Effect of Blood Cadmium Level on Mortality in Patients Undergoing Maintenance Hemodialysis.
Previous studies of general populations indicated environmental exposure to low-level cadmium increases mortality. However, the effect of cadmium exposure on maintenance hemodialysis (MHD) patients is unclear.A total of 937 MHD patients from 3 centers in Taiwan were enrolled in this 36-month observational study. Patients were stratified by baseline blood cadmium level (BCL) into 3 groups: high BCL (>0.521 μg/L; n = 312), intermediate BCL (0.286-0.521 μg/L; n = 313), and low BCL (<0.286 μg/L; n = 312). The mortality rates and causes of death were analyzed.The analytic results demonstrated patients in the high BCL group had a significantly higher prevalence of malnutrition and inflammation than patients in the low and intermediate BCL groups. After 3 years of follow-up, 164 (17.5%) patients died and the major cause of death was cardiovascular disease. A Cox multivariate analysis indicated the high BCL group had increased hazard ratios (HRs) for all-cause mortality (HR = 1.72; 95% confidence interval [CI]: 1.14-2.63; P = 0.018), cardiovascular-related mortality (HR = 1.85; 95% CI: 1.09-3.23; P = 0.032), and infection-related mortality (HR = 2.27; 95% CI: 1.12-4.55; P = 0.035). A Cox multivariate analysis of MHD patients who never smoked (n = 767) indicated the high BCL group had increased HRs for all-cause mortality (HR = 1.67; 95% CI: 1.04-2.63; P = 0.048) and cardiovascular-related mortality (HR = 2.08; 95% CI: 1.08-4.00; P = 0.044).In conclusion, BCL is an important determinant of mortality in MHD patients. Therefore, MHD patients should avoid cadmium exposure as much as possible, such as tobacco smoking and eating cadmium-containing foods.
From the Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei (CWH, THY, KHC, DTLT, JLL, CHW, WHH); Department of Nephrology and Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan (CWH, THY, KHC, DTLT, JLL, CHW, WHH); and Chang Gung University and School of Medicine, Taipei, Taiwan, ROC (CWH, THY, KHC, DTLT, JLL, CHW, WHH).
Ching-Wei
CW
Hsu
Tzung-Hai
TH
Yen
Kuan-Hsing
KH
Chen
Dan-Tzu
DT
Lin-Tan
Ja-Liang
JL
Lin
Cheng-Hao
CH
Weng
Wen-Hung
WH
Huang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002104:Cadmium / Q000097:blood*; D002648:Child; D015897:Comorbidity; D003928:Diabetic Nephropathies / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D007854:Lead / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D055815:Young Adult
D002104:Cadmium; D007854:Lead