A retrospective study on the relation between renal dysfunction and cadmium concentration in rice in individual hamlets in the Jinzu River basin, Toyama Prefecture, Japan

A 30-year follow-up study in a former cadmium-polluted area of Japan: the relationship between cadmium exposure and β2-microglobulin in the urine of Japanese people

Cadmium (Cd) is an environmental pollutant. Long-term exposure to Cd may lead to adverse health effects in humans. Our epidemiological studies showed that urinary Cd (U-Cd) concentrations increased from 2008 through 2014, although they decreased from 1986 through 2008. The aim of this study was to elucidate the long-term effects of the changing trend of cadmium exposure levels (U-Cd) on residents' renal function within 30 years after Cd exposure ceased. In 2016, urine samples were collected from each subject by visiting 20 elderly Japanese people (9 females and 11 males) living in the Kakehashi River basin, a previously Cd-polluted area in Ishikawa, Japan. The geometric means of the β₂-microglobulin (β₂-MG) and urinary Cd (U-Cd) continued to increase from 2014 until 2016. Furthermore, Cd concentration and β₂-MG in urine were still higher than those in the non-polluted areas in Japan. Multivariate linear regression was performed to associate β₂-MG (dependent variable) and U-Cd with sex and age (independent variables). Significant correlations were found among age, U-Cd, and β₂-MG, and these were clearer in females than in males. In summary, we propose that three decades after Cd exposure ceased, age is associated with β₂-MG more strongly than Cd for bodily impact. Moreover, renal tubular dysfunction is irreversible and worsens after exposure to Cd, with females being more sensitive to exposure.

Relationship between mortality and rice cadmium concentration in inhabitants of the polluted Jinzu River basin, Toyama, Japan: A 26 year follow-up

The aim of this study was to investigate the relationship between mortality and rice cadmium (Cd) concentration in inhabitants of a polluted area in Japan. The target subjects were inhabitants of the Jinzu River basin who participated in health examinations for screening of renal dysfunction from 1979 to 1984. The mean rice Cd concentration in each hamlet was used as an index of the Cd exposure. We conducted a 26 year follow-up survey in 3281 inhabitants (1544 men and 1737 women) whose data regarding the rice Cd concentration were available. Mortality risk ratios for all and specific causes were estimated after adjustments for age at baseline, smoking status and history of hypertension using a Cox hazard model or Fine and Gray competing risks regression model. The mortality risk ratios of rice Cd concentration (+0.1 ppm) for all causes in women were significantly increased (risk ratio: 1.04). Furthermore, the relative risks of rice Cd concentration for kidney and urinary tract disease, renal diseases, renal failure and toxic effects of cadmium were significantly increased in both sexes. These findings indicated that increased rice Cd concentration decreased the prognosis for life over a long-term observation in women. This result provides important information for determining the worldwide standard for allowable rice Cd concentration.

Analyzing the role of soil and rice cadmium pollution on human renal dysfunction by correlation and path analysis

The aim of this study was to investigate the role of soil and rice pollution on human renal dysfunction. The participants were 97 inhabitants (46 men and 51 women) who are aged 50 to 60 years old and have been living in Xiaogan (Hubei, China) from birth. We collected samples of soil, rice, and urinary correspondingly. Urinary N-acetyl-β-D-glucosaminidase (NAG) and β-2-microglobulin (β₂MG) were used as indicators of renal dysfunction, and urinary cadmium (U-Cd) was used as indicator of total internal cadmium exposure. We made a hypothesis that soil cadmium concentration (S-Cd) and rice cadmium concentration (R-Cd) could be used as indicators of environmental cadmium exposure. Correlation and path analysis were used to estimate the relationships among the levels of rice cadmium (R-Cd), soil cadmium (S-Cd), urinary cadmium (U-Cd), and renal damage indicators (NAG and β₂MG). Our results showed that there was positive significant relationship between S-Cd (R-Cd, U-Cd), and U-NAG (U-β₂MG). The standard multiple regression describing the relationship between S-Cd (R-Cd, U-Cd) and U-NAG was Y₁ = 1.26X₁-6.53X₂ + 9.32, where Y is U-NAG, X₁ is U-Cd, X₂ is S-Cd. The equation of U-β₂MG was Y = 49.32X₁ + 3085.99X₂ + 143.42, where Y is U-β₂MG, X₁ is U-Cd, X₂ is R-Cd. It is obvious that the effect of S-Cd and R-Cd on NAG or U-β₂MG cannot be ignored. Through our study, we can find that the effects of S-Cd on renal health even as significant as R-Cd. To protect people from the damage of cadmium pollution, it is vital to monitor the situation of soil and rice cadmium pollution.

Estimation of Benchmark Dose of Lifetime Cadmium Intake for Adverse Renal Effects Using Hybrid Approach in Inhabitants of an Environmentally Exposed River Basin in Japan

The aim of this study is to estimate the reference level of lifetime cadmium intake (LCd) as the benchmark doses (BMDs) and their 95% lower confidence limits (BMDLs) for various renal effects by applying a hybrid approach. The participants comprised 3,013 (1,362 men and 1,651 women) and 278 (129 men and 149 women) inhabitants of the Cd-polluted and nonpolluted areas, respectively, in the environmentally exposed Kakehashi River basin. Glucose, protein, aminonitrogen, metallothionein, and β₂ -microglobulin in urine were measured as indicators of renal dysfunction. The BMD and BMDL that corresponded to an additional risk of 5% were calculated with background risk at zero exposure set at 5%. The obtained BMDLs of LCd were 3.7 g (glucose), 3.2 g (protein), 3.7 g (aminonitrogen), 1.7 g (metallothionein), and 1.8 g (β₂ -microglobulin) in men and 2.9 g (glucose), 2.5 g (protein), 2.0 g (aminonitrogen), 1.6 g (metallothionein), and 1.3 g (β₂ -microglobulin) in women. The lowest BMDL was 1.7 g (metallothionein) and 1.3 g (β₂ -microglobulin) in men and women, respectively. The lowest BMDL of LCd (1.3 g) was somewhat lower than the representative threshold LCd (2.0 g) calculated in the previous studies. The obtained BMDLs may contribute to further discussion on the health risk assessment of cadmium exposure.

Oxidative Stress and Cardiovascular Dysfunction Associated with Cadmium Exposure: Beneficial Effects of Curcumin and Tetrahydrocurcumin

Cadmium (Cd) is a non-essential heavy metal with high toxicity potential. Humans are exposed to Cd present in diet, polluted air, and cigarette smoke. Cd exposure has been associated with increased risk of chronic diseases, including hypertension, atherosclerosis, diabetes, and nephropathy, all of which could be attributable to dysfunctional endothelial and smooth muscle cells. Cd toxicity is correlated with increased reactive oxygen formation and depletion of antioxidants, resulting in an oxidative stress. Chelation of Cd has proved useful in the removal of the Cd burden. However, several chelating agents cause side effects in clinical usage. Recent studies have shown that the antioxidant compounds curcumin and tetrahydrocurcumin can alleviate vascular dysfunction and high blood pressure caused by Cd toxicity. In chronic Cd exposure, these antioxidants protect vascular endothelium by increasing nitric oxide (NO•) bioavailability and improving vascular function. Antioxidant activity against Cd intoxication results directly and/or indirectly through free radical scavenging, metal chelation, enhanced expression of the antioxidant defense system, regulation of inflammatory enzymes, increase in NO• bioavailability, and reduction of gastrointestinal absorption and tissue Cd accumulation. This review summarizes current knowledge of Cd-induced oxidative stress and cardiovascular dysfunction and a possible protective effect conferred by the antioxidants curcumin and tetrahydrocurcumin.

Potential for effects of land contamination on human health. 1.The case of cadmium

A review of the epidemiological literature on the potential effects of land contamination shows that the largest body of contaminant-specific research relates to cadmium (Cd). First, a brief outline of the key issues related to the study of health impact of land contamination is presented. The recent literature is then reviewed for evidence of associations and possible causal relationships between exposure to Cd from land contamination and health impact. A large number of studies focusing on Cd arise because of the ready availability of biomarkers of exposure and effect and the demonstrated link between soil Cd and itai-itai disease (severe renal and bone disorders) via dietary exposure in Japan and China. Where dietary differences yield lower exposures, links have been established between Cd in soil and biomarkers of renal or bone dysfunctions, but not to health impacts per se. Potential effects of Cd exposure were also investigated for other health outcomes, including hypertension, cancer incidence, preterm delivery, and semen parameters. In contrast to renal and bone disorders, results are generally inconsistent and require further lines of evidence. Residence in locations with elevated concentrations of Cd in soil is a poor surrogate for exposure, and there are examples where residents in locations with elevated concentrations of Cd in soil did not appear to suffer serious health consequences.

Biochemical changes in urine and plasma of rats in food chain-mediated cadmium toxicity

The present study sets out to assess the toxicity of cadmium (Cd) administered via the food chain. The food chain was mimicked by exposing rats to diet containing milled Cd-exposed catfish as the source of protein. The toxicity of Cd was monitored by the determination of indices of oxidative stress and kidney dysfunction in plasma and urine of the rats after 1- and 3-month exposure periods. The results obtained indicate that Cd exposure in the rats was followed by marked accumulation of the metal in the liver and kidney with time. However, the kidney accumulated more Cd relative to the liver after both exposure periods. The levels of glucose, creatinine and lipid peroxidation were significantly (p < 0.05) increased in both plasma and urine of the rats after 1 month of exposure. Conversely, rats fed the test diet for 3 months had significantly (p < 0.05) decreased level of lipid peroxidation in the plasma and urine. However, the plasma and urine glucose concentrations were restored to levels not significantly (p > 0.05) different from control in rats fed the test diet for 3 months. Similarly, after 3 months, the creatinine level in the plasma was also restored to a level not significantly (p > 0.05) different from that of the control but was significantly (p < 0.05) elevated in the urine. A significant increase in urine protein concentration was demonstrated after 1-month exposure to Cd, but no significant change occurred in the plasma. Rats fed diet containing the Cd-incorporated fish for 3 months also had no significant (p > 0.05) change in plasma and urine protein concentrations. These results suggest that this route of exposure caused kidney impairment, oxidative stress as well as alteration in glucose metabolism after 1 month but not after 3 months, possibly due to adaptation occasioned by the antioxidative defense armory of the rats.

Chronic renal failure in Sri Lanka caused by elevated dietary cadmium: Trojan horse of the green revolution

The endemic of chronic renal failure (CRF) emerged in 2002 in the farming provinces of Sri Lanka. An estimate of dietary cadmium intake was between 15 and 28 μg/kg body weight per week. The mean urinary cadmium in patients diagnosed with stage 5 kidney failure was 7.6 μg/g creatinine and 11.6 μg/g for asymptomatic persons. The agrochemical triple superphosphate (TSP) fertilizer containing 23.5–71.7 mg Cd/kg was the source of cadmium added to soils. Mean Cd content in cultivated vs. uncultivated soils in Anuradhapura district was 0.02 ± 0.01 vs. 0.11 ± 0.19 mg/kg while in Polonnaruwa district, it was 0.005 ± 0.004 vs. 0.016 ± 0.005 mg/kg. Prior to the Green Revolution, the amount of fertilizer used in rice cultivation in 1970 was 32,000 metric tons (Mts) rising to 74,000 Mts in 1975. Up to 68.9 Mts of Cd could have entered into the rice-cascade reservoir environment from TSP use since 1973. Diversion of the Mahaweli River in 1970–1980 further increased cadmium input. Cadmium transfer from Upper Mahaweli water to Polgolla was 72.13 kg/day. Cadmium content of the sediments from reservoirs collecting cadmium from irrigated TSP fertilized crop fields (rice and vegetables) was 1.8–2.4 mg/kg.

Recent applications of benchmark dose method for estimation of reference cadmium exposure for renal effects in man

The initial sign of cadmium (Cd)-induced renal effects is tubular damage, followed by glomerular damage. For the prevention of Cd-induced renal effects, it is essential to establish the reference exposure below which the risk of adverse health effects is low. In earlier Japanese studies, the estimated reference exposure of creatinine (cre)-adjusted urinary cadmium for renal tubular effect ranged from 1.6 to 4.0 microg/g cre in men and 2.3 to 4.6 microg/g cre in women. The benchmark dose (BMD) is defined as the exposure that corresponds to a certain response change from the background. The lower 95% confidence limit of the BMD (BMDL) can be used in risk assessment as a replacement for the no observed adverse effect level. This is a review of all relevant BMDL of Cd exposure for renal effects estimated so far. Based on studies in Japan, the best estimate is considered to be 1.5-3.2 microg/g cre for urinary Cd, 0.09-0.13 mg/kg for rice Cd concentration, and 0.9-1.4 g Cd for lifetime Cd intake. These BMDLs for renal effects were generally lower than the reference exposure expected from earlier studies, indicating the importance of further discussion regarding comprehensive measures to decrease the Cd exposure in the general population.

Estimation of benchmark rice cadmium doses as threshold values for abnormal urinary findings with adjustment for consumption of Jinzu River water

We performed this study to determine whether both eating cadmium (Cd)-polluted rice and drinking and/or cooking with Jinzu River water are associated with renal tubular dysfunction. A multiple logistic regression analysis of retrospective data indicated that both factors may contribute to this condition. Estimated threshold values of rice Cd concentration in men were 0.13-0.27 ppm and 0.09-0.18 ppm in women, without adjustment for use of Jinzu River water. The additional influence of drinking and/or cooking with Jinzu River water was estimated to be about 0.008 ppm.

Influence of consumption of cadmium-polluted rice or Jinzu River water on occurrence of renal tubular dysfunction and/or Itai-itai disease

The aim of this study was to clarify whether consumption of cadmium (Cd)-polluted rice or Jinzu River water exerted any influence on the occurrence of renal tubular dysfunction and/or Itai-itai disease. From the participants of health examinations conducted in 1967 and 1968, 3,078 subjects who had resided for >30 years in the present hamlet and were aged >50 years were selected as the target population and were divided according to their residence in 55 hamlets. In a multiple regression analysis, the regression coefficients between rice-Cd concentration and prevalence of abnormal urinary findings (proteinuria, glucosuria, or proteinuria with glucosuria) or patients with Itai-itai disease were statistically significant between both sexes. The correlation between the prevalence of users of Jinzu River water and the occurrence of glucosuria in men as well as abnormal urinary findings in women was not statistically significant. We surmise that eating Cd-polluted rice and drinking and/or cooking with Jinzu River water influenced the occurrence of Itai-itai disease. The occurrence of renal tubular dysfunction is likely to have also been influenced by both factors, with eating Cd-polluted rice having a greater impact on the occurrence of renal tubular dysfunction as compared to drinking and/or cooking with Jinzu River water.

Influence of drinking and/or cooking with Jinzu River water on the development of Itai-itai disease

This study was undertaken to estimate the amount of cadmium (Cd) exposure needed for the development of Itai-itai disease and the influence of using Jinzu River water for drinking and/or cooking on its development. The subjects comprised 38 Itai-itai disease patients admitted both for questionnaire survey and medical testing. The period when the patients started to perceive leg/back pain was defined as 'mild disease onset' and that when they experienced the most severe manifestations such as ambulatory disturbance as 'severe disease onset'. In a comparison of non-users/users of river water, mean age and lifetime Cd intake (LCd) estimated from the daily consumption of rice and other foods at the onset of mild or severe disease showed smaller values in the users than non-users. LCd in non-users/users of river water for drinking and/or cooking were estimated as 3.46-3.60 g/2.58-2.63 g at mild disease onset and 4.24-4.44 g/3.50-3.54 g at severe disease onset. A portion of the differences in LCd in non-users/users is attributable to the influence of Cd consumption from the use of river water, although it was suggested that LCd estimated from eating Cd-polluted rice exerted a greater influence on the development of Itai-itai disease than drinking and/or cooking with Cd-polluted river water.

Investigation of renal damage among residents in the cadmium-polluted Jinzu River basin, based on health examinations in 1967 and 1968

The purpose of this study was to investigate the prevalence of renal disorders in the Jinzu River basin in Toyama Prefecture, Japan where Itai-itai disease was endemic, based on the results of epidemiological studies performed in 1967 and 1968. Furthermore, was there a regional accumulation of the prevalence of abnormal urinary findings in that area? Early morning urine samples were collected from 13 183 subjects (6155 men, 7028 women) who then responded to questionnaires about lifestyle and health. The subject participation rate was 90%. Our findings showed that subjects living in the area of the Jinzu River basin have significantly higher prevalence of abnormal urinary findings compared to subjects living in neighboring river basins and these geographical distributions demonstrated a definite regional accumulation in those areas. The findings of this study verified the regional accumulation of renal disorders in the Jinzu River basin and indicate an association of the occurrence of renal disorders with the water from the Jinzu River.

Correlation among cadmium levels in river sediment, in rice, in daily foods and in urine of residents in 11 prefectures in Japan

OBJECTIVE

The objective of this study is to examine if overall correlation exists among cadmium levels (Cd) in the general environment, dietary Cd intake, and Cd body burden of local residents.

METHODS

Eleven prefectures in Japan were selected as the areas where large-scale data on Cd levels in urine of adult women (40-49 and 50-59 years of age, respectively) were available to calculate geometric mean (GM) values for each of the prefecture. Other data were cited from published or previously established databases on Cd in the sediments of river bottoms (as a representative of Cd in the environment), Cd in rice for local consumption, and Cd in daily food duplicate samples collected from local women populations, and calculated for GM values for the prefectures. The GM values were subjected to correlation matrix and regression analysis.

RESULTS

Marginally significant (P < 0.10) correlation was detected between Cd in sediment and Cd in rice. Furthermore, correlation of Cd in sediment was significant with Cd in total foods (P < 0.05) and possibly with Cd in urine (P < 0.05-0.10). Importance of data on Cd in rice paddy soil as a missing link is discussed.

CONCLUSIONS

Correlation was demonstrated in the flow of Cd transport from the environment (expressed as Cd contents in river sediments) to humans (in terms of Cd in urine) among general populations in Japan.

Estimation of cumulative cadmium intake causing Itai-itai disease

This study was undertaken to estimate the amount of cadmium (Cd) exposure needed for the development of Itai-itai disease. The investigated subjects comprised 82 Itai-itai disease patients and 11 persons requiring observation who were admitted in 1977 and 1978 for medical testing. With the period when the Itai-itai disease patients started to perceive leg/back pain defined as the 'mild disease onset', and the period when they experienced the most severe manifestations such as ambulatory disturbance and bone fractures defined as 'severe disease onset'. Relative cumulative person number distribution according to life time cadmium intake (LCD) at mild disease onset, severe disease onset, and time of death was depicted as an sigmoid curve and the establishment of probit regression lines was demonstrated between them. LCD at the time when mild disease onset and severe disease onset were recognized in half of the Itai-itai disease patients was 3.1 and 3.8 g, respectively. Furthermore, LCD at the time when mild disease onset and severe disease onset were recognized in 5% of the Itai-itai disease patients was calculated to be 2.6 and 3.3 g, respectively. The present results clarify that Itai-itai disease, the most severe stage of chronic Cd poisoning, occurs at levels of Cd consumption amounting to approximately three-fold of those currently seen in Japan.

Dietary exposure to cadmium at close to the current provisional tolerable weekly intake does not affect renal function among female Japanese farmers

Dietary cadmium (Cd) exposure and renal tubular function were investigated in 1381 female farmers from five districts in Japan (Japanese Multi-centered Environmental Toxicant Study project; JMETS). Dietary Cd exposure of the five populations was assessed from the individual Cd concentrations of the rice consumed by the study participants and the quantities of rice consumed daily. The populations showed a sequential difference in dietary Cd exposure, ranging from a level as low as that of the general Japanese population to one close to the current provisional tolerable weekly intake (PTWI). The levels of urinary Cd excretion, an indicator of Cd accumulation in the kidneys, increased along the same sequential pattern as dietary Cd exposure. However, no differences were observed among the populations in levels of urinary alpha 1-microglobulin and beta 2-microglobulin excretion, which are indicators of renal tubular function. These results indicate that the current PTWI is sufficient to prevent Cd-induced renal dysfunction among the general population.

Determination of trace cadmium in rice by flow injection on-line filterless precipitation-dissolution preconcentration coupled with flame atomic absorption spectrometry

A simple, environmentally friendly, cost-effective, and sensitive method was developed for the determination of trace cadmium in rice by flow injection (FI) on-line precipitation preconcentration coupled with flame atomic absorption spectrometry (FAAS). The precipitation preconcentration of trace cadmium was achieved by on-line merging of the sample and ammonia solutions. The resultant precipitates were on-line collected by a knotted reactor (KR) without filtration. A solution of 1 mol L(-1) HNO(3) was employed to dissolve the collected precipitates and to deliver the analyte into the FAAS system for on-line detection. Preconcentration at a sample loading flow rate of 3.8 mL min(-1) for 35 s gave an enhancement factor of 44 and a detection limit (3sigma) of 0.002 microg g(-1) for the solid sample with a sample throughput of 72 h(-1). The precision (RSD, n = 11) was 2.0% at the 4.0 microg L(-1) level. The concentration of cadmium in a certified reference material (GBW 08511, rice flour) by the developed method using simple aqueous standards for calibration was in good agreement with the certified value. The proposed method was also successfully applied to the determination of trace cadmium in locally collected rice samples.

Dose-response relationship between total cadmium intake calculated from the cadmium concentration in rice collected from each household of farmers and renal dysfunction in inhabitants of the Jinzu River basin, Japan

The association between total cadmium (Cd) intake and abnormal urinary findings was investigated in the Cd-polluted Jinzu River basin. In 1967 and 1968 the most systematic and large-scale health examinations were conducted among the entire population aged over 30 years of this region. We performed this study by targeting the subjects participating in the 1967 health survey conducted mainly in the heavily polluted area. From subjects who had eaten household rice of known Cd concentration, 1,075 inhabitants who had either resided in their current household since birth or who had moved there from a non-polluted area (group A), and 780 inhabitants who had resided in the current household since birth (group B), were selected as the target population. The total Cd intake for each person was calculated from the Cd dose ingested from rice and other foods. Logistic regression analysis was performed using the prevalence of abnormal urinary findings (proteinuria, glucosuria and proteinuria with glucosuria) as the criterion variable and the total Cd intake and age as explanatory variables. In subjects of groups A and B the odds ratios became higher as the dose of total Cd intake increased. Odds ratios in subjects of group A were statistically significant except for glucosuria of men and proteinuria of women. In subjects of group B the odds ratios were also significant for proteinuria + glucosuria of men and glucosuria of women. It was demonstrated that the greater the increase in total Cd intake, the greater the increase in abnormal urinary findings in the Jinzu River basin, and the association of the two factors was very close.

Association between total cadmium intake calculated from the cadmium concentration in household rice and mortality among inhabitants of the cadmium-polluted Jinzu River basin of Japan

A follow-up survey was conducted to investigate the relationship between total Cd intake and mortality in the Jinzu River basin for 6128 days among 757 inhabitants who ingested household rice. When the subjects were divided into two groups, standardized mortality ratios (SMRs) were 0.94 in men and 1.36 in women for the > or = 2.0 g group and 0.68 in men and 0.29 in women for the <2.0 g group (significant in the women). Cox's hazard ratios for men, women, and men+women for the > or = 2.0 g group relative to those in the <2.0 g group were 1.406, 3.955 and 1.950 (significant in the men+women). Using total Cd intake as a continuous variable, the hazard ratios were 1.045, 1.146 and 1.049 in men, women, and men+women (significant in the women), respectively. In the Jinzu River basin, increased total Cd intake appears to exert an adverse influence on life prognosis.

Relationship between cadmium concentration in rice and renal dysfunction in individual subjects of the Jinzu River basin determined using a logistic regression analysis

We investigated the association between the Cd concentration in rice and renal dysfunction in individuals living in the Cd-polluted Jinzu River basin, using a logistic regression analysis. In the cases of logistic regression analysis for people (1) who had either resided in the present hamlet since birth or who had moved there from a non-polluted area and for those (2) who had resided in the present hamlet since birth, except for glucosuria in males, all partial correlation coefficients between the Cd concentration in rice and occurrence of abnormal urinary findings were statistically significant in both sexes. The allowable level of Cd concentration in rice was calculated by substituting the abnormality rates of urinary findings of the controls in the 40-49, 50-59 and 60-69 year age groups into the logistic regression formula for people (3). The value for subjects aged 50 years was 0.13 and 0.17 ppm for males and females, respectively, with regard to proteinuria and 0.15 and 0.10 ppm for males and females, respectively, with regard to proteinuria+glucosuria.

Association between renal dysfunction and mortality among inhabitants in the region around the Jinzu River basin polluted by cadmium

A follow-up study was conducted on 5725 inhabitants (men 2858, women 2867) in and around the Jinzu River basin to determine the influence of environmental Cd exposure on mortality. In the Jinzu River basin, standardized mortality ratios (SMRs) investigated according to urinary findings (protein, glucose, and protein+glucose) were significantly low in the urinary protein-, glucose-, and protein+glucose-negative groups. SMRs calculated after dividing urinary protein- and glucose-positive status into two levels were lowest in the proteinuria- and glycosuria-negative groups and tended to be high in the higher positive groups. In the Jinzu River basin, Cox's hazard ratios were significantly higher for men and women in the urinary protein, glucose and protein+glucose-positive-groups. In the same analysis where the urinary protein- and glucose-positive subjects were divided into two levels, mortality was demonstrated to be higher in the groups with the greater degrees of proteinuria and glycosuria. In the Jinzu River water system almost all SMRs and Cox's hazard ratios showed statistical significance. This was not the case in the other water systems. Mortality of inhabitants with Cd-induced renal injury is increased in the Jinzu River basin.