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Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden.

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  • Additional Information
    • Author(s):
    • Address:
      Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    • Publication Information:
      Sweden
    • Abstract:
      Cadmium (Cd) is a toxic metal with no beneficial biological function. The dissemination of cadmium to the surface environment, by industrial and agricultural practices, has led to increased human exposure. Food is the main source of exposure in the general non-smoking population however in areas close to industrial sources, contact with contaminated environmental media may also be important. Previous studies have shown toxic effects of cadmium on the kidneys and bone, however, considerable uncertainty remains over the exposure levels at which these toxic effects may start to occur and the clinical relevance of the early effects observed following long-term, low-level cadmium exposure. The aims of this thesis were: (1) To assess cadmium body burden and early signs of kidney dysfunction in a population exposed to industrial cadmium emissions and to develop and validate an air dispersion model of these emissions. (2) To identify urinary metabolites, associated with cadmium exposure, using metabolic profiling techniques. (3) To prospectively assess the association between validated estimates of dietary cadmium exposure and chronic kidney disease (CKD) incidence, kidney stone incidence, and fracture incidence, in two large population-based cohorts of men and women. In a population-based sample of 180 subjects, living close to a zinc smelter in Avonmouth, Southwest England, urinary cadmium concentrations (median=0.22 nmol Cd/mmol creatinine) were in the same range as those where associations with kidney and/or bone effects have been observed previously. Three percent had concentrations above 1 nmol Cd/mmol creatinine (~1 µg/g) - the point of departure for tubular proteinuria set by the European Food Safety Authority in 2009. Modelled air cadmium concentrations from the smelter were strongly correlated with those from air monitoring sites (R2=0.84) and were a significant predictor of urinary cadmium (p=0.04). In a cross-sectional analysis, a significant dose-response relationship between urinary cadmium and one of the biomarkers of early tubular dysfunction (N-acetyl-β-D-glucosaminidase) was observed. Metabolic profiling identified six urinary metabolites, either related to mitochondrial metabolism or one carbon metabolism, associated with urinary cadmium. Two large population-based cohorts of men and women from Central Sweden were used to investigate the association between dietary cadmium exposure and incidence of CKD, kidney stones and fractures. Median dietary cadmium exposure levels in our study populations were 19 µg/day in men and 13 µg/day women. During an average of 12 years of follow-up, we ascertained 599 incident cases of CKD among men (481,591 person-years) and 253 among women (415,432 person-years). We did not observe an association between dietary Cd and rate of CKD in men, hazard ratio (HR) 0.97 (95% CI 0.77-1.21) or women HR 0.74 (95% CI 0.53-1.04), either before or after adjustment for potential confounders. During an average of 13 years of follow-up, we ascertained 707 incident cases of kidney stone among men (421,611 person-years) and 290 among women (403,575 person-years). Likewise, we did not observe an association between dietary Cd and rate of kidney stones in men HR 0.97 (95% CI 0.77-1.23) or women HR 0.99 (95%CI 0.89-1.43), either before or after adjustment for potential confounders. We ascertained 2,183 cases of any fracture and 374 cases of hip fracture, during a 10-year follow-up of 20,173 Swedish men. This study provides the first data on hip fracture rates in relation to cadmium exposure and is the first to report an excess risk of any fracture associated with long-term low-level cadmium exposure in men.
    • Number of References:
      185 ref.
    • Subject Terms:
      Public Health
    • Subject Terms:
    • Accession Number:
      atmospheric pollution, beta-N-acetylglucosaminidase, biomarkers, Britain, hip fractures, kidney calculi, kidney disorders, kidney stones, nephropathy, poisons, renal diseases, United Kingdom
    • CABICODES:
      Pollution and Degradation (PP600)
      Food Contamination, Residues and Toxicology (QQ200)
      Human Health and the Environment (VV500)
      Non-communicable Human Diseases and Injuries (VV600)
      Human Toxicology and Poisoning (VV810) (New March 2000)
    • Accession Number:
      7440-43-9; 9012-33-3
    • Publication Information:
      Thesis; ISBN:9789175492384URL:http://publications.ki.se/xmlui/bitstream/handle/10616/41679/Thesis_Laura_Thomas.pdf?sequence=5
    • Accession Number:
      20143273773
    • Copyright:
      ©2014 CAB International
  • Citations
    • ABNT:
      THOMAS, L. D. K. Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden. 2013. Institute of Environmental Medicine, Karolinska Institute, Stockholm; Sweden, 2013. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20143273773. Acesso em: 24 set. 2020.
    • AMA:
      Thomas LDK. Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden. Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden. 2013:80. Accessed September 24, 2020. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20143273773
    • APA:
      Thomas, L. D. K. (2013). Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden [Institute of Environmental Medicine, Karolinska Institute]. In Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden (p. 80).
    • Chicago/Turabian: Author-Date:
      Thomas, L. D. K. 2013. “Cadmium Exposure and Risk of Kidney Effects and Bone Fractures: Population-Based Studies in England and Sweden.” Cadmium Exposure and Risk of Kidney Effects and Bone Fractures: Population-Based Studies in England and Sweden. Stockholm; Sweden: Institute of Environmental Medicine, Karolinska Institute. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20143273773.
    • Harvard:
      Thomas, L. D. K. (2013) Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden, Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden. Institute of Environmental Medicine, Karolinska Institute. Available at: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20143273773 (Accessed: 24 September 2020).
    • Harvard: Australian:
      Thomas, LDK 2013, ‘Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden’, Institute of Environmental Medicine, Karolinska Institute, Stockholm; Sweden, Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden, p. 80, viewed 24 September 2020, .
    • MLA:
      Thomas, L. D. K. “Cadmium Exposure and Risk of Kidney Effects and Bone Fractures: Population-Based Studies in England and Sweden.” Cadmium Exposure and Risk of Kidney Effects and Bone Fractures: Population-Based Studies in England and Sweden, Institute of Environmental Medicine, Karolinska Institute, 2013, p. 80. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20143273773.
    • Chicago/Turabian: Humanities:
      Thomas, L. D. K. “Cadmium Exposure and Risk of Kidney Effects and Bone Fractures: Population-Based Studies in England and Sweden.” Cadmium Exposure and Risk of Kidney Effects and Bone Fractures: Population-Based Studies in England and Sweden. Institute of Environmental Medicine, Karolinska Institute, 2013. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20143273773.
    • Vancouver/ICMJE:
      Thomas LDK. Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden [Internet]. Cadmium exposure and risk of kidney effects and bone fractures: population-based studies in England and Sweden. [Stockholm; Sweden]: Institute of Environmental Medicine, Karolinska Institute; 2013 [cited 2020 Sep 24]. p. 80. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20143273773