Toxic Metals and Chronic Kidney Disease: a Systematic Review of Recent Literature
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Purpose of Review
Arsenic (As), cadmium (Cd), and lead (Pb) are ubiquitous toxicants with evidence of adverse kidney impacts at high exposure levels. There is less evidence whether environmental exposure to As, Cd, or Pb plays a role in development of chronic kidney disease (CKD). We conducted a systematic review to summarize the recent epidemiologic literature examining the relationship between As, Cd, or Pb with CKD.
We included peer-reviewed studies published in English between January 2013 and April 2018 for As and Cd, and all dates prior to April 2018 for Pb. We imposed temporality requirements for both the definition of CKD (as per NKF-KDOQI guidelines) and environmental exposures prior to disease diagnosis. Our assessment included cohort, case-control or cross-sectional study designs that satisfied 5 inclusion criteria. We included a total of eight articles of which three, two, and four studies examined the effects of As, Cd, or Pb, respectively.
Studies of As exposure consistently reported positive association with CKD incidence; studies of Pb exposure were mixed. We found little evidence of association between Cd exposure and CKD. Additional well-designed prospective cohort studies are needed and we present recommendations for future studies.
KeywordsArsenic Cadmium Lead Chronic kidney disease Glomerular filtration rate
Blood lead level
Body mass index
estimated Glomerular Filtration Rate
Systolic blood pressure
Chronic kidney disease of unknown etiology
End-stage renal disease
This work was supported in part by funding from the Mount Sinai Children’s Center Foundation and the NIH (K99ES027508 and T32HD049311).
Compliance with Ethical Standards
Conflict of Interest
Steven Coca reports personal fees from Quark Biopharma, personal fees from Goldfinch Bio, personal fees from Janssen Pharma, personal fees from Renalytix.AI, personal fees from pulseData, outside the submitted work. Emily C. Moody and Alison P. Sanders declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 4.Nigra AE, Sanchez TR, Nachman KE, Harvey D, Chillrud SN, Graziano JH, et al. The effect of the Environmental Protection Agency maximum contaminant level on arsenic exposure in the USA from 2003 to 2014: an analysis of the National Health and Nutrition Examination Survey (NHANES). Lancet Public Health. 2017;2(11):e513–e21.CrossRefGoogle Scholar
- 6.Global Burden of Disease Study C. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800.CrossRefGoogle Scholar
- 7.•• Zheng L, Kuo CC, Fadrowski J, Agnew J, Weaver VM, Navas-Acien A. Arsenic and chronic kidney disease: a systematic review. Curr Environ Health Rep. 2014;1(3):192–207. This systematic review and meta-analysis of arsenic exposure and CKD (up to 2014) included 24 studies. They used an expanded definition of CKD otucome measures, and found evidence for a positive association between arsenic exposure and CKD mortality.CrossRefGoogle Scholar
- 8.•• Byber K, Lison D, Verougstraete V, Dressel H, Hotz P. Cadmium or cadmium compounds and chronic kidney disease in workers and the general population: a systematic review. Crit Rev Toxicol. 2016;46(3):191–240. This extensive systematic review (up to 2014) of cadmium and CKD examined evidence from a total of 34 cohort, case-control, and case-series studies. The authors included a broader case definition of CKD and more relaxed exposure-outcome temporality than the intentionally narrow criteria applied herein.CrossRefGoogle Scholar
- 20.Water NRCUSoAiD, editor. Biomarkers of arsenic exposure. Washington (DC): National Academies Press (US); 1999.Google Scholar
- 26.Swaddiwudhipong W, Nguntra P, Kaewnate Y, Mahasakpan P, Limpatanachote P, Aunjai T, et al. Human health effects from cadmium exposure: comparison between persons living in cadmium-contaminated and non-contaminated areas in northwestern Thailand. Southeast Asian J Trop Med Public Health. 2015;46(1):133–42.PubMedGoogle Scholar
- 45.Levine KE, Redmon JH, Elledge MF, Wanigasuriya KP, Smith K, Munoz B, et al. Quest to identify geochemical risk factors associated with chronic kidney disease of unknown etiology (CKDu) in an endemic region of Sri Lanka-a multimedia laboratory analysis of biological, food, and environmental samples. Environ Monit Assess. 2016;188(10):548.CrossRefGoogle Scholar
- 62.Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3).Google Scholar