Toxic Metals and Chronic Kidney Disease: a Systematic Review of Recent Literature
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Purpose of Review
Arsenic (As), cadmium (Cd), and lead (Pb) are ubiquitous toxicants with evidence of adverse kidney impacts at high exposure levels. There is less evidence whether environmental exposure to As, Cd, or Pb plays a role in development of chronic kidney disease (CKD). We conducted a systematic review to summarize the recent epidemiologic literature examining the relationship between As, Cd, or Pb with CKD.
We included peer-reviewed studies published in English between January 2013 and April 2018 for As and Cd, and all dates prior to April 2018 for Pb. We imposed temporality requirements for both the definition of CKD (as per NKF-KDOQI guidelines) and environmental exposures prior to disease diagnosis. Our assessment included cohort, case-control or cross-sectional study designs that satisfied 5 inclusion criteria. We included a total of eight articles of which three, two, and four studies examined the effects of As, Cd, or Pb, respectively.
Studies of As exposure consistently reported positive association with CKD incidence; studies of Pb exposure were mixed. We found little evidence of association between Cd exposure and CKD. Additional well-designed prospective cohort studies are needed and we present recommendations for future studies.
KeywordsArsenic Cadmium Lead Chronic kidney disease Glomerular filtration rate
Blood lead level
Body mass index
estimated Glomerular Filtration Rate
Systolic blood pressure
Chronic kidney disease of unknown etiology
End-stage renal disease
This work was supported in part by funding from the Mount Sinai Children’s Center Foundation and the NIH (K99ES027508 and T32HD049311).
Compliance with Ethical Standards
Conflict of Interest
Steven Coca reports personal fees from Quark Biopharma, personal fees from Goldfinch Bio, personal fees from Janssen Pharma, personal fees from Renalytix.AI, personal fees from pulseData, outside the submitted work. Emily C. Moody and Alison P. Sanders declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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