Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China; Department of Public Health, Shihezi University School of Medicine, Shihezi 832000, Xinjiang, China.
Ecotoxicol Environ Saf. 2022 Oct 1;244:114048. doi: 10.1016/j.ecoenv.2022.114048. Epub 2022 Sep 2.
As common contaminants, metals are non-negligible risk factors for diabetes and chronic kidney disease. However, whether there is an association between multiple metals exposure and incident chronic kidney disease (CKD) risk in patients with diabetes is unclear. We conducted a prospective study to evaluate these associations. In total, 3071 diabetics with baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m from the Dongfeng-Tongji cohort were included. We measured baseline plasma concentrations of 23 metals and investigated the associations between plasma metal concentrations and CKD in diabetics using logistic regression, the least absolute shrinkage and selection operator (LASSO), and the Bayesian Kernel Machine Regression (BKMR) models. During average 4.6 years of follow-up, 457 diabetics developed CKD (14.9 %). The three models consistently found plasma levels of zinc, arsenic, and rubidium had a positive association with incident CKD risk in patients with diabetes, while titanium, cadmium, and lead had an inverse correlation. The results of BKMR showed a significant and positive overall effect of 23 metals on the risk of CKD, when all of the metals were above the 50th percentile as compared to the median value. In addition, potential interactions of zinc and arsenic, zinc and cadmium, zinc and lead, titanium and arsenic, and cadmium and lead on CKD risk were observed. In summary, we found significant associations of plasma titanium, zinc, arsenic, rubidium, cadmium, and lead with CKD in diabetes and interactions between these metals except for rubidium. Co-exposure to multiple metals was associated with increased CKD risk in diabetics.
作为常见污染物，金属是非糖尿病和慢性肾脏病的不可忽视的危险因素。然而，在糖尿病患者中，多种金属暴露与慢性肾脏病（CKD）发病风险之间是否存在关联尚不清楚。我们进行了一项前瞻性研究来评估这些关联。共有 3071 名来自东风-同济队列的基线估计肾小球滤过率（eGFR）≥60mL/min/1.73m2的糖尿病患者纳入本研究。我们测量了基线血浆中 23 种金属的浓度，并使用逻辑回归、最小绝对收缩和选择算子（LASSO）和贝叶斯核机器回归（BKMR）模型来研究糖尿病患者血浆金属浓度与 CKD 之间的关系。在平均 4.6 年的随访期间，457 名糖尿病患者发生了 CKD（14.9%）。这三种模型一致发现，锌、砷和铷的血浆水平与糖尿病患者的 CKD 发病风险呈正相关，而钛、镉和铅的血浆水平则呈负相关。BKMR 的结果显示，当所有金属的浓度都高于中位数 50%时，23 种金属对 CKD 风险的综合影响具有显著的正相关。此外，还观察到锌和砷、锌和镉、锌和铅、钛和砷以及镉和铅之间对 CKD 风险的潜在相互作用。总之，我们发现糖尿病患者的血浆钛、锌、砷、铷、镉和铅与 CKD 之间存在显著的关联，除了铷之外，这些金属之间还存在相互作用。多种金属的共同暴露与糖尿病患者的 CKD 风险增加有关。
