Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Curr Environ Health Rep. 2018 Dec;5(4):453-463. doi: 10.1007/s40572-018-0212-1.
Arsenic (As), cadmium (Cd), and lead (Pb) are ubiquitous toxicants with evidence of adverse kidney impacts at high exposure levels. There is less evidence whether environmental exposure to As, Cd, or Pb plays a role in development of chronic kidney disease (CKD). We conducted a systematic review to summarize the recent epidemiologic literature examining the relationship between As, Cd, or Pb with CKD.
We included peer-reviewed studies published in English between January 2013 and April 2018 for As and Cd, and all dates prior to April 2018 for Pb. We imposed temporality requirements for both the definition of CKD (as per NKF-KDOQI guidelines) and environmental exposures prior to disease diagnosis. Our assessment included cohort, case-control or cross-sectional study designs that satisfied 5 inclusion criteria. We included a total of eight articles of which three, two, and four studies examined the effects of As, Cd, or Pb, respectively. Studies of As exposure consistently reported positive association with CKD incidence; studies of Pb exposure were mixed. We found little evidence of association between Cd exposure and CKD. Additional well-designed prospective cohort studies are needed and we present recommendations for future studies.
砷（As）、镉（Cd）和铅（Pb）是普遍存在的有毒物质，有大量证据表明高暴露水平会对肾脏造成不良影响。然而，环境暴露于 As、Cd 或 Pb 是否会导致慢性肾病（CKD）的发生，目前相关证据较少。我们进行了一项系统综述，以总结最近关于 As、Cd 或 Pb 与 CKD 之间关系的流行病学文献。
我们纳入了 2013 年 1 月至 2018 年 4 月期间发表的同行评议的英文研究，以及截至 2018 年 4 月之前发表的关于 Pb 的所有研究。我们对 CKD 的定义（按照 NKF-KDOQI 指南）和疾病诊断前的环境暴露都设定了时间要求。我们的评估包括队列、病例对照或横断面研究设计，这些研究均满足 5 项纳入标准。我们共纳入了 8 篇文章，其中 3 篇、2 篇和 4 篇分别研究了 As、Cd 或 Pb 的影响。As 暴露研究一致报告了与 CKD 发生率之间的正相关关系；而 Pb 暴露研究结果不一。我们发现 Cd 暴露与 CKD 之间几乎没有关联的证据。需要进行更多设计合理的前瞻性队列研究，我们为此提出了未来研究的建议。
