title: Mortality and causes of deaths of inhabitants with renal dysfunction induced by cadmium exposure of the polluted Jinzu River basin, Toyama, Japan; a 26-year follow-up.
abstract: BACKGROUND
  We aimed to investigate the mortality and causes of deaths of inhabitants with renal dysfunction induced by cadmium (Cd) exposure caused by heavy environmental contamination.
  
  
  METHODS
  We conducted a 26-year follow-up survey targeting 7529 inhabitants of the Cd-polluted Jinzu River basin and 2149 controls from non-polluted areas who participated in urinary examinations for proteinuria and glucosuria conducted in 1979 to 1984. When the residents were divided into 4 groups, no finding group, glucosuria group, proteinuria group, glucoproteinuria group, mortality risk ratios for all and specific causes of these groups in the polluted area were compared with that of controls without glucosuria and/or proteinuria after adjustments for age at baseline, smoking status, and history of hypertension using Cox's proportional hazard model.
  
  
  RESULTS
  The mortality risk ratios for all causes of proteinuria and glucoproteinuria in men and glucosuria, proteinuria, and glucoproteinuria in women of the polluted areas significantly increased compared with those of the controls with no urinary findings. Respiratory, renal, and cardiovascular diseases and diabetes in men, and all diseases except cerebrovascular diseases in women contributed toward an increased mortality of exposed glucoproteinuria groups, which involved chronic Cd toxicosis with renal tubular dysfunction. In women, the mortality risks for cancer of the colon and rectum, uterus and kidney and urinary tract were significantly higher in the exposed proteinuria and glucoproteinuria groups, suggesting associations between renal damage and cancer risk. In exposed women, the no finding group and glucoproteinuria group also showed increased mortality from ischemic heart diseases, indicating that all exposed women may be at risk for ischemic heart diseases. Although the control glucosuria and/or proteinuria group also showed high mortality for diabetes and renal diseases, the increased risk ratio for renal disease mortality was much higher in exposed subjects with urinary findings, particularly in women.
  
  
  CONCLUSIONS
  These findings indicate that inhabitants with renal effects caused by Cd exposure had a poor life prognosis over long-term observation in both genders. Particularly in women, renal tubular dysfunction indicated by glucoproteinuria may increase mortality from cancer, ischemic heart diseases, and renal diseases.
authors.forename: Shoko
authors.initials: S
authors.lastname: Maruzeni
authors.affiliation: Department of Public Health, Kanazawa Medical University, Uchinada 920-0293, Japan. ni-koei@kanazawa-med.ac.jp.
authors.forename: Muneko
authors.initials: M
authors.lastname: Nishijo
authors.forename: Koshi
authors.initials: K
authors.lastname: Nakamura
authors.forename: Yuko
authors.initials: Y
authors.lastname: Morikawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Sakurai
authors.forename: Motoko
authors.initials: M
authors.lastname: Nakashima
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Kido
authors.forename: Rie
authors.initials: R
authors.lastname: Okamoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nogawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Suwazono
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakagawa
mesh_terms: D001991:Bronchitis / Q000401:mortality / Q000652:urine; D002104:Cadmium / Q000633:toxicity* / Q000652:urine; D002318:Cardiovascular Diseases / Q000401:mortality / Q000652:urine; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality / Q000652:urine; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006029:Glycosuria / Q000209:etiology / Q000401:mortality* / Q000652:urine; D006306:Health Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007674:Kidney Diseases / Q000139:chemically induced* / Q000401:mortality* / Q000652:urine; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000652:urine; D016017:Odds Ratio; D011014:Pneumonia / Q000401:mortality / Q000652:urine; D011507:Proteinuria / Q000209:etiology / Q000401:mortality* / Q000652:urine; D045483:Rivers; D014874:Water Pollutants, Chemical / Q000633:toxicity* / Q000652:urine; D014881:Water Supply
chemical_list: D014874:Water Pollutants, Chemical; D002104:Cadmium