title: Association of environmental cadmium exposure with inflammation and malnutrition in maintenance haemodialysis patients.
abstract: BACKGROUND
  Chronic inflammation and malnutrition are associated with increased risk of cardiovascular death, and may cause protein-energy wasting in individuals with chronic kidney disease. Raised blood cadmium (Cd) levels were observed in maintenance haemodialysis (HD) patients in previous studies. However, the correlation of Cd exposure with inflammation and malnutrition remains uncertain. This study examined the possible adverse effects of environmental Cd exposure in maintenance HD patients.
  
  
  METHODS
  A total of 954 maintenance HD patients were enrolled and divided into four equal-sized groups based on blood Cd levels. Geographic, haematological, biochemical and dialysis-related data were obtained. The analysis included values for nutritional and inflammatory markers.
  
  
  RESULTS
  Abnormal blood Cd levels (> or =1 microg/L) were exhibited in 26.8% (256/954) of studied subjects. More subjects in the highest quartile group were malnourished (chi- square = 23.27; P < 0.0001) and had inflammatory changes (chi-square = 13.99; P = 0.0029) than in the lowest quartile group. Stepwise multiple regression analysis revealed a significant inverse correlation between serum albumin and blood Cd levels. Notably, a 10-fold increase in blood Cd levels was associated with a 0.06 g/dL decrease in serum albumin levels (P = 0.0060). Multivariate regression analysis also demonstrated a positive correlation between inflammatory risk (high-sensitivity C-reactive protein >3 mg/L) and blood Cd levels. The risk ratio of inflammation with a 10-fold increase in blood Cd levels was 1.388 (95% CI: 1.025-1.825, P = 0.0336).
  
  
  CONCLUSIONS
  Environmental Cd exposure is significantly associated with malnutrition, inflammation and even protein-energy wasting in maintenance HD patients. It is important for this population to avoid diets with high Cd concentrations and smoking.
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, 199, Tung-Hwa North Road, Taipei, Taiwan, ROC.
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
authors.forename: Tai-Chin
authors.initials: TC
authors.lastname: Ho
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Huang
authors.forename: Li-Mei
authors.initials: LM
authors.lastname: Yeh
authors.forename: Lan-Mei
authors.initials: LM
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002104:Cadmium / Q000009:adverse effects* / Q000097:blood; D002105:Cadmium Poisoning / Q000097:blood / Q000453:epidemiology*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000139:chemically induced*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000139:chemically induced*; D008875:Middle Aged; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000139:chemically induced; D006435:Renal Dialysis; D055815:Young Adult
chemical_list: D002104:Cadmium