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Chronic Kidney Disease and Heavy Metal Exposure in Children

Avendt-Reeber, Mary, M.D.
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504873108060796

Abstract Details

2017, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Recent adult studies have shown even low level exposure to arsenic (As) in drinking water was associated with kidney dysfunction. These low levels were found in the upper quartile observed in children by the National Health and Nutrition Examination Survey (NHANES). Limited studies exist for evaluating renal function and As in children. One study observed a positive association between As and estimated glomerular filtration rate (eGFR) in children when analyzing NHANES data from 2009-2012. However, this study did not account for the impact of other heavy metals, ie cadmium (Cd), mercury (Hg), and lead (Pb) on renal function. Another method of assessing renal dysfunction is urine albumin to creatinine ratio (ACR). Objective: To assess the association between urinary As, Cd, Hg, and Pb and renal function in children. Methods: NHANES data from 2003-2014 for individuals 12-20 were evaluated in this cross-sectional study. Independent variables included measurements of urine heavy metals of As, Cd, Hg, and Pb normalized to urinary creatinine. Outcome measurements were ACR and eGFR as determined by Schwartz et al. for participants aged 12-17 and by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) for those aged 18-20. Multivariable linear regression models were utilized to assess the association between both ACR and eGFR and urinary concentrations of As, Cd, Hg, and Pb. These models were adjusted for age, gender, race, ethnicity, blood pressure, body mass index, serum hemoglobin A1C, and serum cotinine. Results: A total of 2897 kids aged 12-20 had available data to determine eGFR and urinary As, Cd, Hg, and Pb concentrations. Median eGFR was 105 ml/min/1.73m² (IQR 89-123). Mean heavy metal concentrations, normalized to urinary creatinine, were: As 10.74 µg/g, Cd 0.15 µg/g, Hg 0.45 µg/g, and Pb 0.46 µg/g. Multivariate analysis showed an increase in ACR of 3.77 for every log unit increase in urinary Cd which approached statistical significance (p=0.06). Multivariate analyses showed an increase in eGFR of 1.7 ml/min/1.73m² for each log unit increase in total urinary As (p = 0.04), an increase of 2.4 ml/min/1.73m for each log unit increase in Cd (p = 0.009), an increase of 1.2 ml/min/1.73m for each log unit increase in Hg (p = 0.04), and an increase of 3.6 for each log unit increase in Pb (p=<0.001). There was no significant association seen between urinary Hg and eGFR. Conclusion: A positive association was once again seen with low level exposure of As and eGFR in children. Similar associations were observed with Cd and Pb as well. Investigation of ACR showed a positive relationship between Cd and ACR which approached statistical significance. The positive relationship seen with eGFR may be due to impairment of excretion or due to hyperfiltration. Thus, further prospective studies using additional, more sensitive, markers of renal injury are needed.
Erin Haynes, Dr.P.H. (Committee Chair)
Jane Khoury, M.S (Committee Member)
Mark Mitsnefes, M.D. (Committee Member)
14 p.
Environmental Health

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Citations

  • Avendt-Reeber, M.D., M. (2017). Chronic Kidney Disease and Heavy Metal Exposure in Children [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504873108060796

    APA Style (7th edition)

  • Avendt-Reeber, M.D., Mary. Chronic Kidney Disease and Heavy Metal Exposure in Children. 2017. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504873108060796.

    MLA Style (8th edition)

  • Avendt-Reeber, M.D., Mary. "Chronic Kidney Disease and Heavy Metal Exposure in Children." Master's thesis, University of Cincinnati, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504873108060796

    Chicago Manual of Style (17th edition)

ucin1504873108060796
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This open access ETD is published by University of Cincinnati and OhioLINK.