Associations between arsenic in drinking water and the progression of chronic kidney disease: A nationwide study in Taiwan.
To evaluate the associations between exposure to arsenic in drinking water and the progression of chronic kidney disease (CKD), we conducted a study in Taiwan. We recruited 8854 participants from a nationwide health screening program from 2000 to 2009 who were at least 20 years old and had two checkups in a 24-month period with at least 12 months apart. We defined CKD as having an estimated glomerular filtration rate (eGFR)<90ml/min/1.73m2or renal dysfunction demonstrated by proteinuria and a rapid progression of CKD as a decline in eGFR>5ml/min/1.73m2/year. Arsenic levels were assessed on the basis of a governmental nationwide survey. Of the 8854 participants, 1341 exhibited rapid progression. Participants who lived in areas with arsenic levels≥50μg/L had a higher risk of rapid progression, with an odds ratio of 1.22 (95% confidence interval: 1.05-1.42, p<0.01) after adjusting for hypertension, diabetes mellitus, proteinuria, and anemia. The results showed that a high arsenic level in drinking water was a risk factor for rapid progression of CKD, independent of most of the documented risk factors. Screening and intervention programs should be implemented in endemic areas of exposure to reduce the risk.
Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan.
Ya-Yun
YY
Cheng
Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan; Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaoshiung, Taiwan.
Neng-Chyan
NC
Huang
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Yu-Tzu
YT
Chang
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Junne-Ming
JM
Sung
Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology and Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Urology, Taipei Medical University, Taipei, Taiwan.
Kun-Hung
KH
Shen
Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Chang-Chih
CC
Tsai
Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan. Electronic address: hrguo@mail.ncku.edu.tw.
How-Ran
HR
Guo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001151:Arsenic / Q000009:adverse effects* / Q000032:analysis*; D018450:Disease Progression; D060766:Drinking Water / Q000009:adverse effects* / Q000032:analysis*; D019353:Endemic Diseases; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology; D014874:Water Pollutants, Chemical / Q000009:adverse effects*
D060766:Drinking Water; D014874:Water Pollutants, Chemical; D001151:Arsenic
Arsenic; Chronic kidney disease; Drinking water; Rapid progression; Taiwan