Urine tungsten and chronic kidney disease in rural Colorado.
Urine tungsten and chronic kidney disease in rural Colorado.
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DOI：
10.1016/j.envres.2021.110710
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发表时间：
2021-04
影响因子：
8.3
通讯作者：
James KA
中科院分区：
文献类型：
--
作者：
Fox J;Macaluso F;Moore C;Mesenbring E;Johnson RJ;Hamman RF;James KA
慢性肾脏病（CKD）是全球农业社区发病率和死亡率的一个原因。圣路易斯山谷（SLV）是科罗拉多南部的一个农村农业社区，具有CKD的地理和社会人口风险因素，包括受重金属污染的供水。我们从圣路易斯谷糖尿病研究（一项前瞻性队列研究）中获得了1659例受试者的预先存在的社会人口统计学、临床和尿微量金属数据。我们使用加速失效时间模型（n= 1，659）评估了尿钨（W）与CKD时间之间的前瞻性相关性。此外，使用逻辑模型评估尿W与肾损伤标志物（NGAL、KIM 1）之间的关系，使用Tobit回归（n=816），以及使用多元逻辑回归（n=620）评估流行病学定义的不明原因CKD（CKDu）。即使在控制高血压和糖尿病后，尿W升高与CKD发生时间缩短密切相关。根据CKD的定义，尿W加倍与5年内发生CKD的几率增加27%（95% CI 11%，46%）至31%（14%，51%）相关。尿W和选择的肾损伤标志物之间的关系并不显著，尽管尿NGAL被糖尿病状态改变。当校正已知的CKD危险因素时，尿W升高（> 95%ile）与CKDu显著相关（OR 5.93，1.83，19.21）。我们的数据表明，W暴露增加与CKD时间缩短相关，并可能与CKDu相关。考虑到在控制糖尿病和高血压后相关性的持续性，W可能对肾脏产生主要影响，尽管这需要在未来的研究中进一步评估。
Chronic kidney disease (CKD) is a cause of global morbidity and mortality in agricultural communities. The San Luis Valley (SLV) is a rural agricultural community in southern Colorado with geographic and sociodemographic risk factors for CKD, including a water supply contaminated by heavy metals. We obtained pre-existing sociodemographic, clinical, and urine trace metal data for 1659 subjects from the San Luis Valley Diabetes Study, a prospective cohort study. We assessed prospective associations between urine tungsten (W) and time-to-CKD using accelerated failure time models (n=1,659). Additionally, logistic models were used to assess relationships between urine W and renal injury markers (NGAL, KIM1) using Tobit regression (n=816), as well as epidemiologically-defined CKD of unknown origin (CKDu) using multiple logistic regression (n=620). Elevated urine W was strongly associated with decreased time-to-CKD, even after controlling for hypertension and diabetes. Depending on how CKD was defined, a doubling of urine W was associated with a 27% (95% CI 11%, 46%) to 31% (14%, 51%) higher odds of developing CKD within 5 years. The relationship between urine W and select renal injury markers was not significant, although urine NGAL was modified by diabetes status. Elevated (> 95%ile) urinary W was significantly associated with CKDu (OR 5.93, 1.83, 19.21) while adjusting for known CKD risk factors. Our data suggest that increased exposure to W is associated with decreased time-to-CKD and may be associated with CKDu. Given persistence of associations after controlling for diabetes and hypertension, W may exert a primary effect on the kidney, although this needs to be evaluated further in future studies.
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影响因子：
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作者：
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