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Sotomayor CG, Giubergia F, Groothof D, Ferreccio C, Nolte IM, Navis GJ, Gomes-Neto AW, Kremer D, Knobbe TJ, Eisenga MF, Rodrigo R, Touw DJ, Bakker SJL. Plasma Lead Concentration and Risk of Late Kidney Allograft Failure: Findings From the TransplantLines Biobank and Cohort Studies. Am J Kidney Dis 2022; 80:87-97.e1. [PMID: 34871698 DOI: 10.1053/j.ajkd.2021.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Heavy metals are known to induce kidney damage, and recent studies have linked minor exposures to cadmium and arsenic with increased risk of kidney allograft failure, yet the potential association of lead with late graft failure in kidney transplant recipients (KTRs) remains unknown. STUDY DESIGN Prospective cohort study in The Netherlands. SETTING & PARTICIPANTS We studied outpatient KTRs (n = 670) with a functioning graft for ≥1 year recruited at a university setting (2008-2011) and followed for a median of 4.9 (interquartile range, 3.4-5.5) years. Additionally, patients with chronic kidney disease (n = 46) enrolled in the ongoing TransplantLines Cohort and Biobank Study (2016-2017, ClinicalTrials.gov identifier NCT03272841) were studied at admission for transplant and at 3, 6, 12, and 24 months after transplant. EXPOSURE Plasma lead concentration was log2-transformed to estimate the association with outcomes per doubling of plasma lead concentration and also considered categorically as tertiles of lead distribution. OUTCOME Kidney graft failure (restart of dialysis or repeat transplant) with the competing event of death with a functioning graft. ANALYTICAL APPROACH Multivariable-adjusted cause-specific hazards models in which follow-up of KTRs who died with a functioning graft was censored. RESULTS Median baseline plasma lead concentration was 0.31 (interquartile range, 0.22-0.45) μg/L among all KTRs. During follow-up, 78 (12%) KTRs experienced graft failure. Higher plasma lead concentration was associated with increased risk of graft failure (hazard ratio, 1.59 [95% CI, 1.14-2.21] per doubling; P = 0.006) independent of age, sex, transplant characteristics, estimated glomerular filtration rate, proteinuria, smoking status, alcohol intake, and plasma concentrations of cadmium and arsenic. These findings remained materially unchanged after additional adjustment for dietary intake and were consistent with those of analyses examining lead categorically. In serial measurements, plasma lead concentration was significantly higher at admission for transplant than at 3 months after transplant (P = 0.001), after which it remained stable over 2 years of follow-up (P = 0.2). LIMITATIONS Observational study design. CONCLUSIONS Pretransplant plasma lead concentrations, which decrease after transplant, are associated with increased risk of late kidney allograft failure. These findings warrant further studies to evaluate whether preventive or therapeutic interventions to decrease plasma lead concentration may represent novel risk-management strategies to decrease the rate of kidney allograft failure.
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Affiliation(s)
- Camilo G Sotomayor
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Program of Integrative Biology, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile; Radiology Department, Clinical Hospital University of Chile, University of Chile, Santiago, Chile.
| | - Flavia Giubergia
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Dion Groothof
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ilja M Nolte
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antonio W Gomes-Neto
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim J Knobbe
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F Eisenga
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Daan J Touw
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Fang CW, Ning HC, Huang YC, Chiang YS, Chuang CW, Wang IK, Fan NC, Weng CH, Huang WH, Hsu CW, Yen TH. Trend in blood lead levels in Taiwanese adults 2005-2017. PLoS One 2021; 16:e0260744. [PMID: 34855854 PMCID: PMC8638909 DOI: 10.1371/journal.pone.0260744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
This study examined the trend of blood lead levels (BLLs) in Taiwanese adults and analyzed the variations in the BLL between Linkou (northern) and Kaohsiung (southern) hospital branches. Between 2005 and 2017, 3,804 adult participants received blood lead tests at the Linkou (n = 2,674) and Kaohsiung (n = 1,130) branches of Chang Gung Memorial Hospital. The geometric mean of BLL was 2.77 μg/dL. The adult participants from the Kaohsiung branch were not only age older (49.8±14.1 versus 39.4±14.2 years; P<0.001) and male predominant (65.8 versus 41.7%; P<0.001) but also showed a higher BLL (4.45±3.93 versus 2.82±2.42 μg/dL; P<0.001) and lower estimated glomerular filtration rate (87.62±25.94 versus 93.67±23.88; P<0.001) than those from the Linkou branch. Multivariable logistic regression analysis revealed that the Kaohsiung branch [odds ratio (OR): 7.143; 95% confident interval (CI): 5.682–8.929; P<0.001], older age (OR: 1.008; 95% CI: 1.000–1.015; P = 0.043) and reduced estimated glomerular filtration rate (OR: 1.009; 95% CI: 1.004–1.014; P = 0.001) were significant predictors for BLL > 5 μg/dL. Therefore, this study confirmed a continuous decreasing trend in the BLL in Taiwan after banning leaded petrol in 2000.
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Affiliation(s)
- Chun-Wan Fang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Linkou, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Chen Ning
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Research and Development, Chang Gung Memorial Hospital, Taoyuan, Linkou, Taiwan
| | - Ya-Ching Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Linkou, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shao Chiang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chun-Wei Chuang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Linkou, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Nai-Chia Fan
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hao Weng
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Hung Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Wei Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tzung-Hai Yen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
- * E-mail:
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Chen J, Wang N, Yuan Y, Zhang W, Xia F, Chen B, Dong R, Lu Y. Blood lead, nutrient intake, and renal function among type 2 diabetic patients. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:49063-49073. [PMID: 33939087 DOI: 10.1007/s11356-021-13623-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
Lead (Pb) exposure has been reported to have nephrotoxicity. However, such an effect has not been well investigated in type 2 diabetes (T2D) patients, especially when taking into account the nutrition status of the patients. Therefore, we explore the association between blood lead levels (BLLs), dietary intake of nutrients, and impaired renal function among patients with T2D. We measured BLLs and biochemical parameters of renal injury in 780 patients. Dietary nutrients intake was assessed by a food frequency questionnaire in 420 of 780 participants. We found high BLLs were significantly associated with certain parameters of renal injury, and dietary intake of specific nutrients (mainly micronutrients) was associated with reduced BLLs at high percentile distribution of concentration. BLLs were also found to have moderation effects on the association between specific dietary nutrients and specific renal function parameters.
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Affiliation(s)
- JingSi Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - NingJian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yaqun Yuan
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - FangZhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Bo Chen
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - RuiHua Dong
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - YingLi Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Heavy Metal Toxicity in Chronic Renal Failure and Cardiovascular Disease: Possible Role for Chelation Therapy. Cardiol Rev 2021; 28:312-318. [PMID: 32040019 DOI: 10.1097/crd.0000000000000304] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Exposure to heavy metals is common. This exposure is related to environmental contamination of air, water and soil, occupational exposure, accumulation in food, tobacco, and other factors. Cadmium and lead are notable for their widespread contamination, long-lasting effects in the body, and renal as well as cardiovascular toxicity. Acute toxicity due to high-level exposure, as well as chronic low-level exposure are now well-established pathogenic entities. Both chronic renal failure and ischemic heart disease patients have been treated separately in recent studies with ethylenediaminetetraacetic acid (EDTA) chelation therapy. In patients with chronic kidney disease (serum creatinine: 1.5-4.0 mg/dL) and increased body lead burden, weekly low-dose chelation with calcium EDTA slowed the rate of decline in renal function in patients with diabetes and in non-diabetic patients. In patients with a history of myocardial infarction, the Trial to Assess Chelation Therapy study showed that EDTA chelation decreased the likelihood of cardiovascular events, particularly in patients with diabetes. However, heavy metal levels were not measured in this study. It is clear that more research is needed in this area. There is also a need to more frequently consider and test for the possibility of cadmium and lead toxicity in patients with increased risk, such as those with hypertension, diabetes mellitus, and chronic renal disease.
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5
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Glicklich D, Frishman WH. The Case For Cadmium and Lead Heavy Metal Screening. Am J Med Sci 2021; 362:344-354. [PMID: 34048724 DOI: 10.1016/j.amjms.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 01/24/2023]
Abstract
Exposure to cadmium and lead is widespread, and is related to environmental contamination, occupational sources, food, tobacco and other consumer products. Lower socioeconomic status increases the risk of heavy metal exposure and the diseases associated with cadmium and lead toxicity. Concurrent toxicity with both cadmium and lead is likely but has not often been assessed. There is now substantial evidence linking cadmium and lead to many diseases including hypertension, diabetes mellitus, obesity, cancer, coronary artery disease, chronic kidney disease (CKD) and lung disease. Both chronic renal failure and ischemic heart disease patients have been treated separately in recent studies with calcium disodium ethylenediaminetetraacetic acid (Ca EDTA) chelation therapy. In patients with CKD, serum creatinine 1.5-4.0 mg/dL, and increased body lead burden, weekly low dose chelation with Ca EDTA slowed the rate of decline in renal function in diabetics and non-diabetics. In patients with a history of myocardial infarction, the Trial to Assess Chelation Therapy (TACT) study showed that Ca EDTA chelation decreased the likelihood of cardiovascular events, particularly in diabetics. Ca EDTA chelation administered carefully at lower dosage (<50 mg/kg per week) is generally safe. In the past, acute renal failure associated with much higher dosage was reported. We suggest that the preponderance of the evidence favors a more activist approach towards diagnosis and possible intervention in heavy metal toxicity.
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Affiliation(s)
- Daniel Glicklich
- Kidney Transplant Division, New York Medical College/Westchester Medical Center, Valhalla, NY, USA.
| | - William H Frishman
- Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY, USA
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Wan H, Chen S, Cai Y, Chen Y, Wang Y, Zhang W, Chen C, Wang N, Guo Y, Lu Y. Lead exposure and its association with cardiovascular disease and diabetic kidney disease in middle-aged and elderly diabetic patients. Int J Hyg Environ Health 2020; 231:113663. [PMID: 33212357 DOI: 10.1016/j.ijheh.2020.113663] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
AIMS Previous studies have suggested that a high blood lead level (BLL) is associated with cardiovascular outcomes and impaired renal function in the general population; however, studies investigating the effect of a high BLL on diabetic vascular complications have been limited. We aimed to investigate whether a higher BLL is associated with cardiovascular disease (CVD) and diabetic kidney disease (DKD). METHODS We analyzed 4234 individuals out of 4813 diabetic participants enrolled from seven communities in China in 2018 in this cross-sectional study. Macrovascular measurements, including assessment of common carotid artery (CCA) plaques and their diameters, were performed with ultrasound. CVD was defined as a composite measure including a previous diagnosis of coronary heart disease, myocardial infarction, or stroke. The definition of DKD was an albumin to creatinine ratio (ACR) ≥30 mg/g or an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m2. Linear and logistic regression analyses were used to measure the associations. RESULTS The median age and BLL of the participants were 67 years (interquartile range, 62-72 years) and 26 μg/L (interquartile range, 18-36 μg/L). Compared with the first quartile, the odds ratio (OR) (95% CI) of CCA plaques ranging from none to bilateral in the ordinal logistic regression analysis associated with BLL was 1.53 (1.29, 1.82) in the fourth BLL quartile (P for trend <0.01), and the odds of having CVD was significantly increased by 44% for participants in the fourth quartile (1.44 (1.17, 1.76)) (P for trend <0.01). The odds of DKD in the fourth BLL quartile increased by 36% (1.36 (1.06, 1.74)) compared with that in the first quartile (P for trend <0.05). These associations were adjusted for potential confounders. CONCLUSIONS A high BLL may be a potential risk factor for CVD and DKD in middle-aged and elderly diabetic adults.
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Affiliation(s)
- Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shihan Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yan Cai
- Department of Endocrinology, The Fifth Affiliated Hospital of Kunming Medical University, Yunnan Honghe Prefecture Central Hospital (Ge Jiu People's Hospital), Yunnan, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Yuyu Guo
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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7
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Sotomayor CG, Groothof D, Vodegel JJ, Eisenga MF, Knobbe TJ, IJmker J, Lammerts RGM, de Borst MH, Berger SP, Nolte IM, Rodrigo R, Slart RHJA, Navis GJ, Touw DJ, Bakker SJL. Plasma cadmium is associated with increased risk of long-term kidney graft failure. Kidney Int 2020; 99:1213-1224. [PMID: 32941876 DOI: 10.1016/j.kint.2020.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 12/26/2022]
Abstract
The kidney is one of the most sensitive organs to cadmium-induced toxicity, particularly in conditions of long-term oxidative stress. We hypothesized that, in kidney transplant recipients, nephrotoxic exposure to cadmium represents an overlooked hazard for optimal graft function. To test this, we performed a prospective cohort study and included 672 outpatient kidney transplant recipients with a functioning graft of beyond one year. The median plasma cadmium was 58 ng/L. During a median 4.9 years of follow-up, 78 kidney transplant recipients developed graft failure with a significantly different distribution across tertiles of plasma cadmium (13, 26, and 39 events, respectively). Plasma cadmium was associated with an increased risk of graft failure (hazard ratio 1.96, 95% confidence interval 1.56‒2.47 per log2 ng/L). Similarly, a dose-response relationship was observed over increasing tertiles of plasma cadmium, after adjustments for potential confounders (donor, recipient, transplant and lifestyle characteristics), robust in both competing risk and sensitivity analyses. These findings were also consistent for kidney function decline (graft failure or doubling of serum creatinine). Thus, plasma cadmium is independently associated with an increased risk of long-term kidney graft failure and decline in kidney function. Further studies are needed to investigate whether exposure to cadmium represents an otherwise overlooked modifiable risk factor for adverse long-term graft outcomes in different populations.
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Affiliation(s)
- Camilo G Sotomayor
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Dion Groothof
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joppe J Vodegel
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F Eisenga
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim J Knobbe
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan IJmker
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rosa G M Lammerts
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin H de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ramón Rodrigo
- Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Riemer H J A Slart
- Department of Nuclear and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Huang WH, Hu CC, Yen TH, Hsu CW, Weng CH. Blood lead level: an overlooked risk of carpal tunnel syndrome in hemodialysis patients. Ren Fail 2020; 41:786-793. [PMID: 31498017 PMCID: PMC6746292 DOI: 10.1080/0886022x.2019.1657894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Carpal tunnel syndrome (CTS) is a severe complication observed in long-term maintenance hemodialysis (MHD) patients. The most common cause of CTS is dialysis-related β2-microglobulin amyloidosis, which is associated with inflammation and oxidative stress in dialysis patients. Patients on MHD have higher blood lead levels (BLLs) than the general population. Lead (Pb) exposure in chronic dialysis patients has been noted to induce oxidative stress and inflammation. Therefore, lead-related inflammation and oxidative stress might contribute to CTS. Methods: The medical records of 866 MHD patients were reviewed. Two hundred and thirty-four patients with symptoms of CTS were surveyed by senior neurologists via physical examinations and nerve conduction studies. Patients in this study were stratified into groups with low-normal (<10 μg/dL), high-normal (10 to 20 μg/dL), and abnormal (>20 μg/dL) BLLs. The associations between CTS and BLLs and the clinical data were analyzed. Results: Multivariate logistic regression analyses showed that Log BLL (OR: 54.810, 95% CI: 13.622-220.54, p < .001), high-normal BLLs (OR: 4.839, 95% CI: 2.262-10.351, p < .001) with low-normal BLL as a reference, high BLLs (OR: 12.952, 95% CI: 5.391-31.119, p < .001) with low-normal BLL as a reference, and a BLL >12.3 μg/dL (OR: 6.827, 95% CI: 3.737-12.472, p < .001) were positively associated with CTS according to three different analyses. Discussion: In conclusion, blood lead levels were positively associated with CTS in patients on MHD. Dialysis patients should pay more attention to their environmental exposure to Pb. Avoidance of environmental Pb may reduce the incidence of CTS in MHD patients. Future studies will address the role of Pb in the pathophysiology of CTS in this patient population.
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Affiliation(s)
- Wen-Hung Huang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Clinical Poison Center, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Chang Gung University College of Medicine , Taoyuan , Taiwan
| | - Ching-Chih Hu
- Chang Gung University College of Medicine , Taoyuan , Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University , Taoyuan , Taiwan.,Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Tzung-Hai Yen
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Clinical Poison Center, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Chang Gung University College of Medicine , Taoyuan , Taiwan
| | - Ching-Wei Hsu
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Clinical Poison Center, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Chang Gung University College of Medicine , Taoyuan , Taiwan
| | - Cheng-Hao Weng
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Clinical Poison Center, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Chang Gung University College of Medicine , Taoyuan , Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University , Taoyuan , Taiwan
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Calderon Moreno R, Navas-Acien A, Escolar E, Nathan DM, Newman J, Schmedtje JF, Diaz D, Lamas GA, Fonseca V. Potential Role of Metal Chelation to Prevent the Cardiovascular Complications of Diabetes. J Clin Endocrinol Metab 2019; 104:2931-2941. [PMID: 30869793 PMCID: PMC9136707 DOI: 10.1210/jc.2018-01484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/07/2019] [Indexed: 02/12/2023]
Abstract
CONTEXT For decades, there has been epidemiologic evidence linking chronic toxic metal exposure with cardiovascular disease, suggesting a therapeutic role for metal chelation. Given the lack of compelling scientific evidence, however, the indications for metal chelation were never clearly defined. To determine the safety and efficacy of chelation therapy, the National Institutes of Health funded the Trial to Assess Chelation Therapy (TACT). TACT was the first double-blind, randomized, controlled trial to demonstrate an improvement in cardiovascular outcomes with edetate disodium therapy in patients with prior myocardial infarction. The therapeutic benefit was striking among the prespecified subgroup of patients with diabetes. DESIGN We review the published literature focusing on the atherogenic nature of diabetes, as well as available evidence from clinical trials, complete and in progress, of metal chelation with edetate disodium therapy in patients with diabetes. RESULTS The TACT results support the concept that ubiquitous toxic metals such as lead and cadmium may be modifiable risk factors for cardiovascular disease, particularly in patients with diabetes. CONCLUSIONS The purpose of this review is to discuss the potential mechanisms unifying the pathogenesis of atherogenic factors in diabetes with toxic metal exposure, and the potential role of metal chelation.
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Affiliation(s)
| | - Ana Navas-Acien
- Columbia University Mailman School of Public Health, New York, New York
| | - Esteban Escolar
- Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida
| | - David M Nathan
- Diabetes Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jonathan Newman
- Department of Medicine, New York University School of Medicine, New York, New York
| | | | - Denisse Diaz
- Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida
- Correspondence and Reprint Requests: Denisse Diaz, MD, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, Florida 33140. E-mail:
| | - Gervasio A Lamas
- Department of Medicine, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida
| | - Vivian Fonseca
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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10
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Harrison TG, Tam-Tham H, Hemmelgarn BR, Elliott M, James MT, Ronksley PE, Jun M. Change in Proteinuria or Albuminuria as a Surrogate for Cardiovascular and Other Major Clinical Outcomes: A Systematic Review and Meta-analysis. Can J Cardiol 2018; 35:77-91. [PMID: 30595186 DOI: 10.1016/j.cjca.2018.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/04/2018] [Accepted: 10/25/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There is ongoing controversy around the surrogacy of proteinuria or albuminuria, particularly for cardiovascular (CV) outcomes, which remain the leading cause of morbidity and mortality among patients with chronic kidney disease. We performed a systematic review and meta-analysis of the literature to assess the surrogacy of changing proteinuria or albuminuria for CV events, end-stage renal disease (ESRD), and all-cause mortality. METHODS CENTRAL, EMBASE, and MEDLINE were searched (from inception to October 2017). All randomized controlled trials in adults that reported change in proteinuria or albuminuria and ≥ 10 CV, ESRD, or all-cause mortality events were included. We calculated treatment effect ratios (TERs), defined as the ratio of the treatment effect on a clinical outcome and the effect on the change in the surrogate outcome. TERs close to 1 indicate greater agreement between the clinical outcome and changing proteinuria or albuminuria. RESULTS Thirty-six trials were included in the meta-analysis. We observed inconsistent treatment effects for proteinuria and CV events (20 trials; TER 1.11 [95% confidence interval (CI), 1.01-1.22]) with moderate heterogeneity (I2 = 51%, P = 0.005). Treatment effects on proteinuria or albuminuria were also inconsistent with the effects on all-cause mortality (21 trials; TER 1.17 [95% CI, 1.07-1.28]; I2 = 35%, P for heterogeneity = 0.06), although they were similar with the effects on ESRD (23 trials; TER 0.99 [95% CI, 0.88-1.13]; I2 = 9%, P for heterogeneity = 0.337). CONCLUSIONS Change in proteinuria or albuminuria might be a suitable surrogate outcome for ESRD. However, overall treatment effects on these potential surrogates are inconsistent and overestimate the treatment effects on CV events and all-cause mortality.
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Affiliation(s)
- Tyrone G Harrison
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Helen Tam-Tham
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Meghan Elliott
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Min Jun
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; The George Institute for Global Health, University of New South Wales, Sydney, Australia.
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11
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Huang YS, Wang SH, Chen SM, Lee JA. Metabolic profiling of metformin treatment for low-level Pb-induced nephrotoxicity in rat urine. Sci Rep 2018; 8:14587. [PMID: 30275489 PMCID: PMC6167321 DOI: 10.1038/s41598-018-32501-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease is a worldwide problem, and Pb contamination is a potential risk factor. Since current biomarkers are not sensitive for the diagnosis of Pb-induced nephrotoxicity, novel biomarkers are needed. Metformin has both hypoglycaemic effects and reno-protection ability. However, its mechanism of action is unknown. We aimed to discover the early biomarkers for the diagnosis of low-level Pb-induced nephrotoxicity and understand the mechanism of reno-protection of metformin. Male Wistar rats were randomly divided into control, Pb, Pb + ML, Pb + MH and MH groups. Pb (250 ppm) was given daily via drinking water. Metformin (50 or 100 mg/kg/d) was orally administered. Urine was analysed by nuclear magnetic resonance (NMR)-based metabolomics coupled with multivariate statistical analysis, and potential biomarkers were subsequently quantified. The results showed that Pb-induced nephrotoxicity was closely correlated with the elevation of 5-aminolevulinic acid, D-lactate and guanidinoacetic acid in urine. After co-treatment with metformin, 5-aminolevulinic acid and D-lactate were decreased. This is the first demonstration that urinary 5-aminolevulinic acid, D-lactate and guanidinoacetic acid could be early biomarkers of low-level Pb-induced nephrotoxicity in rats. The reno-protection of metformin might be attributable to the reduction of D-lactate excretion.
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Affiliation(s)
- Yu-Shen Huang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing St., Taipei, Taiwan
| | - Shwu-Huey Wang
- Core Facility Center, Department of Research Development, Taipei Medical University, 250 Wuxing St., Taipei, Taiwan
- Department of Biochemistry and Molecular Cell Biology, School of Medicine, Taipei Medical University, 250 Wuxing St., Taipei, Taiwan
| | - Shih-Ming Chen
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing St., Taipei, Taiwan.
| | - Jen-Ai Lee
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing St., Taipei, Taiwan.
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12
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Abdullah F, Mohd Yusoff AR, Wan Abu Bakar WA, Ismail R, Syafiuddin A. Preparation, characterization, and lead removal appraisal of zinc aluminate prepared at different calcination temperatures. J CHIN CHEM SOC-TAIP 2018. [DOI: 10.1002/jccs.201700472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Faizuan Abdullah
- Department of Natural Resources and Sustainability, Faculty of Earth Science; Universiti Malaysia Kelantan, 17600 Jeli; Kelantan Malaysia
| | - Abdull Rahim Mohd Yusoff
- Department of Chemistry, Faculty of Science; Universiti Teknologi Malaysia; Johor Bahru Johor Malaysia
- Centre for Sustainable Nanomaterials, Ibnu Sina Institute for Scientific and Industrial Research; Universiti Teknologi Malaysia; Johor Bahru Johor Malaysia
| | - Wan Azelee Wan Abu Bakar
- Department of Chemistry, Faculty of Science; Universiti Teknologi Malaysia; Johor Bahru Johor Malaysia
| | - Razali Ismail
- Department of Chemistry, Faculty of Science; Universiti Teknologi Malaysia; Johor Bahru Johor Malaysia
| | - Achmad Syafiuddin
- Department of Environmental Engineering, Faculty of Civil Engineering; Universiti Teknologi Malaysia; Johor Bahru Johor Malaysia
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13
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14
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Mathew RO, Schulman-Marcus J, Nichols EL, Newman JD, Bangalore S, Farkouh M, Sidhu MS. Chelation Therapy as a Cardiovascular Therapeutic Strategy: the Rationale and the Data in Review. Cardiovasc Drugs Ther 2017; 31:619-625. [DOI: 10.1007/s10557-017-6759-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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15
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Bloomgarden Z. Chelation for diabetes complications: A neglected approach? J Diabetes 2017; 9:318-319. [PMID: 28074558 DOI: 10.1111/1753-0407.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
,Zou1 ,,。,,,,,2-4 。、、、56 ,。2(T2D),、、7 。1,,8 。,,(TETA),、D-9 。 ,。,TETAT2D10 ;11 ,12 。24,50T2D,EDTA,EDTA13 。,1708EDTA,18%14 ,63341%, + 15 ,16 ;17 。 ?、、,,18 。Zou1 ,。.
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16
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Rationale for the Successful Management of EDTA Chelation Therapy in Human Burden by Toxic Metals. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8274504. [PMID: 27896275 PMCID: PMC5118545 DOI: 10.1155/2016/8274504] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/31/2016] [Accepted: 09/18/2016] [Indexed: 12/22/2022]
Abstract
Exposure to environmental and occupational toxicants is responsible for adverse effects on human health. Chelation therapy is the only procedure able to remove toxic metals from human organs and tissue, aiming to treat damage related to acute and/or chronic intoxication. The present review focuses on the most recent evidence of the successful use of the chelating agent ethylenediaminetetraacetic acid (EDTA). Assessment of toxic-metal presence in humans, as well as the rationale of EDTA therapy in cardiovascular and neurodegenerative diseases, is reported.
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17
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Jun M, Turin TC, Woodward M, Perkovic V, Lambers Heerspink HJ, Manns BJ, Tonelli M, Hemmelgarn BR. Assessing the Validity of Surrogate Outcomes for ESRD: A Meta-Analysis. J Am Soc Nephrol 2015; 26:2289-302. [PMID: 25556165 DOI: 10.1681/asn.2014040396] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/31/2014] [Indexed: 01/13/2023] Open
Abstract
Validation of current and promising surrogate outcomes for ESRD in randomized controlled trials (RCTs) has been limited. We conducted a systematic review and meta-analysis of RCTs to further inform the ability of surrogate outcomes for ESRD to predict the efficacy of various interventions on ESRD. MEDLINE, EMBASE, and CENTRAL (from inception through September 2013) were searched. All RCTs in adults with proteinuria, diabetes, or CKD stages 1-4 or renal transplant recipients reporting ≥10 ESRD events and a surrogate outcome (change in proteinuria or doubling of serum creatinine [DSCR]) for ESRD during a ≥1-year follow-up were included. Two reviewers abstracted trial characteristics and outcome data independently. To assess the correlation between the surrogate outcomes and ESRD, we determined the treatment effect ratio (TER), defined as the ratio of the treatment effects on ESRD and the effects on the change in surrogate outcomes. TERs close to 1 indicate greater agreement between ESRD and the surrogate, and these ratios were pooled across interventions. We identified 27 trials (97,458 participants; 4187 participants with ESRD). Seven trials reported the effects on change in proteinuria and showed consistent effects for proteinuria and ESRD (TER, 0.82; 95% confidence interval, 0.59 to 1.16), with minimal heterogeneity. Twenty trials reported on DSCR. Treatment effects on DSCR were consistent with the effects on ESRD (TER, 0.98; 95% confidence interval, 0.85 to 1.14), with moderate heterogeneity. In conclusion, DSCR is generally a good surrogate for ESRD, whereas data on proteinuria were limited. Further assessment of the surrogacy of proteinuria using prospective RCTs is warranted.
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Affiliation(s)
- Min Jun
- Department of Medicine, Division of Nephrology, The George Institute for Global Health, The University of Sydney, Sydney, Australia
| | - Tanvir Chowdhury Turin
- Department of Community Health Sciences, and Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark Woodward
- Department of Community Health Sciences, and The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; and
| | - Vlado Perkovic
- The George Institute for Global Health, The University of Sydney, Sydney, Australia
| | - Hiddo J Lambers Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Braden J Manns
- Department of Medicine, Division of Nephrology, Department of Community Health Sciences, and
| | | | - Brenda R Hemmelgarn
- Department of Medicine, Division of Nephrology, Department of Community Health Sciences, and
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18
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Said S, Hernandez GT. Environmental exposures, socioeconomics, disparities, and the kidneys. Adv Chronic Kidney Dis 2015; 22:39-45. [PMID: 25573511 DOI: 10.1053/j.ackd.2014.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/30/2014] [Accepted: 09/09/2014] [Indexed: 12/27/2022]
Abstract
Kidney disease disproportionately affects racial and ethnic minority populations, the poor, and the socially disadvantaged. The excess risk of kidney disease among minority and disadvantaged populations can only be partially explained by an excess of diabetes, hypertension, and poor access to preventive care. Disparities in the environmental exposure to nephrotoxicants have been documented in minority and disadvantaged populations and may explain some of the excess risk of kidney disease. High-level environmental and occupational exposure to lead, cadmium, and mercury are known to cause specific nephropathies. However, there is growing evidence that low-level exposures to heavy metals may contribute to the development of CKD and its progression. In this article, we summarize the excess risk of environmental exposures among minority and disadvantaged populations. We also review the epidemiologic and clinical data linking low-level environmental exposure to lead, cadmium, and mercury to CKD and its progression. Finally, we briefly describe Mesoamerican nephropathy, an epidemic of CKD affecting young men in Central America, which may have occupational and environmental exposures contributing to its development.
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19
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Cao Y, Skaug MA, Andersen O, Aaseth J. Chelation therapy in intoxications with mercury, lead and copper. J Trace Elem Med Biol 2015; 31:188-92. [PMID: 24894443 DOI: 10.1016/j.jtemb.2014.04.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/15/2022]
Abstract
In the present review we provide an update of the appropriate use of chelating agents in the treatment of intoxications with compounds of mercury, lead and copper. The relatively new chelators meso-2,3-dimercaptosuccinic acid (DMSA) and 2,3-dimercapto-propanesulphonate (DMPS) can effectively mobilize deposits of mercury as well as of lead into the urine. These drugs can be administered orally and have relatively low toxicity compared to the classical antidote dimercaptopropanol (BAL). d-Penicillamine has been widely used in copper overload, although 2,3-dimercaptosuccinic acid or tetrathiomolybdate may be more suitable alternatives today. In copper-toxicity, a free radical scavenger might be recommended as adjuvant to the chelator therapy.
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Affiliation(s)
- Yang Cao
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marit Aralt Skaug
- Faculty of Public Health, Hedmark University College, Elverum, Norway.
| | - Ole Andersen
- Department of Science, Systems and Models, Roskilde University, Roskilde, Denmark
| | - Jan Aaseth
- Innlandet Hospital Trust, Kongsvinger Hospital Division, Kongsvinger, Norway
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20
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Batuman V, Wedeen RP. The Persistence of Chronic Lead Nephropathy. Am J Kidney Dis 2014; 64:1-3. [DOI: 10.1053/j.ajkd.2014.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/10/2014] [Indexed: 11/11/2022]
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21
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Yang SK, Xiao L, Song PA, Xu XX, Liu FY, Sun L. Is lead chelation therapy effective for chronic kidney disease? A meta-analysis. Nephrology (Carlton) 2013; 19:56-9. [PMID: 24341661 DOI: 10.1111/nep.12162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shi-kun Yang
- Department of Nephrology; The Second Xiangya Hospital; Kidney Institute of Central South University; Changsha Hunan Province China
| | - Li Xiao
- Department of Nephrology; The Second Xiangya Hospital; Kidney Institute of Central South University; Changsha Hunan Province China
| | - Pan-ai Song
- Department of Nephrology; The Second Xiangya Hospital; Kidney Institute of Central South University; Changsha Hunan Province China
| | - Xiao-xuan Xu
- Department of Nephrology; The Second Xiangya Hospital; Kidney Institute of Central South University; Changsha Hunan Province China
| | - Fu-you Liu
- Department of Nephrology; The Second Xiangya Hospital; Kidney Institute of Central South University; Changsha Hunan Province China
| | - Lin Sun
- Department of Nephrology; The Second Xiangya Hospital; Kidney Institute of Central South University; Changsha Hunan Province China
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22
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Escolar E, Lamas GA, Mark DB, Boineau R, Goertz C, Rosenberg Y, Nahin RL, Ouyang P, Rozema T, Magaziner A, Nahas R, Lewis EF, Lindblad L, Lee KL. The effect of an EDTA-based chelation regimen on patients with diabetes mellitus and prior myocardial infarction in the Trial to Assess Chelation Therapy (TACT). Circ Cardiovasc Qual Outcomes 2013; 7:15-24. [PMID: 24254885 DOI: 10.1161/circoutcomes.113.000663] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The Trial to Assess Chelation Therapy (TACT) showed clinical benefit of an EDTA-based infusion regimen in patients aged ≥50 years with prior myocardial infarction. Diabetes mellitus before enrollment was a prespecified subgroup. METHODS AND RESULTS Patients received 40 infusions of EDTA chelation or placebo. A total of 633 (37%) patients had diabetes mellitus (322 EDTA and 311 placebo). EDTA reduced the primary end point (death, reinfarction, stroke, coronary revascularization, or hospitalization for angina; 25% versus 38%; hazard ratio, 0.59; 95% confidence interval [CI], 0.44-0.79; P<0.001) over 5 years. The result remained significant after Bonferroni adjustment for multiple subgroups (99.4% CI, 0.39-0.88; adjusted P=0.002). All-cause mortality was reduced by EDTA chelation (10% versus 16%; hazard ratio, 0.57; 95% CI, 0.36-0.88; P=0.011), as was the secondary end point (cardiovascular death, reinfarction, or stroke; 11% versus 17%; hazard ratio, 0.60; 95% CI, 0.39-0.91; P=0.017). However, after adjusting for multiple subgroups, those results were no longer significant. The number needed to treat to reduce 1 primary end point over 5 years was 6.5 (95% CI, 4.4-12.7). There was no reduction in events in non-diabetes mellitus (n=1075; P=0.877), resulting in a treatment by diabetes mellitus interaction (P=0.004). CONCLUSIONS Post-myocardial infarction patients with diabetes mellitus aged ≥50 demonstrated a marked reduction in cardiovascular events with EDTA chelation. These findings support efforts to replicate these findings and define the mechanisms of benefit. However, they do not constitute sufficient evidence to indicate the routine use of chelation therapy for all post-myocardial infarction patients with diabetes mellitus. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00044213.
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Affiliation(s)
- Esteban Escolar
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL
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Environmental lead exposure accelerates progressive diabetic nephropathy in type II diabetic patients. BIOMED RESEARCH INTERNATIONAL 2013; 2013:742545. [PMID: 23555094 PMCID: PMC3600262 DOI: 10.1155/2013/742545] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/24/2013] [Indexed: 11/18/2022]
Abstract
Whether environmental lead exposure has a long-term effect on progressive diabetic nephropathy in type II diabetic patients remains unclear. A total of 107 type II diabetic patients with stage 3 diabetic nephropathy (estimated glomerular filtration rate (eGFR) range, 30-60 mL/min/1.73 m(2)) with normal body lead burden (BLB) (<600 μ g/72 hr in EDTA mobilization tests) and no history of exposure to lead were prospectively followed for 2 years. Patients were divided into high-normal BLB (>80 μ g) and low-normal BLB (<80 μ g) groups. The primary outcome was a 2-fold increase in the initial creatinine levels, long-term dialysis, or death. The secondary outcome was a change in eGFR over time. Forty-five patients reached the primary outcome within 2 years. Although there were no differences in baseline data and renal function, progressive nephropathy was slower in the low-normal BLB group than that in the high-normal BLB group. During the study period, we demonstrated that each 100 μ g increment in BLB and each 10 μ g increment in blood lead levels could decrease GFR by 2.2 mL/min/1.72 m(2) and 3.0 mL/min/1.72 m(2) (P = 0.005), respectively, as estimated by generalized equations. Moreover, BLB was associated with increased risk of achieving primary outcome. Environmental exposure to lead may have a long-term effect on progressive diabetic nephropathy in type II diabetic patients.
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Weaver VM, Fadrowski JJ, Jaar BG. Does Calcium Disodium EDTA Slow CKD Progression? Am J Kidney Dis 2012; 60:503-6. [DOI: 10.1053/j.ajkd.2012.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/06/2012] [Indexed: 11/11/2022]
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Monensin potentiates lead chelation efficacy of MiADMSA in rat brain post chronic lead exposure. Food Chem Toxicol 2012; 50:4449-60. [PMID: 22982480 DOI: 10.1016/j.fct.2012.08.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 01/04/2023]
Abstract
The present study evaluates combination therapy with a chelating agent, MiADMSA and a Na(+) ionophore, monensin against sub-chronic lead toxicity in rats. Animals were exposed to 0.1% lead in drinking water for 16 weeks and then treated with either MiADMSA at 50mg/kg body weight, or monensin at 10mg/kg, or both in combination for a period of 5 days was administered. Biomarkers indicative of oxidative stress like ROS, GSH, GSSG and TBARS demonstrated lead-induced toxic manifestations in blood, kidney and brain. Antioxidants like SOD, catalase and glutathione peroxidase along with specific lead biomarker, blood ALAD were also severely depleted in lead intoxicated animals. Serum parameters and histopathological findings supported the said results. MiADMSA treatment during both mono- and combination therapy with monensin, restored the antioxidant status and recovered biochemical and haematological variables due to lead. However, monensin alone was not found to be effective in the given scenario. Interestingly, combination therapy in its ability to revert lead-induced overall systemic toxicity was only found at par with the MiADMSA monotherapy except for its chelation potential. Monensin given in combination with MiADMSA potentiated its lead chelation ability especially from brain, along with maintaining the normal copper concentrations in the organ unlike MiADMSA monotherapy.
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