PDF(Pubmed)
Abstract：
BACKGROUND: Chronic Kidney Disease of unknown cause (CKDu) a disease of exclusion, and remains unexplained in various parts of the world, including India. Previous studies have reported mixed findings about the role of heavy metals or agrochemicals in CKDu. These studies compared CKDu with healthy controls but lacked subjects with CKD as controls. The purpose of this study was to test the hypothesis whether heavy metals, i.e. Arsenic (As), Cadmium (Cd), Lead (Pb), and Chromium (Cr) are associated with CKDu, in central India.
METHODS: The study was conducted in a case-control manner at a tertiary care hospital. CKDu cases (n = 60) were compared with CKD (n = 62) and healthy subjects (n = 54). Blood and urine levels of As, Cd, Pb, and Cr were measured by Inductively Coupled Plasma- Optical Emission Spectrometry. Pesticide use, painkillers, smoking, and alcohol addiction were also evaluated. The median blood and urine metal levels were compared among the groups by the Kruskal-Wallis rank sum test.
RESULTS: CKDu had significantly higher pesticide and surface water usage as a source of drinking water. Blood As levels (median, IQR) were significantly higher in CKDu 91.97 (1.3-132.7) µg/L compared to CKD 4.5 (0.0-58.8) µg/L and healthy subjects 39.01 (4.8-67.4) µg/L (p < 0.001) On multinominal regression age and sex adjusted blood As was independently associated with CKDu[ OR 1.013 (95%CI 1.003-1.024) P < .05].Blood and urinary Cd, Pb, and Cr were higher in CKD compared to CKDu (p > .05). Urinary Cd, Pb and Cr were undetectable in healthy subjects and were significantly higher in CKDu and CKD compared to healthy subjects (P = < 0.001). There was a significant correlation of Cd, Pb and Cr in blood and urine with each other in CKDu and CKD subjects as compared to healthy subjects. Surface water use also associated with CKDu [OR 3.178 (95%CI 1.029-9.818) p < .05).
CONCLUSIONS: The study showed an independent association of age and sex adjusted blood As with CKDu in this Indian cohort. Subjects with renal dysfunction (CKDu and CKD) were found to have significantly higher metal burden of Pb, Cd, As, and Cr as compared to healthy controls. CKDu subjects had significantly higher pesticide and surface water usage, which may be the source of differential As exposure in these subjects.
METHODS: The study was conducted in a case-control manner at a tertiary care hospital. CKDu cases (n = 60) were compared with CKD (n = 62) and healthy subjects (n = 54). Blood and urine levels of As, Cd, Pb, and Cr were measured by Inductively Coupled Plasma- Optical Emission Spectrometry. Pesticide use, painkillers, smoking, and alcohol addiction were also evaluated. The median blood and urine metal levels were compared among the groups by the Kruskal-Wallis rank sum test.
RESULTS: CKDu had significantly higher pesticide and surface water usage as a source of drinking water. Blood As levels (median, IQR) were significantly higher in CKDu 91.97 (1.3-132.7) µg/L compared to CKD 4.5 (0.0-58.8) µg/L and healthy subjects 39.01 (4.8-67.4) µg/L (p < 0.001) On multinominal regression age and sex adjusted blood As was independently associated with CKDu[ OR 1.013 (95%CI 1.003-1.024) P < .05].Blood and urinary Cd, Pb, and Cr were higher in CKD compared to CKDu (p > .05). Urinary Cd, Pb and Cr were undetectable in healthy subjects and were significantly higher in CKDu and CKD compared to healthy subjects (P = < 0.001). There was a significant correlation of Cd, Pb and Cr in blood and urine with each other in CKDu and CKD subjects as compared to healthy subjects. Surface water use also associated with CKDu [OR 3.178 (95%CI 1.029-9.818) p < .05).
CONCLUSIONS: The study showed an independent association of age and sex adjusted blood As with CKDu in this Indian cohort. Subjects with renal dysfunction (CKDu and CKD) were found to have significantly higher metal burden of Pb, Cd, As, and Cr as compared to healthy controls. CKDu subjects had significantly higher pesticide and surface water usage, which may be the source of differential As exposure in these subjects.
摘要：
背景：不明原因慢性肾脏病（CKDu）是一种排斥疾病，在世界各地仍然无法解释，包括印度。先前的研究报道了关于重金属或农用化学品在CKDu中的作用的混合发现。这些研究将CKDu与健康对照进行了比较，但缺乏以CKD为对照的受试者。这项研究的目的是检验重金属是否，即砷(As)，镉(Cd),铅(Pb),和铬（Cr）与CKDu有关，在印度中部。
方法：本研究以病例对照的方式在三级医院进行。将CKDu病例（n=60）与CKD（n=62）和健康受试者（n=54）进行比较。血液和尿液中的As,Cd,Pb,和Cr通过电感耦合等离子体发射光谱法测量。农药使用,止痛药,吸烟,和酒精成瘾也进行了评估。通过Kruskal-Wallis秩和检验比较各组之间的中位血液和尿液金属水平。
结果：CKDu作为饮用水来源的农药和地表水使用量明显更高。血液水平（中位数，与CKD4.5（0.0-58.8）µg/L和健康受试者39.01（4.8-67.4）µg/L相比，CKDu91.97（1.3-132.7）µg/L的IQR）明显更高（p<0.001）在多因素回归上，年龄和性别调整后的血As与CKDu独立相关[OR1.013（95CI1.003-1.024）P<.05]。血液和尿镉，Pb,与CKDu相比，CKD中的Cr更高（p>0.05）。尿镉,Pb和Cr在健康受试者中检测不到，并且在CKDu和CKD中明显高于健康受试者（P=<0.001）。Cd存在显著的相关性,与健康受试者相比，CKDu和CKD受试者的血液和尿液中的Pb和Cr彼此。地表水使用也与CKDu相关[OR3.178（95CI1.029-9.818）p<.05）。
结论：该研究表明，在这个印度队列中，年龄和性别调整后的血液与CKDu存在独立关联。肾功能不全的受试者（CKDu和CKD）被发现具有显著较高的Pb金属负荷，Cd,As,和Cr与健康对照相比。CKDu受试者的农药和地表水使用量明显较高，这可能是这些受试者暴露差异的来源。
方法：本研究以病例对照的方式在三级医院进行。将CKDu病例（n=60）与CKD（n=62）和健康受试者（n=54）进行比较。血液和尿液中的As,Cd,Pb,和Cr通过电感耦合等离子体发射光谱法测量。农药使用,止痛药,吸烟,和酒精成瘾也进行了评估。通过Kruskal-Wallis秩和检验比较各组之间的中位血液和尿液金属水平。
结果：CKDu作为饮用水来源的农药和地表水使用量明显更高。血液水平（中位数，与CKD4.5（0.0-58.8）µg/L和健康受试者39.01（4.8-67.4）µg/L相比，CKDu91.97（1.3-132.7）µg/L的IQR）明显更高（p<0.001）在多因素回归上，年龄和性别调整后的血As与CKDu独立相关[OR1.013（95CI1.003-1.024）P<.05]。血液和尿镉，Pb,与CKDu相比，CKD中的Cr更高（p>0.05）。尿镉,Pb和Cr在健康受试者中检测不到，并且在CKDu和CKD中明显高于健康受试者（P=<0.001）。Cd存在显著的相关性,与健康受试者相比，CKDu和CKD受试者的血液和尿液中的Pb和Cr彼此。地表水使用也与CKDu相关[OR3.178（95CI1.029-9.818）p<.05）。
结论：该研究表明，在这个印度队列中，年龄和性别调整后的血液与CKDu存在独立关联。肾功能不全的受试者（CKDu和CKD）被发现具有显著较高的Pb金属负荷，Cd,As,和Cr与健康对照相比。CKDu受试者的农药和地表水使用量明显较高，这可能是这些受试者暴露差异的来源。
