Striking association between urinary cadmium level and albuminuria among Torres Strait Islander people with diabetes.
OBJECTIVE
Indigenous people of the Torres Strait (Australia) have greater potential for cadmium exposure and renal damage than other Australians due to high cadmium in some traditional seafood and a high prevalence of Type 2 diabetes, hypertension, smoking, and obesity. This study explored associations between albuminuria and an index of cadmium exposure (urinary cadmium excretion) in the presence and absence of Type 2 diabetes.


METHODS
Two population-based, cross-sectional studies were undertaken in the Torres Strait to obtain data on body mass index (BMI), blood pressure, chronic disease, smoking, urinary cadmium, and albumin creatinine ratio (ACR).


RESULTS
Age- and BMI-adjusted urinary cadmium levels were significantly higher (p<0.01) among people with diabetes and albuminuria (n=22, geometric mean (GM) 1.91 microg Cd/g creatinine) compared to those with diabetes and normal ACR (n=21, GM 0.74 microg Cd/g creatinine). Urinary cadmium was also strongly associated (p<0.001) with ACR among people with diabetes in regression models and remained significant after controlling for age, sex, BMI, smoking status, and hypertension (or continuous systolic and diastolic measurements).


CONCLUSIONS
While the study has methodological limitations and the nature of the association is unclear, the striking dose-dependent links between markers of cadmium exposure and of Type 2 diabetic nephropathy highlight the need for further definitive research on the health effects of cadmium in the presence of diabetes.
Haswell-Elkins
Melissa
M
North Queensland Health Equalities Promotion Unit, School of Medicine, University of Queensland, Cairns, Qld 4870, Australia. Melissa_haswell@health.qld.gov.au
Satarug
Soisungwan
S
O'Rourke
Peter
P
Moore
Michael
M
Ng
Jack
J
McGrath
Victor
V
Walmby
Maria
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000652:urine*; D002104:Cadmium / Q000652:urine*; D002105:Cadmium Poisoning / Q000150:complications / Q000652:urine*; D003924:Diabetes Mellitus, Type 2 / Q000652:urine*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011793:Queensland
D002104:Cadmium