Prospective associations between environmental heavy metal exposure and renal outcomes in adults with chronic kidney disease

Tsai, Chun Chieh; Wu, Ching-Kuan; Kor, Chew Teng; Lian, Ie Bin; Chang, Chin Hua; Chang, Teng Hsiang; Chang, Chi-Ching; Chiu, Ping Fang

doi:10.1111/nep.13089

Cited by 46 publications

(19 citation statements)

References 23 publications

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“…Ni also causes direct damage to DNA, inhibits repair systems, and prevents methylation. It injures tissues through cytotoxicity, indirect damage (notably, to renal tubular epithelial cells), and immune dysregulation, processes known to accelerate renal disease and increase risk of ESRD through chronic exposures and repeat injury [29][30][31]. Still, surprisingly little is known about long-term effects of Ni on human kidneys or health status, and evidence regarding low-dose, repeat, or chronic exposure or in combination with other exposures, is lacking.…”

Section: Plos Onementioning

confidence: 99%

“…The kidney accumulates excess metal ions through reabsorption, and in the setting of repeat or chronic exposures, even when the exposure level is low, the potential for renal injury is considerable [32]. Once damaged, increased susceptibility to further insult can accelerate loss of renal mass and function, leading to rapidly progressing and severe disease [31,33]. In particular, the kidney is the primary target organ for Ni accumulation, and a link between Ni exposure and end-stage renal disease has already been described [25,31].…”

Section: Plos Onementioning

confidence: 99%

“…Once damaged, increased susceptibility to further insult can accelerate loss of renal mass and function, leading to rapidly progressing and severe disease [31,33]. In particular, the kidney is the primary target organ for Ni accumulation, and a link between Ni exposure and end-stage renal disease has already been described [25,31]. Ni exposed renal tissue reveals tubular injury with interstitial inflammation and focal damage concentrated at the corticomedullary junction [24,25] which is consistent with our findings on biopsy of acute MeN cases [14].…”

Section: Plos Onementioning

confidence: 99%

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Evidence of nickel and other trace elements and their relationship to clinical findings in acute Mesoamerican Nephropathy: A case-control analysis

et al. 2020

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Background Although there are several hypothesized etiologies of Mesoamerican Nephropathy (MeN), evidence has not yet pointed to the underlying cause. Exposure to various trace elements can cause the clinical features observed in MeN. Methods and findings We measured 15 trace elements, including heavy metals, in renal case-patients (n = 18) and healthy controls (n = 36) in a MeN high-risk region of Nicaragua. Toenails clippings from study participants were analyzed using inductively coupled plasma mass spectrometry. A case-control analysis was performed, and concentrations were also analyzed over participant characteristics and clinical parameters. Nickel (Ni) concentrations were significantly higher in toenails from cases (1.554 mg/kg [0.176–42.647]) than controls (0.208 mg/kg [0.055–51.235]; p<0.001). Ni concentrations correlated positively with serum creatinine levels (p = 0.001) and negatively with eGFR (p = 0.001). Greater Ni exposure was also associated with higher leukocyte (p = 0.001) and neutrophil (p = 0.003) counts, fewer lymphocytes (p = 0.003), and lower hemoglobin (p = 0.004) and hematocrit (p = 0.011). Conclusions Low-dose, chronic environmental exposure to Ni is a possible health risk in this setting. Ni intoxication and resulting systemic and renal effects could explain the clinical signs observed during early MeN. This study provides compelling evidence for a role of Ni in the acute renal impairment observed in this MeN high-risk population. Additional work to assess exposure levels in a larger and heterogeneous population, identify environmental sources of Ni and exposure pathways, and evaluate the link between Ni and MeN pathogenesis are urgently needed.

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Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

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Evidence of nickel and other trace elements and their relationship to clinical findings in acute Mesoamerican Nephropathy: A case-control analysis

et al. 2020

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“…Moreover, HD patients are more frequently exposed to erythropoietin, immunosuppressants and heavy metals during treatment or due to the nature of the underlying disease, all of which may be associated with carcinogenesis or the apoptosis of cells with damaged DNA and neoplastically transformed cells. These findings could, at least partially, explain the increased incidence of hematologic and lymphatic malignancies among patients undergoing HD …”

Section: Discussionmentioning

confidence: 94%

“…These findings could, at least partially, explain the increased incidence of hematologic and lymphatic malignancies among patients undergoing HD. 24,25 End-stage renal disease is associated with significant morbidity and mortality, and higher rates of cardiovascular complications have been reported in HD patients independently of traditional risk factors, such as hypertension, diabetes and dyslipidemia. 2 Compared to relatively young patients, older HD patients are more likely to die from other causes before developing malignancy.…”

Section: Discussionmentioning

confidence: 99%

Higher risk of malignant neoplasms in young adults with end‐stage renal disease receiving haemodialysis: A nationwide population‐based study

Pan

Sun

et al. 2019

Nephrology

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AimPrevious investigations have shown that end‐stage renal disease (ESRD) is associated with an increased risk of malignancies. The aim of this study was to explore the association between ESRD in patients undergoing maintenance haemodialysis (HD) and the incidence of malignancies according to age.MethodsWe analysed a nationwide cohort retrieved from Taiwan's National Health Insurance Research Database to study the incidence of malignancies in patients who were and were not receiving HD. One million beneficiaries were randomly selected and followed from 2005 to 2013. Of these 1 000 000 patients, 3055 developed ESRD and commenced maintenance HD during this period. For each HD patient, four age‐, gender‐ and diabetes‐matched controls were selected from the database (n = 12 220). We further stratified the patients according to age. The study endpoint was the occurrence of malignancy.ResultsThe incidence rates of malignancy were 6.8% and 4.9% in the HD and control groups, respectively. Competing risk regression analysis indicated that age, HD, male gender and diabetes were associated with an increased risk of malignancy. When further stratified according to age, the odds ratios of developing cancer were 5.8, 1.9, 1.9 and 1.5 among the HD patients aged <40 years, 40–49 years, 50–59 years and 60–69 years, respectively.ConclusionThe patients with ESRD who received HD had a significantly higher cumulative risk of malignancy, especially those with a young age. Therefore, specialized cancer screening protocols for young HD patients might help to prolong their lifespan.

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Medimetallomics and Clinimetallomics

Yin,

Li,

Zhao

et al. 2024

Applied Metallomics

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Prospective associations between environmental heavy metal exposure and renal outcomes in adults with chronic kidney disease

Abstract: Patients with CKD, with long-term exposure to soil-based heavy metals, had rapid progression to ESRD. Groups of minerals from the same source of contamination may accumulate and lead to additional harm.

Cited by 46 publications

References 23 publications

Evidence of nickel and other trace elements and their relationship to clinical findings in acute Mesoamerican Nephropathy: A case-control analysis

Evidence of nickel and other trace elements and their relationship to clinical findings in acute Mesoamerican Nephropathy: A case-control analysis

Higher risk of malignant neoplasms in young adults with end‐stage renal disease receiving haemodialysis: A nationwide population‐based study

Medimetallomics and Clinimetallomics

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