The association of urine arsenic with prevalent and incident chronic kidney disease: evidence from the Strong Heart Study.
The association of urine arsenic with prevalent and incident chronic kidney disease: evidence from the Strong Heart Study.
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DOI：
10.1097/ede.0000000000000313
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发表时间：
2015-07
期刊：
影响因子：
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通讯作者：
Navas-Acien A
中科院分区：
文献类型：
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作者：
Zheng LY;Umans JG;Yeh F;Francesconi KA;Goessler W;Silbergeld EK;Bandeen-Roche K;Guallar E;Howard BV;Weaver VM;Navas-Acien A
很少有研究评估低至中度砷水平与慢性肾脏疾病（CKD）之间的关系。目的是评估无机砷暴露与美国印第安成年人普遍和偶然CKD的关系。我们评估了参与强心脏研究（SHS）的3,851名年龄在45-74岁之间的美国印第安人的无机砷暴露与CKD的关系，并在横断面分析中评估了3,119名成年人的随访数据。在基线时测定尿液中的无机砷、一甲基膦酸盐和二甲基膦酸盐。CKD定义为eGFR≤60 mL/min/1.73m2，肾移植或透析。CKD患病率为10.3%。尿液中无机和甲基化砷（总砷）的中位数（IQR）浓度为9.7 (5.8,15.7)μg/L。在总砷含量的四分位数范围内，流行CKD的校正OR （95% CI）为0.7(0.6,0.8)，主要是由于与无机砷呈负相关（OR为0.4(0.3,0.4)）。调整无机砷后，单甲基膦酸盐和二甲基膦酸盐与流行的CKD呈正相关（OR 3.8和1.8）。ΣAs IQR中CKD发生的调整HR为1.2（1.03,1.41）。无机砷、一甲基膦酸盐和二甲基膦酸盐对应的HR分别为1.0（0.9、1.2）、1.2（1.00、1.3）和1.2（1.0、1.4）。尿无机砷与流行的CKD呈负相关，表明肾脏疾病影响无机砷的排泄。砷的种类与CKD的发生呈正相关。需要重复测量的研究来进一步表征砷与肾脏疾病发展之间的关系。
Few studies have evaluated associations between low to moderate arsenic levels and chronic kidney disease (CKD). The objective was to evaluate the associations of inorganic arsenic exposure with prevalent and incident CKD in American Indian adults. We evaluated the associations of inorganic arsenic exposure with CKD in American Indians who participated in the Strong Heart Study (SHS) in 3,851 adults aged 45–74 years in a cross-sectional analysis, and 3,119 adults with follow-up data in a prospective analysis. Inorganic arsenic, monomethylarsonate, and dimethylarsinate were measured in urine at baseline. CKD was defined as eGFR≤60 mL/min/1.73m2, kidney transplant or dialysis. CKD prevalence was 10.3%. The median (IQR) concentration of inorganic plus methylated arsenic species (total arsenic) in urine was 9.7 (5.8, 15.7) μg/L. The adjusted OR (95% CI) of prevalent CKD for an interquartile range in total arsenic was 0.7 (0.6, 0.8), mostly due to an inverse association with inorganic arsenic (OR 0.4 (0.3, 0.4)). Monomethylarsonate and dimethylarsinate were positively associated with prevalent CKD after adjustment for inorganic arsenic (OR 3.8 and 1.8). The adjusted HR of incident CKD for an IQR in ΣAs was 1.2 (1.03, 1.41). The corresponding HR for inorganic arsenic, monomethylarsonate and dimethylarsinate were 1.0 (0.9, 1.2), 1.2 (1.00, 1.3) and 1.2 (1.0, 1.4). The inverse association of urine inorganic arsenic with prevalent CKD suggests that kidney disease affects excretion of inorganic arsenic. Arsenic species were positively associated with incident CKD. Studies with repeated measures are needed to further characterize the relationship between arsenic and kidney disease development.