Kuo Pai-Feng, Huang Yun-Ting, Chuang Min-Hsiang, Jiang Ming-Yan
Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
PLoS One. 2024 Dec 17;19(12):e0315688. doi: 10.1371/journal.pone.0315688. eCollection 2024.
While the nephrotoxicity of lead and cadmium is well-established, the impact of low-level exposure on risk of chronic kidney disease (CKD) and long-term health outcomes, especially in CKD patients, remains unclear. This study examines the association between low-level lead and cadmium exposure with risks of CKD and long-term mortality.
We analyzed data from adult participants of 2003-2012 National Health and Nutrition Examination Survey in the United States. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2. Elevated blood lead (≥ 1.5 μg/dL) and cadmium (≥ 0.4 μg/L) levels were assessed for their associations with CKD and all-cause mortality, with survival tracked until December 31, 2019.
Among the 24,810 participants (mean age 44.4 years, 48.9% male), 1,309 (3.9%) had CKD. Lead and cadmium levels were significantly higher in participants with CKD compared to those without. Elevated lead (OR: 1.41, 95% CI: 1.15-1.74) and cadmium (OR: 1.23, 95% CI: 1.03-1.46) levels were both associated with increased CKD risk, with the highest risk in those with both lead ≥ 1.5 μg/dL and cadmium ≥ 0.4 μg/L (OR: 1.65, 95% CI 1.27-2.14). During a median follow-up of 141 months, 2,255 participants died (7.0 per 10,000 person-months). Elevated cadmium was associated with higher mortality risk in CKD (HR: 1.42, 95% CI: 1.07-1.88) and non-CKD populations (HR: 1.40, 95% CI: 1.24-1.58), while lead levels were not significantly associated with mortality in either group. Participants with both elevated lead and cadmium had a significantly higher mortality risk (HR: 1.32, 95% CI: 1.13-1.54).
Low-level cadmium and lead exposure are linked to increased CKD risk, with cadmium also associated with higher long-term mortality in both CKD and non-CKD populations. These findings highlight the need for public health efforts to reduce exposure and further research on long-term impacts.
虽然铅和镉的肾毒性已得到充分证实，但低水平暴露对慢性肾脏病（CKD）风险和长期健康结局的影响仍不明确，尤其是在CKD患者中。本研究探讨低水平铅和镉暴露与CKD风险及长期死亡率之间的关联。
我们分析了2003 - 2012年美国国家健康与营养检查调查中成年参与者的数据。CKD定义为估算肾小球滤过率<60 ml/min/1.73 m²。评估血铅（≥1.5 μg/dL）和镉（≥0.4 μg/L）水平升高与CKD及全因死亡率的关联，并追踪生存情况直至2019年12月31日。
在24,810名参与者（平均年龄44.4岁，48.9%为男性）中，1,309人（3.9%）患有CKD。与未患CKD的参与者相比，患CKD者的铅和镉水平显著更高。血铅水平升高（比值比：1.41，95%置信区间：1.15 - 1.74）和镉水平升高（比值比：1.23，95%置信区间：1.03 - 1.46）均与CKD风险增加相关，血铅≥1.5 μg/dL且镉≥0.4 μg/L的参与者风险最高（比值比：1.65，95%置信区间1.27 - 2.14）。在中位随访141个月期间，2,255名参与者死亡（每10,000人月7.0例）。镉水平升高与CKD人群（风险比：1.42，95%置信区间：1.07 - 1.88）和非CKD人群（风险比：1.40，95%置信区间：1.24 - 1.58）的较高死亡风险相关，而铅水平在两组中与死亡率均无显著关联。血铅和镉水平均升高的参与者死亡风险显著更高（风险比：1.32，95%置信区间：1.13 - 1.54）。
低水平镉和铅暴露与CKD风险增加有关，镉还与CKD和非CKD人群的较高长期死亡率相关。这些发现凸显了公共卫生工作在减少暴露方面的必要性以及对长期影响进行进一步研究的需求。
