez-Plaza M, Navas-Acien A, Crainiceanu CM, Guallar E. Cadmium exposure and hypertension in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Environ Health Perspect. 2008; 116:51–56.

22. Navas-Acien A, Selvin E, Sharrett AR, Calderon-Aranda E, Silbergeld E, Guallar E. Lead, cadmium, smoking, and increased risk of peripheral arterial disease. Circulation. 2004; 109:3196–3201.

23. Akesson A, Lundh T, Vahter M, Bjellerup P, Lidfeldt J, Nerbrand C, Samsioe G, Strömberg U, Skerfving S. Tubular and glomerular kidney effects in Swedish women with low environmental cadmium exposure. Environ Health Perspect. 2005; 113:1627–1631.

24. Evans M, Fored CM, Nise G, Bellocco R, Nyrén O, Elinder CG. Occupational lead exposure and severe CKD: a population-based case-control and prospective observational cohort study in Sweden. Am J Kidney Dis. 2010; 55:497–506.

25. Lash JP, Go AS, Appel LJ, He J, Ojo A, Rahman M, Townsend RR, Xie D, Cifelli D, Cohan J, et al. Chronic Renal Insufficiency Cohort (CRIC) Study Group. Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol. 2009; 4:1302–1311.

26. Hwang SJ, Tsai JC, Chen HC. Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrology (Carlton). 2010; 15:3–9.

27. Hippisley-Cox J, Coupland C. Predicting the risk of chronic Kidney Disease in men and women in England and Wales: prospective derivation and external validation of the QKidney Scores. BMC Fam Pract. 2010; 11:49.

28. Hassan HA, El-Agmy SM, Gaur RL, Fernando A, Raj MH, Ouhtit A. In vivo evidence of hepato- and reno-protective effect of garlic oil against sodium nitrite-induced oxidative stress. Int J Biol Sci. 2009; 5:249–255.

29. Kilikdar D, Mukherjee D, Mitra E, Ghosh AK, Basu A, Chandra AM, Bandyoapdhyay D. Protective effect of aqueous garlic extract against lead-induced hepatic injury in rats. Indian J Exp Biol. 2011; 49:498–510.

30. Hu H, Rabinowitz M, Smith D. Bone lead as a biological marker in epidemiologic studies of chronic toxicity: conceptual paradigms. Environ Health Perspect. 1998; 106:1–8.