End-stage renal disease and low level exposure to lead, cadmium and mercury; a population-based, prospective nested case-referent study in Sweden

• Published in: Environmental health Vol. 12; no. 1; p. 9
• Main Authors: Sommar, Johan Nilsson, Svensson, Maria K, Björ, Bodil M, Elmståhl, Sölve I, Hallmans, Göran, Lundh, Thomas, Schön, Staffan MI, Skerfving, Staffan, Bergdahl, Ingvar A
• Format: Journal Article
• Language: English
• Published: London BioMed Central 23.01.2013; BioMed Central Ltd; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Arbetsmedicin och miljömedicin; Biobank; Bioindicators; Biomarkers - blood; Blood; Cadmium; Cadmium - blood; Cadmium - toxicity; Case-Control Studies; Case-referent; Chronic kidney failure; Clinical Medicine; Confidence intervals; Diabetes; Earth and Environmental Science; End-stage renal disease; Environment; Environmental Exposure; Environmental Health; Environmental Monitoring; Erythrocytes; Erythrocytes - chemistry; Female; Gender; Health aspects; Health facilities; Health Sciences; Hemodialysis; Humans; Hypertension; Hälsovetenskap; Kidney diseases; Kidney Failure, Chronic - chemically induced; Kidney Failure, Chronic - epidemiology; Klinisk medicin; Lead; Lead - blood; Lead - toxicity; Male; Mass Spectrometry; Medical and Health Sciences; Medical examination; Medical research; Medical screening; Medicin och hälsovetenskap; Medicine; Medicine, Experimental; Mercury; Mercury - blood; Mercury - toxicity; Middle Aged; Occupational Health and Environmental Health; Occupational health and safety; Occupational Medicine/Industrial Medicine; Participation; Population; Prospective Studies; Public Health; Risk assessment; Risk factors; Spectrophotometry, Atomic; Studies; Sweden - epidemiology; Sweden; Lead; Cadmium; End-stage renal disease; Mercury; Biobank; Case-referent
• ISSN: 1476-069X; 1476-069X
• DOI: 10.1186/1476-069X-12-9

Background Cadmium (Cd), lead (Pb), and mercury (Hg) cause toxicological renal effects, but the clinical relevance at low-level exposures in general populations is unclear. The objective of this study is to assess the risk of developing end-stage renal disease in relation to Cd, Pb, and Hg exposure. Methods A total of 118 cases who later in life developed end-stage renal disease, and 378 matched (sex, age, area, and time of blood sampling) referents were identified among participants in two population-based prospective cohorts (130,000 individuals). Cd, Pb, and Hg concentrations were determined in prospectively collected samples. Results Erythrocyte lead was associated with an increased risk of developing end-stage renal disease (mean in cases 76 μg/L; odds ratio (OR) 1.54 for an interquartile range increase, 95% confidence interval (CI) 1.18-2.00), while erythrocyte mercury was negatively associated (2.4 μg/L; OR 0.75 for an interquartile range increase, CI 0.56-0.99). For erythrocyte cadmium, the OR of developing end-stage renal disease was 1.15 for an interquartile range increase (CI 0.99-1.34; mean Ery-Cd among cases: 1.3 μg/L). The associations for erythrocyte lead and erythrocyte mercury, but not for erythrocyte cadmium, remained after adjusting for the other two metals, smoking, BMI, diabetes, and hypertension. Gender-specific analyses showed that men carried almost all of the erythrocyte lead and erythrocyte cadmium associated risks. Conclusions Erythrocyte lead is associated with end-stage renal disease but further studies are needed to evaluate causality. Gender-specific analyses suggest potential differences in susceptibility or in exposure biomarker reliability.