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Associations between urinary excretion of cadmium and proteins in a nonsmoking population: renal toxicity or normal physiology?

Akerstrom M, Sallsten G, Lundh T, Barregard L - Environ. Health Perspect. (2012)

Bottom Line: We also found significant positive associations of urinary flow with excretion of U-Cd, U-Alb, and U-A1M.Associations between short-term changes in U-Cd and markers of kidney function within individual nonsmoking study participants are unlikely to reflect effects of Cd toxicity.A more likely explanation is that these associations result from normal variation in renal function, including changes in urinary flow, that influence the urinary excretion of both Cd and proteins in the same direction.

View Article: PubMed Central - PubMed

Affiliation: Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden. magnus.akerstrom@amm.gu.se

ABSTRACT

Background: Associations between cadmium (Cd) and kidney function have been reported even at low levels of exposure in the general population. Recently, the causality of these associations has been questioned.

Objectives: We examined associations between urinary Cd (U-Cd; a biomarker of exposure) and urinary proteins that are used as biomarkers of kidney effects, based on repeated short-term sampling in healthy subjects.

Methods: Twenty-four hour urine samples were collected on 2 separate days at six fixed times from 30 healthy nonsmoking men and women (median age 39 years). We analyzed the samples (N = 354) for Cd (i.e., U-Cd) and two proteins used as kidney function biomarkers: urinary albumin (U-Alb) and alpha-1-microglobulin (U-A1M). Concentrations were adjusted for creatinine concentration or for specific gravity, and excretion rates (mass per hour) were calculated. Possible associations were assessed within each individual participant, and mean correlations and regressions were evaluated.

Results: We found clear positive mean associations within individuals between the excretion of U-Cd [mean, 0.11 µg/g creatinine (range, 0.01-0.52 µg/g creatinine)] and both U-Alb and U-A1M. The associations were stronger for excretion rates and concentrations adjusted for specific gravity than for concentrations adjusted for creatinine. We also found significant positive associations of urinary flow with excretion of U-Cd, U-Alb, and U-A1M.

Conclusions: Associations between short-term changes in U-Cd and markers of kidney function within individual nonsmoking study participants are unlikely to reflect effects of Cd toxicity. A more likely explanation is that these associations result from normal variation in renal function, including changes in urinary flow, that influence the urinary excretion of both Cd and proteins in the same direction. These effects of normal variability may result in overestimation of the adverse effects of Cd on kidney function at low-level Cd exposure.

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Related in: MedlinePlus

Example showing the association, for 1 of 30 individual participants, between Cd excretion rates (A,B) and Cd concentrations adjusted for SG (C,D), and Cd concentrations adjusted for U-Crea concentration (E,F) and U-Alb (A,C,E), or U-A1M (B,E,F), respectively.
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f1: Example showing the association, for 1 of 30 individual participants, between Cd excretion rates (A,B) and Cd concentrations adjusted for SG (C,D), and Cd concentrations adjusted for U-Crea concentration (E,F) and U-Alb (A,C,E), or U-A1M (B,E,F), respectively.

Mentions: Associations between excretion of U-Cd and U-Alb. On average, U-Cd excretion was positively associated with U-Alb excretion within individual participants (see Figure 1 for an example of data for all samples from an individual participant and Figure 2 for the distributions of means across participants). The association was stronger for excretion rates (overall mean rS = 0.44, p < 0.001) and concentrations adjusted for SG (overall mean rS = 0.37, p < 0.001) compared with concentrations adjusted for U-Crea (overall mean rS = 0.26, p = 0.001). Exclusion of overnight samples (n = 59), values < LOD (n = 113), or very diluted or concentrated samples [U-Crea < 0.3 g/L or > 3.0 g/L (n = 28), respectively, or SG < 1.010 or > 1.030 (n = 85)] did not change the overall results, and there were no significant sex differences in the association between U-Cd and U-Alb (data not shown). Overall means were similar when participants were stratified by age (above/below median 39 years) or BMI (above/below median 23.9 kg/m2) (data not shown).


Associations between urinary excretion of cadmium and proteins in a nonsmoking population: renal toxicity or normal physiology?

Akerstrom M, Sallsten G, Lundh T, Barregard L - Environ. Health Perspect. (2012)

Example showing the association, for 1 of 30 individual participants, between Cd excretion rates (A,B) and Cd concentrations adjusted for SG (C,D), and Cd concentrations adjusted for U-Crea concentration (E,F) and U-Alb (A,C,E), or U-A1M (B,E,F), respectively.
© Copyright Policy - public-domain
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569687&req=5

f1: Example showing the association, for 1 of 30 individual participants, between Cd excretion rates (A,B) and Cd concentrations adjusted for SG (C,D), and Cd concentrations adjusted for U-Crea concentration (E,F) and U-Alb (A,C,E), or U-A1M (B,E,F), respectively.
Mentions: Associations between excretion of U-Cd and U-Alb. On average, U-Cd excretion was positively associated with U-Alb excretion within individual participants (see Figure 1 for an example of data for all samples from an individual participant and Figure 2 for the distributions of means across participants). The association was stronger for excretion rates (overall mean rS = 0.44, p < 0.001) and concentrations adjusted for SG (overall mean rS = 0.37, p < 0.001) compared with concentrations adjusted for U-Crea (overall mean rS = 0.26, p = 0.001). Exclusion of overnight samples (n = 59), values < LOD (n = 113), or very diluted or concentrated samples [U-Crea < 0.3 g/L or > 3.0 g/L (n = 28), respectively, or SG < 1.010 or > 1.030 (n = 85)] did not change the overall results, and there were no significant sex differences in the association between U-Cd and U-Alb (data not shown). Overall means were similar when participants were stratified by age (above/below median 39 years) or BMI (above/below median 23.9 kg/m2) (data not shown).

Bottom Line: We also found significant positive associations of urinary flow with excretion of U-Cd, U-Alb, and U-A1M.Associations between short-term changes in U-Cd and markers of kidney function within individual nonsmoking study participants are unlikely to reflect effects of Cd toxicity.A more likely explanation is that these associations result from normal variation in renal function, including changes in urinary flow, that influence the urinary excretion of both Cd and proteins in the same direction.

View Article: PubMed Central - PubMed

Affiliation: Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden. magnus.akerstrom@amm.gu.se

ABSTRACT

Background: Associations between cadmium (Cd) and kidney function have been reported even at low levels of exposure in the general population. Recently, the causality of these associations has been questioned.

Objectives: We examined associations between urinary Cd (U-Cd; a biomarker of exposure) and urinary proteins that are used as biomarkers of kidney effects, based on repeated short-term sampling in healthy subjects.

Methods: Twenty-four hour urine samples were collected on 2 separate days at six fixed times from 30 healthy nonsmoking men and women (median age 39 years). We analyzed the samples (N = 354) for Cd (i.e., U-Cd) and two proteins used as kidney function biomarkers: urinary albumin (U-Alb) and alpha-1-microglobulin (U-A1M). Concentrations were adjusted for creatinine concentration or for specific gravity, and excretion rates (mass per hour) were calculated. Possible associations were assessed within each individual participant, and mean correlations and regressions were evaluated.

Results: We found clear positive mean associations within individuals between the excretion of U-Cd [mean, 0.11 µg/g creatinine (range, 0.01-0.52 µg/g creatinine)] and both U-Alb and U-A1M. The associations were stronger for excretion rates and concentrations adjusted for specific gravity than for concentrations adjusted for creatinine. We also found significant positive associations of urinary flow with excretion of U-Cd, U-Alb, and U-A1M.

Conclusions: Associations between short-term changes in U-Cd and markers of kidney function within individual nonsmoking study participants are unlikely to reflect effects of Cd toxicity. A more likely explanation is that these associations result from normal variation in renal function, including changes in urinary flow, that influence the urinary excretion of both Cd and proteins in the same direction. These effects of normal variability may result in overestimation of the adverse effects of Cd on kidney function at low-level Cd exposure.

Show MeSH
Related in: MedlinePlus