Renal Effects and Carcinogenicity of Occupational Exposure to Uranium: A Meta-Analysis.
OBJECTIVE
Uranium is a heavy metal with alpha radioactivity. We state the hypothesis that uranium exposure is harmful to human kidneys and carcinogenic to body tissues. Therefore, we review epidemiological studies from people with known long-lasting uranium exposure.


METHODS
Three meta-analyses are performed using clinical studies published in the PubMed database and applying RevMan 5.3 from the Cochrane Collaboration to calculate the outcome. The first two meta-analyses examine the standardized mortality ratio (SMR) and the standardized incidence ratio for any cancers of uranium workers who were operating in areas ranging from uranium processing to the assembly of final uranium products. The third meta-analysis evaluates the nephrotoxic risk in uranium workers as well as soldiers and of individuals with exposure to drinking water containing uranium.


RESULTS
Overall and contrasting to our hypothesis, the tumor risk is significantly lower for uranium workers than for control groups (SMR = 0.90 with a 95% confidence interval of 0.84 to 0.96). In addition and also contrasting to our hypothesis, the risk of nephrotoxicity is not increased either. This holds for both the incidence and the mortality due to renal cell carcinoma or due to acute kidney injury or chronic kidney disease. In contrast, a significantly better creatinine clearance is found for the uranium cohort as compared to the control groups (mean difference = 7.66 with a 95% confidence interval of 0.12 to 15.2).


CONCLUSIONS
Our hypothesis that a chronic uranium exposure is associated with an increased risk of cancer mortality or of kidney failure is refuted by clinical data. The decreased risk may result from better medical surveillance of uranium workers.
Nephrology, Department of Internal Medicine 1, Ulm University, Ulm, Germany.
Leonhard
L
Stammler
Ambulatorium Wiesendamm, Basel, Switzerland.
Andreas
A
Uhl
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Benjamin
B
Mayer
Nephrology, Department of Internal Medicine 1, Ulm University, Ulm, Germany.
Frieder
F
Keller
Biomarker; Carcinogenicity; Kidney; Meta-analysis; Standardized incidence ratio; Standardized mortality ratio; Uranium exposure