Department of Nutrition, Xin Hua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
J Trace Elem Med Biol. 2021 Jan;63:126657. doi: 10.1016/j.jtemb.2020.126657. Epub 2020 Sep 28.
It is unclear whether arsenic exerts adverse health effects on the kidney at low- and moderate- levels of exposure. We prospectively examined toenail arsenic concentrations measured during young adulthood in relation to incidence of chronic kidney disease (CKD) in midlife.
A total of 3768 participants (53 % female and 48 % blacks) in the Coronary Artery Risk Development in Young Adults (CARDIA) study were included. Arsenic concentration in toenail clippings was assessed by using inductively coupled plasma mass spectrometry at CARDIA exam year 2. Incident CKD was identified if having estimated glomerular filtration rate <60 mL/min per 1.73 m² or albuminuria >30 mg/g. The association between toenail arsenic levels and CKD incidence over a mean of 24 years of follow-up was examined using multivariable-adjusted Cox proportional hazards models.
After controlling for potential confounders, including demographics, socioeconomics, lifestyle factors, clinical measurements of blood pressure, lipids, and glucose, and medical history, arsenic exposure measured in toenails was not associated with CKD incidence (quintile 5 versus quintile 1: hazard ratio = 1.04, 95 % confidence interval = 0.78-1.40, P for trend = 0.38).
This longitudinal study does not support the hypothesis that low- and moderate- levels of arsenic exposure are associated with elevated incidence of CKD in the US general population. Further studies are need to investigate species of arsenic biomarkers in relation to nephrotoxicity.
目前尚不清楚砷在低水平和中等水平暴露时是否会对肾脏产生不良健康影响。我们前瞻性地研究了成年早期测量的趾甲砷浓度与中年慢性肾脏病（CKD）发病之间的关系。
共有 3768 名（53%为女性，48%为黑人）来自冠状动脉风险发展青年（CARDIA）研究的参与者纳入本研究。采用电感耦合等离子体质谱法在 CARDIA 研究的第 2 年检测趾甲夹中的砷浓度。如果估算肾小球滤过率<60 mL/min/1.73 m²或白蛋白尿>30 mg/g，则确定为 CKD 病例。使用多变量调整的 Cox 比例风险模型，在平均 24 年的随访期间，检查趾甲砷水平与 CKD 发病之间的关联。
在控制了潜在的混杂因素，包括人口统计学、社会经济状况、生活方式因素、血压、血脂和血糖的临床测量值以及病史后，趾甲中砷暴露与 CKD 发病无关（第 5 quintile 与第 1 quintile：风险比=1.04，95%置信区间=0.78-1.40，P 趋势=0.38）。
本纵向研究不支持低水平和中等水平砷暴露与美国普通人群 CKD 发病率升高相关的假设。需要进一步研究与肾毒性相关的砷生物标志物的种类。
