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American Journal of Epidemiology Advance Access originally published online on August 21, 2009
American Journal of Epidemiology 2009 170(9):1156-1164; doi:10.1093/aje/kwp248
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Blood Cadmium and Lead and Chronic Kidney Disease in US Adults: A Joint Analysis

Ana Navas-Acien, Maria Tellez-Plaza, Eliseo Guallar, Paul Muntner, Ellen Silbergeld, Bernard Jaar and Virginia Weaver

Correspondence to Dr. Virginia Weaver, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room W7513A, Baltimore, MD 21205 (e-mail: vweaver{at}jhsph.edu).

Received for publication January 6, 2009. Accepted for publication July 21, 2009.

Environmental cadmium and lead exposures are widespread, and both metals are nephrotoxic at high exposure levels. Few studies have evaluated the associations between low-level cadmium and clinical renal outcomes, particularly with respect to joint cadmium and lead exposure. The geometric mean levels of blood cadmium and lead were 0.41 µg/L (3.65 nmol/L) and 1.58 µg/dL (0.076 µmol/L), respectively, in 14,778 adults aged ≥20 years who participated in the National Health and Nutrition Examination Survey (1999–2006). After adjustment for survey year, sociodemographic factors, chronic kidney disease risk factors, and blood lead, the odds ratios for albuminuria (≥30 mg/g creatinine), reduced estimated glomerular filtration rate (eGFR) (<60 mL/minute/1.73 m2), and both albuminuria and reduced eGFR were 1.92 (95% confidence interval (CI): 1.53, 2.43), 1.32 (95% CI: 1.04, 1.68), and 2.91 (95% CI: 1.76, 4.81), respectively, comparing the highest with the lowest blood cadmium quartiles. The odds ratios comparing participants in the highest with the lowest quartiles of both cadmium and lead were 2.34 (95% CI: 1.72, 3.18) for albuminuria, 1.98 (95% CI: 1.27, 3.10) for reduced eGFR, and 4.10 (95% CI: 1.58, 10.65) for both outcomes. These findings support consideration of cadmium and lead as chronic kidney disease risk factors in the general population and provide novel evidence of risk with environmental exposure to both metals.

albuminuria; cadmium; creatinine; glomerular filtration rate; kidney diseases; lead; metals; nutrition surveys

Abbreviations: CI, confidence interval; eGFR, estimated glomerular filtration rate; NHANES, National Health and Nutrition Examination Survey


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