Laboratory for Epidemiology, Department of Health Care Management, Chang-Gung University, Taoyuan City, Taiwan; Healthy Aging Research Center, Chang-Gung University, Taoyuan City, Taiwan.
Department of Public Health, School of Medicine, Taipei Medical University, Taipei, Taiwan.
Am J Kidney Dis. 2017 Dec;70(6):787-797. doi: 10.1053/j.ajkd.2017.06.012. Epub 2017 Aug 23.
Arsenic exposure is associated with decreased kidney function. The association between low to moderate arsenic exposure and kidney disease has not been fully clarified.
The association between arsenic exposure from drinking water and chronic kidney disease (CKD) was examined in a long-term prospective observational study.
SETTING & PARTICIPANTS: 6,093 participants 40 years and older were recruited from arseniasis-endemic areas in northeastern Taiwan. Arsenic levels were 28.0, 92.8, and 295.7μg/L at the 50th, 75th, and 90th percentiles, respectively.
Well-water arsenic and urinary total arsenic (inorganic plus methylated arsenic species) concentrations, adjusted for urinary creatinine concentration.
Kidney diseases (ICD-9 codes: 250.4, 274.1, 283.11, 403.*1, 404.*2, 404.*3, 440.1, 442.1, 447.3, or 580-589) and CKD (ICD-9 code: 585) ascertained using Taiwan's National Health Insurance database 1998 to 2011.
HRs contrasting CKD risk across arsenic exposure levels were estimated using Cox regression. Prevalence ORs for proteinuria (protein excretion ≥ 200mg/g) comparing quartiles of total urinary arsenic concentrations were estimated using logistic regression.
We identified 1,104 incident kidney disease cases, including 447 CKD cases (incidence rates, 166.5 and 67.4 per 10 person-years, respectively). A dose-dependent association between well-water arsenic concentrations and kidney diseases was observed after adjusting for age, sex, education, body mass index, cigarette smoking, alcohol consumption, and analgesic use. Using arsenic concentration ≤ 10.0μg/L as reference, multivariable-adjusted HRs for incident CKD were 1.12 (95% CI, 0.88-1.42), 1.33 (95% CI, 1.03-1.72), and 1.33 (95% CI, 1.00-1.77) for arsenic concentrations of 10.1 to 49.9, 50.0 to 149.9, and ≥150.0μg/L, respectively (P for trend=0.02). The association between arsenic concentration and kidney diseases was stronger for women (P for interaction=0.06). Arsenic values in the range of 50th to 75th and 75th to 100th percentiles of total urinary arsenic concentrations were associated with 50% and 67% higher prevalences, respectively, of proteinuria.
Kidney diseases and CKD outcomes were based on diagnostic codes. Glomerular filtration rates were not available. Other heavy metals were not measured.
This study describes the temporal relationship between arsenic concentrations ≥ 10μg/L in drinking water and CKD. A dose-dependent association between well-water arsenic concentration and kidney diseases was observed. Higher creatinine-adjusted urinary total arsenic concentrations were associated with a higher prevalence of proteinuria.
砷暴露与肾功能下降有关。低至中度砷暴露与肾脏疾病之间的关联尚未完全阐明。
在一项长期前瞻性观察研究中，研究了饮用水砷暴露与慢性肾脏病（CKD）之间的关系。
6093 名年龄在 40 岁及以上的参与者来自台湾东北部的砷中毒流行地区。砷水平分别为第 50、75 和 90 百分位数的 28.0、92.8 和 295.7μg/L。
井水砷和尿总砷（无机和甲基化砷物种）浓度，经尿肌酐浓度校正。
使用台湾国家健康保险数据库 1998 年至 2011 年确定的肾脏疾病（ICD-9 代码：250.4、274.1、283.11、403.*1、404.*2、404.*3、440.1、442.1、447.3 或 580-589）和 CKD（ICD-9 代码：585）。
使用 Cox 回归估计 CKD 风险在不同砷暴露水平下的 HR。使用逻辑回归估计尿总砷浓度四分位间距与蛋白尿（蛋白质排泄≥200mg/g）之间的患病率 OR。
我们发现了 1104 例新发肾脏疾病病例，包括 447 例 CKD 病例（发病率分别为 166.5 和 67.4/10 人年）。在调整年龄、性别、教育程度、体重指数、吸烟、饮酒和使用止痛药后，发现井水砷浓度与肾脏疾病之间存在剂量依赖性关联。以砷浓度≤10.0μg/L 为参考，砷浓度为 10.1-49.9、50.0-149.9 和≥150.0μg/L 时，多变量校正后 CKD 的 HR 分别为 1.12（95%CI，0.88-1.42）、1.33（95%CI，1.03-1.72）和 1.33（95%CI，1.00-1.77）（趋势 P=0.02）。砷浓度与肾脏疾病之间的关联在女性中更强（交互作用 P=0.06）。尿总砷浓度第 50-75 百分位数和第 75-100 百分位数的范围与蛋白尿的患病率分别增加 50%和 67%有关。
肾脏疾病和 CKD 结局基于诊断代码。肾小球滤过率不可用。其他重金属未测量。
本研究描述了饮用水中砷浓度≥10μg/L 与 CKD 之间的时间关系。发现井水砷浓度与肾脏疾病之间存在剂量依赖性关联。更高的肌酐校正尿总砷浓度与蛋白尿的患病率更高有关。
