Sotomayor Camilo G, Groothof Dion, Vodegel Joppe J, Gacitúa Tomás A, Gomes-Neto António W, Osté Maryse C J, Pol Robert A, Ferreccio Catterina, Berger Stefan P, Chong Guillermo, Slart Riemer H J A, Rodrigo Ramón, Navis Gerjan J, Touw Daan J, Bakker Stephan J L
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
J Clin Med. 2020 Feb 3;9(2):417. doi: 10.3390/jcm9020417.
Arsenic is toxic to many organ systems, the kidney being the most sensitive target organ. We aimed to investigate whether, in kidney transplant recipients (KTRs), the nephrotoxic exposure to arsenic could represent an overlooked hazard for graft survival. We performed a prospective cohort study of 665 KTRs with a functional graft ≥1 year, recruited in a university setting (2008‒2011), in The Netherlands. Plasma arsenic was measured by ICP-MS, and dietary intake was comprehensively assessed using a validated 177-item food-frequency questionnaire. The endpoint graft failure was defined as restart of dialysis or re-transplantation. Median arsenic concentration was 1.26 (IQR, 1.04‒2.04) µg/L. In backwards linear regression analyses we found that fish consumption (std β = 0.26; < 0.001) was the major independent determinant of plasma arsenic. During 5 years of follow-up, 72 KTRs developed graft failure. In Cox proportional-hazards regression analyses, we found that arsenic was associated with increased risk of graft failure (HR 1.80; 95% CI 1.28-2.53; = 0.001). This association remained materially unaltered after adjustment for donor and recipient characteristics, immunosuppressive therapy, eGFR, primary renal disease, and proteinuria. In conclusion, in KTRs, plasma arsenic is independently associated with increased risk of late graft failure.
砷对许多器官系统都有毒性，肾脏是最敏感的靶器官。我们旨在研究在肾移植受者（KTRs）中，砷的肾毒性暴露是否可能是移植肾存活的一个被忽视的危险因素。我们对荷兰一所大学（2008 - 2011年）招募的665例移植肾功能≥1年的KTRs进行了一项前瞻性队列研究。通过电感耦合等离子体质谱法（ICP-MS）测定血浆砷，并使用经过验证的177项食物频率问卷全面评估饮食摄入量。终点移植肾失败定义为重新开始透析或再次移植。砷浓度中位数为1.26（四分位间距，1.04 - 2.04）μg/L。在反向线性回归分析中，我们发现鱼类消费（标准化β = 0.26；P < 0.001）是血浆砷的主要独立决定因素。在5年的随访期间，72例KTRs出现移植肾失败。在Cox比例风险回归分析中，我们发现砷与移植肾失败风险增加相关（风险比1.80；95%置信区间1.28 - 2.53；P = 0.001）。在对供体和受体特征、免疫抑制治疗、估算肾小球滤过率（eGFR）、原发性肾脏疾病和蛋白尿进行调整后，这种关联基本保持不变。总之，在KTRs中，血浆砷与晚期移植肾失败风险增加独立相关。
