Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, New York, USA.
Crit Rev Toxicol. 2021 Feb;51(2):165-182. doi: 10.1080/10408444.2021.1891196. Epub 2021 May 7.
We performed a systematic review and meta-analysis to examine the relationship between heavy metals (HMs) exposure and the risk of chronic kidney disease (CKD). Databases of Web of Science, Embase, MEDLINE, and Scopus were searched through June 2020 to identify studies assessing the relationships between exposure to HMs (i.e. cadmium, lead, arsenic, mercury) and the risk of CKD, evaluated by decreased estimated glomerular filtration rate (eGFR) and/or increased proteinuria risks in adults (≥18 years). Data were pooled by random-effects models and expressed as weighted mean differences and 95% confidence intervals. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Twenty-eight eligible articles ( = 107,539 participants) were included. Unlike eGFR risk ( = 0.10), Cadmium exposure was associated with an increased proteinuria risk (OR = 1.35; 95% CI: 1.13, 1.61; < 0.001; = 79.7%). Lead exposure was associated with decreased eGFR (OR = 1.12; 95%CI: 1.03, 1.22; = 0.008; = 87.8%) and increased proteinuria (OR = 1.25; 95% CI: 1.04, 1.49; = 0.02; = 79.6) risks. Further, arsenic exposure was linked to a decreased eGFR risk (OR = 1.55; 95% CI: 1.05, 2.28; = 0.03; = 89.1%) in contrast to mercury exposure ( = 0.89). Only two studies reported the link between arsenic exposure and proteinuria risk, while no study reported the link between mercury exposure and proteinuria risk. Exposure to cadmium, lead, and arsenic may increase CKD risk in adults, albeit studies were heterogeneous, warranting further investigations. Our observations support the consideration of these associations for preventative, diagnostic, monitoring, and management practices of CKD.
我们进行了系统评价和荟萃分析，以研究重金属（HM）暴露与慢性肾脏病（CKD）风险之间的关系。通过 2020 年 6 月的 Web of Science、Embase、MEDLINE 和 Scopus 数据库搜索，以评估成年人（≥18 岁） HM（即镉、铅、砷、汞）暴露与估算肾小球滤过率（eGFR）降低和/或蛋白尿风险增加之间关系的研究。通过随机效应模型汇总数据，并表示为加权均数差和 95%置信区间。使用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。纳入了 28 篇符合条件的文章（=107539 名参与者）。与 eGFR 风险（ = 0.10）不同，镉暴露与蛋白尿风险增加相关（OR=1.35；95%CI：1.13，1.61； < 0.001； = 79.7%）。铅暴露与 eGFR 降低（OR=1.12；95%CI：1.03，1.22； = 0.008； = 87.8%）和蛋白尿增加（OR=1.25；95%CI：1.04，1.49； = 0.02； = 79.6%）风险相关。此外，砷暴露与 eGFR 降低风险相关（OR=1.55；95%CI：1.05，2.28； = 0.03； = 89.1%），而汞暴露则无此相关性（ = 0.89）。只有两项研究报告了砷暴露与蛋白尿风险之间的联系，而没有研究报告汞暴露与蛋白尿风险之间的联系。镉、铅和砷的暴露可能会增加成年人患 CKD 的风险，尽管研究存在异质性，但需要进一步的研究。我们的观察结果支持将这些关联考虑用于 CKD 的预防、诊断、监测和管理实践。
