Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases Research, Beijing, China.
Front Public Health. 2024 Jul 22;12:1403878. doi: 10.3389/fpubh.2024.1403878. eCollection 2024.
Population aging is a pivotal trend observed globally, and the exposure to heavy metals can exacerbate the aging process and lead to kidney damage. However, the impact of combined heavy metal exposure on renal function among older individuals remains elusive. Our study employs machine learning techniques to delve into the effects and underlying mechanisms of mixed exposure to heavy metals on the renal function of the aging population.
This study extracted comprehensive data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2020. A total of 3,175 participants aged 60 years and above, with complete information on six metals - lead, cadmium, manganese, cobalt, mercury, and selenium, along with relevant covariates, were included in the study. To assess the impact of single or mixed metal exposure on the renal function of older adult individuals, various statistical techniques were employed: multiple logistic regression, weighted quantitative sum (WQS) regression, Bayesian kernel machine regression (BKMR), and mediation effects analysis.
Multiple logistic regression revealed that selenium and manganese were protective factors for chronic kidney disease (CKD). Cobalt was a risk factor for CKD. High concentrations of lead, cadmium, and cobalt were risk factors for urinary albumin creatinine ratio (ACR). WQS analyses revealed that mixed metal exposure was positively correlated with estimated glomerular filtration rate (eGFR) but negatively correlated with CKD. Selenium and manganese can neutralize the effects of other metals on eGFR. Mixed metal exposure was positively correlated with ACR, with lead and cadmium having a substantial effect. Mediation analysis showed that uric acid (UA) had a mediating effect of 9.7% and -19.7% in the association between mixed metals exposure and proteinuria and CKD, respectively.
The impact of heavy metals on renal function in the older adult differs from that of adolescents and adults. This study suggests that elevated levels of mixed metals exposure are linked to proteinuria and CKD, with UA serving as a mediating factor.
人口老龄化是全球观察到的一个关键趋势，而重金属暴露会加剧衰老过程并导致肾脏损伤。然而，老年人中重金属混合暴露对肾功能的影响仍不清楚。我们的研究使用机器学习技术深入研究混合重金属暴露对老年人群肾功能的影响及其潜在机制。
本研究从 2015 年至 2020 年期间进行的国家健康和营养检查调查（NHANES）中提取了全面的数据。共纳入了 3175 名年龄在 60 岁及以上、有关于六种金属（铅、镉、锰、钴、汞和硒）以及相关协变量的完整信息的参与者。为了评估单一或混合金属暴露对老年个体肾功能的影响，我们使用了多种统计技术：多变量逻辑回归、加权定量和（WQS）回归、贝叶斯核机器回归（BKMR）和中介效应分析。
多变量逻辑回归显示，硒和锰是慢性肾脏病（CKD）的保护因素。钴是 CKD 的风险因素。高浓度的铅、镉和钴是尿白蛋白肌酐比（ACR）的风险因素。WQS 分析显示，混合金属暴露与估算肾小球滤过率（eGFR）呈正相关，与 CKD 呈负相关。硒和锰可以中和其他金属对 eGFR 的影响。混合金属暴露与 ACR 呈正相关，其中铅和镉的影响较大。中介分析显示，尿酸（UA）在混合金属暴露与蛋白尿和 CKD 之间的关联中具有 9.7%和-19.7%的中介效应。
重金属对老年人肾功能的影响与青少年和成年人不同。本研究表明，混合金属暴露水平升高与蛋白尿和 CKD 相关，UA 是一个中介因素。
