Cadmium exposure and end-stage renal disease

Hellström, Lennart; Elinder, Carl‐Gustaf; Dahlberg, B; Lundberg, Marc; Järup, Lars; Persson, Bertil; Axelson, Olav

doi:10.1053/ajkd.2001.28589

Cited by 172 publications

(97 citation statements)

References 28 publications

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“…In conclusion, the levels of cadmium among the women in this study were moderately high with at least one-third excreting over 2 mg cadmium per gram creatinine and at possible risk of renal damage, especially in combination with diabetes (Buchet et al, 1990;Jarup et al 1998;Hellstrom et al, 2001;Akesson et al, 2005). Although there are limitations in the data, the strength of the associations observed and their ability to address concerns raised by the Elders and women involved, especially for informing their children about turtle and dugong liver and kidney and wild clam consumption, add to the growing body of literature enabling toxicological research to help meet people's information needs about these issues (Kim et al, 1998;Kuhnlein and Chan, 2000;Johansen et al, 2004;Judd et al, 2004).…”

Section: Discussionmentioning

confidence: 59%

“…Although the critical effect level was initially estimated at 200 mg/g kidney cortex, recent studies have linked measurable effects on renal tubules at much lower levels (Buchet et al, 1990;Jarup et al, 1998;Jarup et al, 2000;Hellstrom et al, 2001;Akesson et al, 2005). There is a relatively small gap between actual (24 to 42 mg per day globally) and the currently accepted ''safe'' intake of 70 mg per day (or 7 mg/kg body weight per week) (JEFCA, 2003).…”

Section: Introductionmentioning

confidence: 99%

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Exploring potential dietary contributions including traditional seafood and other determinants of urinary cadmium levels among indigenous women of a Torres Strait Island (Australia)

Haswell‐Elkins

McGrath²,

Moore³

et al. 2007

J Expo Sci Environ Epidemiol

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Indigenous people of the Torres Strait Islands have been concerned about the safety of their traditional seafoods since the discovery of high cadmium levels in the liver and kidney of dugong and turtle in 1996. This study explored links between urinary cadmium levels and consumption frequency of these traditional foods and piloted a community-based methodology to identify potential determinants of cadmium exposure and accumulation. Consultations led to selection of one community for study from which 60 women aged 30 to 50 years participated in health and food frequency survey, urine collection and a routine health check. Urinary cadmium levels were determined by inductively coupled plasma-mass spectrometry; data were analysed using SPSS-14. The geometric mean cadmium level in this group of women was 1.17 (arithmetic mean 1.86) mg/g creatinine with one-third exceeding 2.0 mg/g creatinine. Heavy smoking (Z300 pack years) was linked to higher cadmium in urine, as was increasing age and waist circumference. Analysis of ageadjusted residuals revealed significant associations (Po0.05) between cadmium level and higher consumption of turtle liver and kidney, locally gathered clams, peanuts, coconut, chocolate and potato chips. Dugong kidney consumption approached significance (P ¼ 0.06). Multiple regression revealed that 40% (adjusted r 2 ) of variation in cadmium level was explained by the sum of these associated foods plus heavy smoking, age and waist circumference. No relationships between cadmium and pregnancy history were found. This paper presents a novel approach to explore contributions of foods and other factors to exposure to toxins at community level and the first direct evidence that frequent turtle (and possibly dugong) liver and kidney and wild clam consumption is linked to higher urinary cadmium levels among Torres Strait Islander women.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Exploring potential dietary contributions including traditional seafood and other determinants of urinary cadmium levels among indigenous women of a Torres Strait Island (Australia)

Haswell‐Elkins

McGrath²,

Moore³

et al. 2007

J Expo Sci Environ Epidemiol

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show abstract

“…Nearly 12% of samples in this study contained levels of cadmium above 2 mg cadmium per gram creatinine; even lower levels are increasingly linked with markers of renal damage in the general population (Buchet et al, 1990;Jarup et al, 1998;Jarup et al, 2000;Hellstrom et al, 2001;Satarug et al, 2003;Akesson et al, 2005). Although the ''critical effect level'' among people with diabetes remains undefined, there is ample evidence indicating that it is lower than that of otherwise healthy people (Buchet et al, 1990;Roels et al, 1991;Satarug et al, 2000;Satarug et al, 2003;Akesson et al, 2005).…”

Section: Discussionmentioning

confidence: 75%

“…or 10 mg/g creatinine in urine (Roels et al, 1991;World Health Organisation (WHO), 1992). More recent population-based studies reveal markers of renal tubule damage at cadmium levels ranging from less than one to three mg/g creatinine in urine (Buchet et al, 1990;Jarup et al, 1998Jarup et al, , 2000Hellstrom et al, 2001;Noonan et al, 2002;Satarug et al, 2003;Akesson et al, 2005). A recent study has suggested a causal link between cadmium and diabetes (Schwartz et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Urinary excretion of cadmium among Torres Strait Islanders (Australia) at risk of elevated dietary exposure through traditional foods

Haswell‐Elkins

Imray

Satarug³

et al. 2006

J Expo Sci Environ Epidemiol

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This study explored urinary cadmium levels among Torres Strait Islanders in response to concerns about potential health impact of high levels of cadmium in some traditional seafood (dugong and turtle liver and kidney). Cadmium levels were measured by inductively coupled mass spectrometry in de-identified urine samples collected during general screening programs in 1996 in two communities with varying dugong and turtle catch statistics. Statistical analysis was performed to identify links between cadmium levels and demographic and background health information. Geometric mean cadmium level among the sample group was 0.83 mg/g creatinine with 12% containing over 2 mg/g creatinine. Cadmium level was most strongly associated with age (46% of variation), followed by sex (females 4males, 7%) and current smoking status (smokers 4non-smokers, 4.7%). Adjusting model conditions suggested further positive associations between cadmium level and diabetes (p ¼ 0.05) and residence in the predicted higher exposure community (p ¼ 0.07). Positive correlations between cadmium and body fat in bivariate analysis were eliminated by control for age and sex. This study found only suggestive differences in cadmium levels between two communities with predicted variation in exposure from traditional foods. However, the data indicate that factors linked with higher cadmium accumulation overlap with those of renal disease risk (i.e. older, females, smokers, diabetes) and suggest that levels may be sufficient to contribute to renal pathology. More direct assessment of exposure and health risks of cadmium to Torres Strait Islanders is needed given the disproportionate level of diet-related disease and the cultural importance of dugong and turtle. This study highlights the need to consider social and cultural variation in exposure and to define ''safe'' cadmium levels during diabetes given its rising global prevalence.

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“…In a recent study detailing a 5-year follow-up of a subpopulation chosen for its high urinary cadmium levels, Hotz et al (1999) concluded that in environmentally exposed populations, tubular effects were not associated with progressive deterioration in renal function after the implementation of exposure reduction measures. In the case of ongoing low-level environmental exposure, however, cadmium does appear to be a determinant for the development of end-stage renal disease (Hellström et al 2001).…”

Section: Case Discussionmentioning

confidence: 96%

Cadmium exposure and nephropathy in a 28-year-old female metals worker.

Wittman¹,

Hu²

2002

Environ Health Perspect

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A 28-year-old female presented for evaluation of left flank pain and polyuria after having been exposed to cadmium in the jewelry manufacturing industry for approximately 3 years. This patient possessed both elevated 24-hr urinary β 2 -microglobulin and elevated blood cadmium levels. Approximately 6 months after initial presentation, the patient resigned from her job due to shortness of breath, chest pain, and anxiety. Exposure to cadmium in the jewelry industry is a significant source of occupational cadmium exposure. Other occupational sources include the manufacture of nickel-cadmium batteries, metal plating, zinc and lead refining, smelting of cadmium and lead, and production of plastics. Cadmium is also an environmental pollutant that accumulates in leafy vegetables and plants, including tobacco. Major toxicities anticipated from cadmium exposure involve the renal, pulmonary, and, to a lesser extent, gastrointestinal systems. These include the development of renal proximal tubular dysfunction, glomerular damage with progressive renal disease, and respiratory symptoms including pneumonitis and emphysema. Low-level cadmium exposure has also been associated with increased urinary calcium excretion and direct bone toxicity, effects that recent research suggests may result in the development of osteoporosis. The body burden of cadmium, over half of which may reside in the kidneys, is most often measured through the use of urinary cadmium levels. Blood cadmium measurements generally reflect current or recent exposure and are especially useful in cases with a short exposure period and only minimal accumulation of cadmium in the kidneys. Both β 2 -microglobulin and α 1 -microglobulin serve as organ-specific, early-effect biomarkers of tubular proteinuria and thus play a role in identifying early signs of cadmium-induced renal damage in those with potential exposures. In addition to ensuring workplace compliance with Occupational Safety and Health Administration-mandated monitoring and screening measures, it is prudent for those with cadmium exposure to maintain adequate intake of both iron and calcium, appropriate measures even in the absence of exposure.

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Cadmium exposure and end-stage renal disease

Cited by 172 publications

References 28 publications

Exploring potential dietary contributions including traditional seafood and other determinants of urinary cadmium levels among indigenous women of a Torres Strait Island (Australia)

Exploring potential dietary contributions including traditional seafood and other determinants of urinary cadmium levels among indigenous women of a Torres Strait Island (Australia)

Urinary excretion of cadmium among Torres Strait Islanders (Australia) at risk of elevated dietary exposure through traditional foods

Cadmium exposure and nephropathy in a 28-year-old female metals worker.

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