PDF(Pubmed)
Abstract：
Cadmium (Cd) is a pervasive, toxic environmental pollutant that preferentially accumulates in the tubular epithelium of the kidney. Current evidence suggests that the cumulative burden of Cd here leads to the progressive loss of the glomerular filtration rate (GFR). In this study, we have quantified changes in estimated GFR (eGFR) and albumin excretion (Ealb) according to the levels of blood Cd ([Cd]b) and excretion of Cd (ECd) after adjustment for confounders. ECd and Ealb were normalized to creatinine clearance (Ccr) as ECd/Ccr and Ealb/Ccr. Among 482 residents of Cd-polluted and non-polluted regions of Thailand, 8.1% had low eGFR and 16.9% had albuminuria (Ealb/Ccr) × 100 ≥ 20 mg/L filtrate. In the low Cd burden group, (ECd/Ccr) × 100 < 1.44 µg/L filtrate, eGFR did not correlate with ECd/Ccr (β = 0.007) while an inverse association with ECd/Ccr was found in the medium (β = -0.230) and high burden groups (β = -0.349). Prevalence odds ratios (POR) for low eGFR were increased in the medium (POR 8.26) and high Cd burden groups (POR 3.64). Also, eGFR explained a significant proportion of Ealb/Ccr variation among those with middle (η2 0.093) and high [Cd]b tertiles (η2 0.132) but did not with low tertiles (η2 0.001). With an adjustment of eGFR, age and BMI, the POR values for albuminuria were increased in the middle (POR 2.36) and high [Cd]b tertiles (POR 2.74) and those with diabetes (POR 6.02) and hypertension (2.05). These data indicate that (ECd/Ccr) × 100 of 1.44 µg/L filtrate (0.01-0.02 µg/g creatinine) may serve as a Cd threshold level based on which protective exposure guidelines should be formulated.
摘要：
镉(Cd)是普遍存在的，有毒的环境污染物，优先积累在肾小管上皮。目前的证据表明，Cd的累积负担会导致肾小球滤过率（GFR）的逐渐丧失。在这项研究中,我们根据校正混杂因素后的血液Cd([Cd]b)和Cd排泄(ECd)水平,量化了估计GFR(eGFR)和白蛋白排泄(Ealb)的变化.将ECd和Ealb标准化为肌酐清除率(Ccr)为ECd/Ccr和Ealb/Ccr。在泰国Cd污染和非污染地区的482名居民中，8.1%的患者eGFR较低，16.9%的患者出现白蛋白尿(Ealb/Ccr)×100≥20mg/L滤液。在低Cd负荷组中，(ECd/Ccr)×100<1.44µg/L滤液，eGFR与ECd/Ccr无关（β=0.007），而在中等（β=-0.230）和高负荷组（β=-0.349）中发现与ECd/Ccr呈负相关。在中等（POR8.26）和高Cd负荷组（POR3.64）中，低eGFR的患病率优势比（POR）增加。此外，eGFR解释了中等（η20.093）和高[Cd]b三元（η20.132）但低三元（η20.001）的Ealb/Ccr变异的显着比例。随着eGFR的调整，年龄和BMI,在中(POR2.36)和高[Cd]b三元(POR2.74)以及糖尿病(POR6.02)和高血压(2.05)患者中,蛋白尿的POR值增加。这些数据表明，1.44µg/L滤液（0.01-0.02µg/g肌酐）的（ECd/Ccr）×100可以作为Cd阈值水平，应根据该阈值制定保护性暴露指南。
