title: Association between arsenic exposure from drinking water and proteinuria: results from the Health Effects of Arsenic Longitudinal Study.
abstract: BACKGROUND
  Proteinuria has been recognized as a marker for an increased risk of chronic renal disease. It is unclear whether arsenic (As) exposure from drinking water is associated with proteinuria.
  
  
  METHODS
  We evaluated the association between As exposure from drinking water and proteinuria in 11,122 participants in the Health Effects of Arsenic Longitudinal Study (HEALS). Proteinuria was detected by urinary dipstick tests at baseline and at 2-year intervals. As exposure variables included baseline well As and changes in urinary As during follow-up modelled as time-dependent variables in the analyses.
  
  
  RESULTS
  At baseline, well As was positively related to prevalence of proteinuria; prevalence odds ratios (PORs) for proteinuria in increasing quintiles of well As (≤ 7, 8-39, 40-91, 92-179 and 180-864 µg/l) were 1.00 (ref), POR 0.99 [95% confidence interval (CI) 0.77-1.27], POR 1.23 (95% CI 0.97-1.57), POR 1.50 (95% CI 1.18-1.89) and POR 1.59 (95% CI 1.26-2.00) (P for trend <0.01). Hazard ratios for incidence of proteinuria were POR 0.83 (95% CI 0.67-1.03) and POR 0.91 (95% CI 0.74-1.12) for participants with a decreasing level of >70 and 17-70 µg/l in urinary As over time, respectively, and were POR 1.17 (95% CI 0.97-1.42) and POR 1.42 (95% CI 1.16-1.73) for participants with an increasing level of 16-68 and >68 µg/l in urinary As over time, respectively, compared with the group with relatively little changes in urinary As as the reference group (urinary As -16 to 15 µg/l).
  
  
  CONCLUSIONS
  The findings suggest that there are adverse effects of As exposure on the risk of proteinuria and the effects are modifiable by recent changes in As exposure.
authors.affiliation: Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA. yu.chen@nyumc.org
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Faruque
authors.initials: F
authors.lastname: Parvez
authors.forename: Mengling
authors.initials: M
authors.lastname: Liu
authors.forename: Gene R
authors.initials: GR
authors.lastname: Pesola
authors.forename: Mary V
authors.initials: MV
authors.lastname: Gamble
authors.forename: Vesna
authors.initials: V
authors.lastname: Slavkovich
authors.forename: Tariqul
authors.initials: T
authors.lastname: Islam
authors.forename: Alauddin
authors.initials: A
authors.lastname: Ahmed
authors.forename: Rabiul
authors.initials: R
authors.lastname: Hasan
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Graziano
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
mesh_terms: D017677:Age Distribution; D001151:Arsenic / Q000009:adverse effects*; D020261:Arsenic Poisoning / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003906:Developing Countries; D060766:Drinking Water / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D011507:Proteinuria / Q000453:epidemiology* / Q000209:etiology; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D016482:Urinalysis
chemical_list: D060766:Drinking Water; D001151:Arsenic