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Cadmium, type 2 diabetes, and kidney damage in a cohort of middle-aged women

Artikel i vetenskaplig tidskrift
Författare Lars Barregård
Göran Bergström
Björn Fagerberg
Publicerad i Environmental Research
Volym 135
Sidor 311-316
ISSN 0013-9351
Publiceringsår 2014
Publicerad vid Wallenberglaboratoriet
Institutionen för neurovetenskap och fysiologi, sektionen för fysiologi
Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för arbets-och miljömedicin
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 311-316
Språk en
Länkar dx.doi.org/10.1016/j.envres.2014.09...
Ämnesord Cadmium, Type 2 diabetes, Kidney, Albumin, Retinol-binding protein, Estimated glomerular filtration, GLOMERULAR-FILTRATION-RATE, URINARY CADMIUM, RENAL-FUNCTION, BLOOD, CADMIUM, SWEDISH WOMEN, POPULATION, EXPOSURE, ASSOCIATIONS, PERFORMANCE, PREVALENCE, Environmental Sciences, Public, Environmental & Occupational Health
Ämneskategorier Klinisk medicin

Sammanfattning

Background: It has been proposed that diabetic patients are more sensitive to the nephrotoxicity of cadmium (Cd) compared to non-diabetics, but few studies have examined this in humans, and results are inconsistent. Aim: To test the hypothesis that women with type 2 diabetes mellitus (DM) or impaired glucose tolerance (IGT) have higher risk of kidney damage from cadmium compared to women with normal glucose tolerance (NGT). Methods: All 64-year-old women in Gothenburg, Sweden, were invited to a screening examination including repeated oral glucose tolerance tests. Random samples of women with DM, IGT, and NGT were recruited for further clinical examinations. Serum creatinine was measured and used to calculate estimated glomerular filtration rate (eGFR). Albumin (Alb) and retinol-binding protein (RBP) were analyzed in a 12 h urine sample. Cadmium in blood (B-Cd) and urine (U-Cd) was determined using inductively coupled plasma mass spectrometry. Associations between markers of kidney function (eGFR, Alb, and RBP) and quartiles of B-Cd and U-Cd were evaluated in models, including also blood pressure and smoking habits. Results: The mean B-Cd (n=590) was 0.53 mu g/L (median 0.34 mu g/L). In multivariable models, a significant interaction was seen between high B-Cd (upper quartile, >0.56 mu g/L) and DM (point estimate +0.40 mg Alb/12 h, P=0.04). In stratified analyzes, the effect of high B-Cd on Alb excretion was significant in women with DM (53% higher Alb/12 h, P=0.03), but not in women with IGT or NGT. Models with urinary albumin adjusted for creatinine showed similar results. In women with DM, the multivariable odds ratio (OR) for microalbuminuria (>15 mg/12 h) was increased in the highest quartile of B-Cd vs. B-Cd quartiles 1-3 in women with DM (OR 4.2, 95% confidence interval 1.1-12). No such effect was found in women with IGT or NGT. There were no associations between B-Cd and eGFR or excretion of RBP, and no differences between women with DM, IGT, or NGT regarding effect of B-Cd on eGFR or RBP. Conclusion: The present study provides support for the hypothesis that women with DM have higher risk of renal glomerular damage from cadmium exposure compared to women without DM. (C) 2014 Elsevier Inc. All rights reserved.

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