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Association of environmental cadmium exposure with inflammation and malnutrition in maintenance haemodialysis patients.
Nephrol Dial Transplant. 2009 Apr; 24(4):1282-8.ND

Abstract

BACKGROUND

Chronic inflammation and malnutrition are associated with increased risk of cardiovascular death, and may cause protein-energy wasting in individuals with chronic kidney disease. Raised blood cadmium (Cd) levels were observed in maintenance haemodialysis (HD) patients in previous studies. However, the correlation of Cd exposure with inflammation and malnutrition remains uncertain. This study examined the possible adverse effects of environmental Cd exposure in maintenance HD patients.

METHODS

A total of 954 maintenance HD patients were enrolled and divided into four equal-sized groups based on blood Cd levels. Geographic, haematological, biochemical and dialysis-related data were obtained. The analysis included values for nutritional and inflammatory markers.

RESULTS

Abnormal blood Cd levels (> or =1 microg/L) were exhibited in 26.8% (256/954) of studied subjects. More subjects in the highest quartile group were malnourished (chi- square = 23.27; P < 0.0001) and had inflammatory changes (chi-square = 13.99; P = 0.0029) than in the lowest quartile group. Stepwise multiple regression analysis revealed a significant inverse correlation between serum albumin and blood Cd levels. Notably, a 10-fold increase in blood Cd levels was associated with a 0.06 g/dL decrease in serum albumin levels (P = 0.0060). Multivariate regression analysis also demonstrated a positive correlation between inflammatory risk (high-sensitivity C-reactive protein >3 mg/L) and blood Cd levels. The risk ratio of inflammation with a 10-fold increase in blood Cd levels was 1.388 (95% CI: 1.025-1.825, P = 0.0336).

CONCLUSIONS

Environmental Cd exposure is significantly associated with malnutrition, inflammation and even protein-energy wasting in maintenance HD patients. It is important for this population to avoid diets with high Cd concentrations and smoking.

Authors+Show Affiliations

Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, 199, Tung-Hwa North Road, Taipei, Taiwan, ROC.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19028751

Citation

Hsu, Ching-Wei, et al. "Association of Environmental Cadmium Exposure With Inflammation and Malnutrition in Maintenance Haemodialysis Patients." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 24, no. 4, 2009, pp. 1282-8.
Hsu CW, Lin JL, Lin-Tan DT, et al. Association of environmental cadmium exposure with inflammation and malnutrition in maintenance haemodialysis patients. Nephrol Dial Transplant. 2009;24(4):1282-8.
Hsu, C. W., Lin, J. L., Lin-Tan, D. T., Yen, T. H., Huang, W. H., Ho, T. C., Huang, Y. L., Yeh, L. M., & Huang, L. M. (2009). Association of environmental cadmium exposure with inflammation and malnutrition in maintenance haemodialysis patients. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 24(4), 1282-8. https://doi.org/10.1093/ndt/gfn602
Hsu CW, et al. Association of Environmental Cadmium Exposure With Inflammation and Malnutrition in Maintenance Haemodialysis Patients. Nephrol Dial Transplant. 2009;24(4):1282-8. PubMed PMID: 19028751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of environmental cadmium exposure with inflammation and malnutrition in maintenance haemodialysis patients. AU - Hsu,Ching-Wei, AU - Lin,Ja-Liang, AU - Lin-Tan,Dan-Tzu, AU - Yen,Tzung-Hai, AU - Huang,Wen-Hung, AU - Ho,Tai-Chin, AU - Huang,Yen-Lin, AU - Yeh,Li-Mei, AU - Huang,Lan-Mei, Y1 - 2008/11/21/ PY - 2008/11/26/pubmed PY - 2009/8/8/medline PY - 2008/11/26/entrez SP - 1282 EP - 8 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 24 IS - 4 N2 - BACKGROUND: Chronic inflammation and malnutrition are associated with increased risk of cardiovascular death, and may cause protein-energy wasting in individuals with chronic kidney disease. Raised blood cadmium (Cd) levels were observed in maintenance haemodialysis (HD) patients in previous studies. However, the correlation of Cd exposure with inflammation and malnutrition remains uncertain. This study examined the possible adverse effects of environmental Cd exposure in maintenance HD patients. METHODS: A total of 954 maintenance HD patients were enrolled and divided into four equal-sized groups based on blood Cd levels. Geographic, haematological, biochemical and dialysis-related data were obtained. The analysis included values for nutritional and inflammatory markers. RESULTS: Abnormal blood Cd levels (> or =1 microg/L) were exhibited in 26.8% (256/954) of studied subjects. More subjects in the highest quartile group were malnourished (chi- square = 23.27; P < 0.0001) and had inflammatory changes (chi-square = 13.99; P = 0.0029) than in the lowest quartile group. Stepwise multiple regression analysis revealed a significant inverse correlation between serum albumin and blood Cd levels. Notably, a 10-fold increase in blood Cd levels was associated with a 0.06 g/dL decrease in serum albumin levels (P = 0.0060). Multivariate regression analysis also demonstrated a positive correlation between inflammatory risk (high-sensitivity C-reactive protein >3 mg/L) and blood Cd levels. The risk ratio of inflammation with a 10-fold increase in blood Cd levels was 1.388 (95% CI: 1.025-1.825, P = 0.0336). CONCLUSIONS: Environmental Cd exposure is significantly associated with malnutrition, inflammation and even protein-energy wasting in maintenance HD patients. It is important for this population to avoid diets with high Cd concentrations and smoking. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/19028751/Association_of_environmental_cadmium_exposure_with_inflammation_and_malnutrition_in_maintenance_haemodialysis_patients_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfn602 DB - PRIME DP - Unbound Medicine ER -