Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Environ Pollut. 2021 May 1;276:116653. doi: 10.1016/j.envpol.2021.116653. Epub 2021 Feb 5.
Environmental lead exposure has been linked with reduced kidney function. However, evidence about its role in diabetic kidney damage, especially when considering the nutritional status of vitamin D, is sparse. In this observational study, we investigated the association between low-level lead exposure and urinary albumin-to-creatinine ratio (UACR) and assessed potential impact of vitamin D among 4033 diabetic patients in Shanghai, China. Whole blood lead was measured by graphite furnace atomic absorption spectrometry. Serum 25-hydroxyvitamin D [25(OH)D] was tested using a chemiluminescence immunoassay. The associations of blood lead with UACR and albuminuria, defined as UACR ≥30 mg/g, according to 25(OH)D levels were analyzed using linear and Poisson regression models. A doubling of blood lead level was associated with a 10.7% higher UACR (95% CI, 6.19%-15.5%) in diabetic patients with 25(OH)D < 50 nmol/L, whereas the association was attenuated toward null (2.03%; 95% CI, -5.18% to 9.78%) in those with 25(OH)D ≥ 50 nmol/L. Similarly, the risk ratios of prevalent albuminuria per doubling of blood lead level between the two groups were 1.09 (95% CI, 1.03-1.15) and 0.99 (95% CI, 0.86-1.14), respectively. Joint analysis demonstrated that a combination of high blood lead and low 25(OH)D corresponded to significantly higher UACR. Among diabetic patients with 25(OH)D < 50 nmol/L, the increment of UACR relative to blood lead was more remarkable in those with reduced estimated glomerular filtration rate (<60 mL/min/1.73 m). These results suggested that higher blood lead levels were associated with increased urinary albumin excretion in diabetic patients with vitamin D deficiency. Further prospective studies are needed to validate our findings and to determine whether vitamin D supplementation yields a benefit.
环境铅暴露与肾功能降低有关。然而，关于其在糖尿病肾病损害中的作用的证据很少，尤其是在考虑维生素 D 的营养状况时。在这项观察性研究中，我们在中国上海的 4033 名糖尿病患者中调查了低水平铅暴露与尿白蛋白/肌酐比值（UACR）之间的关联，并评估了维生素 D 的潜在影响。全血铅采用石墨炉原子吸收光谱法测定。血清 25-羟维生素 D [25(OH)D]采用化学发光免疫分析法检测。根据 25(OH)D 水平，使用线性和泊松回归模型分析了血铅与 UACR 和白蛋白尿（定义为 UACR≥30mg/g）的关系。在 25(OH)D<50nmol/L 的糖尿病患者中，血铅水平升高一倍，UACR 升高 10.7%（95%CI，6.19%-15.5%），而在 25(OH)D≥50nmol/L 的患者中，这种关联趋于零（2.03%；95%CI，-5.18%至 9.78%）。同样，两组血铅水平升高一倍时，常见白蛋白尿的风险比分别为 1.09（95%CI，1.03-1.15）和 0.99（95%CI，0.86-1.14）。联合分析表明，高血铅和低 25(OH)D 结合可显著增加 UACR。在 25(OH)D<50nmol/L 的糖尿病患者中，与血铅相比，eGFR 降低（<60mL/min/1.73m）的患者 UACR 增加更为显著。这些结果表明，在维生素 D 缺乏的糖尿病患者中，较高的血铅水平与尿白蛋白排泄增加有关。需要进一步的前瞻性研究来验证我们的发现，并确定维生素 D 补充是否有益。
