Chronic kidney disease of uncertain aetiology: prevalence and causative factors in a developing country.
Chronic kidney disease of uncertain aetiology: prevalence and causative factors in a developing country.
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DOI：
10.1186/1471-2369-14-180
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发表时间：
2013-08-27
期刊：
影响因子：
2.3
通讯作者：
CKDu National Research Project Team
中科院分区：
文献类型：
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作者：
Jayatilake N;Mendis S;Maheepala P;Mehta FR;CKDu National Research Project Team
这项研究描述了病因不明的慢性肾脏疾病（CKDu），不能归因于糖尿病，高血压或其他已知的病因，已经出现在斯里兰卡的中北部地区。进行了一项横断面研究，以确定CKDu的患病率和危险因素。砷，镉，铅，硒，农药和其他元素进行了分析，从个人与CKDu的生物样本，并与流行和非流行地区的年龄和性别匹配的控制。对这两个地区的食物、水、土壤和农用化学品进行了重金属分析。CKDu的年龄标准化患病率在男性中为12.9%（95%置信区间[CI] = 11.5%至14.4%），在女性中为16.9%（95% CI = 15.5%至18.3%）。CKDu的严重阶段在男性中更常见（3期：男性与女性= 23.2%与7.4%; 4期：男性与女性= 22.0%与7.3%; P < 0.001）。年龄>39岁者和从事养殖（鹅膏蕈类）者的风险增加（OR [比值比]分别为1.926，95% CI = 1.561 ~ 2.376和1.195，95% CI = 1.007 ~ 1.418，P < 0.05）。男性和从事水稻种植的个体患病风险降低（OR = 0.745，95% CI = 0.562 ~ 0.988和OR = 0.732，95% CI = 0.542 ~ 0.988，P < 0.05）。尿镉平均浓度CKDu组（1.039 μg/g）显著高于病区对照组（0.646 μg/g，P < 0.001）和非病区对照组（0.345 μg/g，P < 0.05）。尿镉的敏感性和特异性分别为70%和68.3%（受试者工作特征曲线下面积= 0.682，95% CI = 0.61 ~ 0.75，临界值≥0.397 μg/g）。尿镉浓度与CKDu分期呈明显的剂量-效应关系（P < 0.05）。CKDu患者的尿镉和砷浓度处于已知会导致肾损伤的水平。来自流行地区的食品中镉和铅含量高于参考水平。63%的CKDu患者血清硒<90 μg/l，31.6%的CKDu患者血清中农药残留高于参考水平。这些结果表明，流行地区的人们通过食物链和农药长期暴露于低水平的镉。CKDu患者尿镉排泄量显著增加，尿镉浓度与CKDu分期呈剂量-效应关系，提示镉暴露是CKDu发病的危险因素。在CKDu患者中观察到的硒缺乏和遗传易感性表明，它们可能是CKDu发展的易感因素。
This study describes chronic kidney disease of uncertain aetiology (CKDu), which cannot be attributed to diabetes, hypertension or other known aetiologies, that has emerged in the North Central region of Sri Lanka. A cross-sectional study was conducted, to determine the prevalence of and risk factors for CKDu. Arsenic, cadmium, lead, selenium, pesticides and other elements were analysed in biological samples from individuals with CKDu and compared with age- and sex-matched controls in the endemic and non-endemic areas. Food, water, soil and agrochemicals from both areas were analysed for heavy metals. The age-standardised prevalence of CKDu was 12.9% (95% confidence interval [CI] = 11.5% to 14.4%) in males and 16.9% (95% CI = 15.5% to 18.3%) in females. Severe stages of CKDu were more frequent in males (stage 3: males versus females = 23.2% versus 7.4%; stage 4: males versus females = 22.0% versus 7.3%; P < 0.001). The risk was increased in individuals aged >39 years and those who farmed (chena cultivation) (OR [odds ratio] = 1.926, 95% CI = 1.561 to 2.376 and OR = 1.195, 95% CI = 1.007 to 1.418 respectively, P < 0.05). The risk was reduced in individuals who were male or who engaged in paddy cultivation (OR = 0.745, 95% CI = 0.562 to 0.988 and OR = 0.732, 95% CI = 0.542 to 0.988 respectively, P < 0.05). The mean concentration of cadmium in urine was significantly higher in those with CKDu (1.039 μg/g) compared with controls in the endemic and non-endemic areas (0.646 μg/g, P < 0.001 and 0.345 μg/g, P < 0.05) respectively. Urine cadmium sensitivity and specificity were 70% and 68.3% respectively (area under the receiver operating characteristic curve = 0.682, 95% CI = 0.61 to 0.75, cut-off value ≥0.397 μg/g). A significant dose–effect relationship was seen between urine cadmium concentration and CKDu stage (P < 0.05). Urine cadmium and arsenic concentrations in individuals with CKDu were at levels known to cause kidney damage. Food items from the endemic area contained cadmium and lead above reference levels. Serum selenium was <90 μg/l in 63% of those with CKDu and pesticides residues were above reference levels in 31.6% of those with CKDu. These results indicate chronic exposure of people in the endemic area to low levels of cadmium through the food chain and also to pesticides. Significantly higher urinary excretion of cadmium in individuals with CKDu, and the dose–effect relationship between urine cadmium concentration and CKDu stages suggest that cadmium exposure is a risk factor for the pathogensis of CKDu. Deficiency of selenium and genetic susceptibility seen in individuals with CKDu suggest that they may be predisposing factors for the development of CKDu.