Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
Department of Medicine, Mackay Medical College, New Taipei, Taiwan.
Ann Acad Med Singap. 2023 Aug 30;52(8):398-410. doi: 10.47102/annals-acadmedsg.202357.
Chronic kidney disease (CKD) is a condition defined as a persistent change in kidney structure or function, or both, that compromises human health. Environmental exposure to heavy metals (e.g. cadmium, lead, arsenic and mercury) is common, and high exposure levels are known to cause nephrotoxicity. Micronutrients such as selenium and zinc are positively associated with better kidney function and renal outcomes. This study determined the associations between CKD and heavy metal exposures measured in blood or urine within a community-dwelling population, and assessed whether and how selenium and zinc modified the associations.
Data were extracted from 4 cycles of the US National Health and Nutrition Examination Survey (NHANES) database (2011-2012, 2013-2014, 2015-2016 and 2017-2018).
Univariate analysis showed that higher quartiles of plasma lead and cadmium concentration were more likely associated with CKD than the lowest quartile, and along with folate, were linked to greater odds of CKD. Conversely, as plasma selenium and serum zinc increased, the odds of CKD decreased. Multivariate analysis had similar results after adjusting for relevant confounders. Higher plasma cadmium quartiles were associated with higher odds of CKD. Associations between higher quartiles of plasma selenium and serum zinc were significantly associated with lower odds of CKD.
Elevated blood levels of heavy metals increase CKD, whereas elevated concentrations of plasma selenium and serum zinc decrease CKD. A high serum zinc concentration appears to interact with low-toxicity heavy metals to reduce CKD risk. This study suggests that increased selenium and zinc in the body along with avoidance of heavy metal exposures could protect against CKD.
慢性肾脏病（CKD）是一种定义为肾脏结构或功能持续变化，或两者兼有的疾病，会影响人类健康。人们普遍会接触到重金属（如镉、铅、砷和汞），已知高水平暴露会导致肾毒性。微量元素，如硒和锌，与更好的肾功能和肾脏结局呈正相关。本研究旨在确定在社区居住人群中血液或尿液中重金属暴露与 CKD 之间的关联，并评估硒和锌是否以及如何改变这些关联。
数据取自美国国家健康和营养检查调查（NHANES）数据库的 4 个周期（2011-2012 年、2013-2014 年、2015-2016 年和 2017-2018 年）。
单变量分析显示，与最低四分位数相比，血浆铅和镉浓度较高的四分位数更有可能与 CKD 相关，并且与叶酸一起，与 CKD 的发病几率更高相关。相反，随着血浆硒和血清锌的增加，CKD 的几率降低。调整了相关混杂因素后，多变量分析也得出了类似的结果。更高的血浆镉四分位数与 CKD 的发病几率更高相关。血浆硒和血清锌四分位数较高与 CKD 的发病几率较低呈显著相关。
血液中重金属水平升高会增加 CKD 的发病几率，而血浆硒和血清锌浓度升高会降低 CKD 的发病几率。高血清锌浓度似乎与低毒性重金属相互作用，降低 CKD 风险。本研究表明，体内增加硒和锌的摄入并避免重金属暴露可能有助于预防 CKD。
