Department of Statistic, Computer Science and Applications "G.Parenti", University of Florence, Florence, Italy.
Department of Statistic, Computer Science and Applications "G.Parenti", University of Florence, Florence, Italy.
Sci Total Environ. 2024 Jan 1;906:167165. doi: 10.1016/j.scitotenv.2023.167165. Epub 2023 Sep 25.
Several observational studies investigated the relationship between environmental cadmium exposure and risk of chronic kidney disease (CKD). However, results from epidemiological studies are conflicting and wide variabilities have been reported.
We conducted a meta-analysis to evaluate the relationship between environmental cadmium exposure and CKD risk, as assessed by decreased estimated Glomerular Filtration Rate (eGFR) in adults.
PubMed, Embase and the Cochrane library databases were searched for studies published up to July 2023. A random-effects model using the restricted maximum likelihood (REML) method was used to calculate the overall estimate to assess the association between cadmium exposure and eGFR. Subgroup analysis, funnel plot, Egger's test, and the trim-and-fill method were also conducted.
Thirty-one articles, 3 cohorts, 2 case-control and 26 cross-sectional studies, across 8 countries, involving 195.015 participants were included. The meta-analysis demonstrated an inverse association between high cadmium exposure and eGFR levels (standardized regression coefficient β = -0.09; 95 % CI = -0.15, -0.04). The subgroup analysis showed that the inverse association was significantly higher for blood cadmium exposure (β = -0.12; 95 % CI = -0.18, -0.06) than for urinary concentrations (β = -0.04; 95 % CI: -0.10, 0.03) or dietary exposure (β = -0.03; 95 % CI = -0.19, 0.14). Stratified analysis by different study design also showed an inverse association between cadmium exposure and eGFR, more evident in the cross-sectional studies (β = -0.11; 95 % CI = -0.18, -0.03) than in the cohort (β = -0.05; 95 % CI = -0.26, 0.17) and in the case-control studies (β = -0.05; 95 % CI = -0.32, 0.21).
Our meta-analysis indicated that environmental cadmium exposure is associated with increased risk of CKD, as assessed by decreased eGFR, and this association is more evident for blood cadmium concentrations than for urinary concentrations or dietary exposure. Nevertheless, additional high quality prospective studies are needed to confirm the association between cadmium exposure and risk of CKD.
多项观察性研究探讨了环境镉暴露与慢性肾脏病（CKD）风险之间的关系。然而，流行病学研究的结果存在冲突，且报道的差异较大。
我们进行了一项荟萃分析，以评估环境镉暴露与通过估计肾小球滤过率（eGFR）降低评估的成人 CKD 风险之间的关系。
检索截至 2023 年 7 月发表的 PubMed、Embase 和 Cochrane 图书馆数据库中的研究。使用受限极大似然法（REML）的随机效应模型计算整体估计值，以评估镉暴露与 eGFR 之间的关联。还进行了亚组分析、漏斗图、Egger 检验和修剪填充法。
共纳入 8 个国家的 31 篇文章（3 项队列研究、2 项病例对照研究和 26 项横断面研究），涉及 195.015 名参与者。荟萃分析表明，高镉暴露与 eGFR 水平呈负相关（标准化回归系数β=-0.09；95%置信区间=-0.15，-0.04）。亚组分析显示，血液镉暴露的负相关关系（β=-0.12；95%置信区间=-0.18，-0.06）显著高于尿浓度（β=-0.04；95%置信区间：-0.10，0.03）或膳食暴露（β=-0.03；95%置信区间=-0.19，0.14）。不同研究设计的分层分析也表明，镉暴露与 eGFR 之间存在负相关，横断面研究中的这种相关性更为明显（β=-0.11；95%置信区间=-0.18，-0.03），而队列研究中的相关性则较弱（β=-0.05；95%置信区间=-0.26，0.17），病例对照研究中的相关性则更弱（β=-0.05；95%置信区间=-0.32，0.21）。
我们的荟萃分析表明，环境镉暴露与 eGFR 降低评估的 CKD 风险增加有关，血液镉浓度与这种相关性比尿浓度或膳食暴露更为明显。然而，需要更多高质量的前瞻性研究来证实镉暴露与 CKD 风险之间的关系。
