Associations between exposure to heavy metals and the risk of chronic kidney disease: a systematic review and meta-analysis

Abstract

We performed a systematic review and meta-analysis to examine the relationship between heavy metals (HMs) exposure and the risk of chronic kidney disease (CKD). Databases of Web of Science, Embase, MEDLINE, and Scopus were searched through June 2020 to identify studies assessing the relationships between exposure to HMs (i.e. cadmium, lead, arsenic, mercury) and the risk of CKD, evaluated by decreased estimated glomerular filtration rate (eGFR) and/or increased proteinuria risks in adults (≥18 years). Data were pooled by random-effects models and expressed as weighted mean differences and 95% confidence intervals. The risk of bias was assessed by the Newcastle–Ottawa scale (NOS). Twenty-eight eligible articles (n = 107,539 participants) were included. Unlike eGFR risk (p = 0.10), Cadmium exposure was associated with an increased proteinuria risk (OR = 1.35; 95% CI: 1.13, 1.61; p < 0.001; I² = 79.7%). Lead exposure was associated with decreased eGFR (OR = 1.12; 95%CI: 1.03, 1.22; p = 0.008; I² = 87.8%) and increased proteinuria (OR = 1.25; 95% CI: 1.04, 1.49; p = 0.02; I² = 79.6) risks. Further, arsenic exposure was linked to a decreased eGFR risk (OR = 1.55; 95% CI: 1.05, 2.28; p = 0.03; I² = 89.1%) in contrast to mercury exposure (p = 0.89). Only two studies reported the link between arsenic exposure and proteinuria risk, while no study reported the link between mercury exposure and proteinuria risk. Exposure to cadmium, lead, and arsenic may increase CKD risk in adults, albeit studies were heterogeneous, warranting further investigations. Our observations support the consideration of these associations for preventative, diagnostic, monitoring, and management practices of CKD.

Keywords:

• Human health
• exposure
• heavy metals
• kidney
• renal dysfunction

Acknowledgements

The authors gratefully acknowledge the pre-submission reviews provided by Dr. Bijan Bina, Professor of Environmental Health Department of Environmental Health Engineering, School of Health Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences; Dr. Karim Ebrahimpour, Assistant Professor of Toxicology and Pharmacology Department of Environmental Health Engineering, School of Health Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences; Dr. Ali Fatehizadeh, Assistant Professor of Environmental Health Department of Environmental Health Engineering, School of Health Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences. All aspects of this article, including the research questions addressed, the methods developed and applied, and the conclusions reached, are solely the authors’. Moreover, the authors would like to thank the Isfahan University of Medical Sciences of Iran [Grant No. 199284] for the financial support of this work.

Declaration of interest

The authors report no conflicts of interest. The authors’ affiliation is as shown on the cover page. The institutions with which the authors are affiliated are academic institutions, and the authors take sole responsibility for the writing and content of the manuscript. The authors were compensated using internal institutional funds [Grant No. 199284], no external funding was used to support the authors.

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