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Cadmium or cadmium compounds and chronic kidney disease in workers and the general population: a systematic review


Byber, Katarzyna; Lison, Dominique; Verougstraete, Violaine; Dressel, Holger; Hotz, Philipp (2016). Cadmium or cadmium compounds and chronic kidney disease in workers and the general population: a systematic review. Critical Reviews in Toxicology, 46(3):191-240.

Abstract

Background: Cadmium (Cd) is abundantly documented as a metal mainly affecting tubular function both in workers and in the general population indirectly exposed via the environment. Results from epidemiological studies linking Cd exposure and risk of progression to chronic kidney disease (CKD) are, however, conflicting. Objectives: To perform a systematic review of the association between Cd exposure and CKD. Methods: A systematic appraisal of publications found in MEDLINE (1946–2014), EMBASE (1974–2012) and an in-house database (1986–2013) was conducted. Additional studies were searched for by contacting experts and checking reference lists. Search terms used key and text words. No language restriction was applied. Cohort, case–control and case-series with follow-up including individual and objective assessment of occupational or environmental exposure were eligible. Studies were selected and data extracted by two independent reviewers using predefined forms. Study characteristics and results were extracted to structured tables. Synthesis was qualitative and results appraised with causality criteria. Results: Thirty-four exposed groups, totaling more than 3000 participants, were eligible. Overall, results disclosed no convincing evidence supporting a risk of progression to CKD in populations exposed to Cd. Lack of information about methods, risk of bias and heterogeneity were identified as limitations and precluded conducting a meta-analysis. Publication bias did not appear as a major problem. Conclusions: This qualitative systematic review does not support the contention that human exposure to Cd leads to progressive CKD. Abbreviations: AQC: analytical quality control; A1MG: a1-microglobulin; B2MG: b2-microglobulin; Cd: cadmium; Cd-B: cadmium in blood; Cd-kidney: Cd in kidney; Cd-liver: Cd in liver; Cd-U: cadmium in urine; CI: confidence interval; ClC5: chloride channel 5; CKD: chronic kidney disease; CKD-EPI: CKD Epidemiology Collaboration; CKDu: chronic kidney disease of unknown origin; ESRD: end-stage renal disease (kidney failure treated by dialysis or transplantation); GFR: glomerular filtration rate; eGFR: estimated glomerular filtration rate; GM: geometric mean; GSD: geometric standard deviation; HMW: high-molecular-weight; ICD: International Classification of Diseases; KDIGO: Kidney Disease Improving Global Outcomes; LMW: low-molecular-weight; MDRD: Modification of Diet in Renal Disease; mGFR: measured GFR; NA: non-applicable; NAG: N-acetyl-b-D-glucosaminidase; NI: no information; ND: not done; ns: non-significant; P: plasma; RBP: retinol-binding protein; RRT: renal replacement therapy; S: serum; SD: standard deviation; SMR: standardized mortality ratio; U: urine

Abstract

Background: Cadmium (Cd) is abundantly documented as a metal mainly affecting tubular function both in workers and in the general population indirectly exposed via the environment. Results from epidemiological studies linking Cd exposure and risk of progression to chronic kidney disease (CKD) are, however, conflicting. Objectives: To perform a systematic review of the association between Cd exposure and CKD. Methods: A systematic appraisal of publications found in MEDLINE (1946–2014), EMBASE (1974–2012) and an in-house database (1986–2013) was conducted. Additional studies were searched for by contacting experts and checking reference lists. Search terms used key and text words. No language restriction was applied. Cohort, case–control and case-series with follow-up including individual and objective assessment of occupational or environmental exposure were eligible. Studies were selected and data extracted by two independent reviewers using predefined forms. Study characteristics and results were extracted to structured tables. Synthesis was qualitative and results appraised with causality criteria. Results: Thirty-four exposed groups, totaling more than 3000 participants, were eligible. Overall, results disclosed no convincing evidence supporting a risk of progression to CKD in populations exposed to Cd. Lack of information about methods, risk of bias and heterogeneity were identified as limitations and precluded conducting a meta-analysis. Publication bias did not appear as a major problem. Conclusions: This qualitative systematic review does not support the contention that human exposure to Cd leads to progressive CKD. Abbreviations: AQC: analytical quality control; A1MG: a1-microglobulin; B2MG: b2-microglobulin; Cd: cadmium; Cd-B: cadmium in blood; Cd-kidney: Cd in kidney; Cd-liver: Cd in liver; Cd-U: cadmium in urine; CI: confidence interval; ClC5: chloride channel 5; CKD: chronic kidney disease; CKD-EPI: CKD Epidemiology Collaboration; CKDu: chronic kidney disease of unknown origin; ESRD: end-stage renal disease (kidney failure treated by dialysis or transplantation); GFR: glomerular filtration rate; eGFR: estimated glomerular filtration rate; GM: geometric mean; GSD: geometric standard deviation; HMW: high-molecular-weight; ICD: International Classification of Diseases; KDIGO: Kidney Disease Improving Global Outcomes; LMW: low-molecular-weight; MDRD: Modification of Diet in Renal Disease; mGFR: measured GFR; NA: non-applicable; NAG: N-acetyl-b-D-glucosaminidase; NI: no information; ND: not done; ns: non-significant; P: plasma; RBP: retinol-binding protein; RRT: renal replacement therapy; S: serum; SD: standard deviation; SMR: standardized mortality ratio; U: urine

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Additional indexing

Contributors:Division of Occupational and Environmental Medicine
Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2016
Deposited On:26 Nov 2015 11:32
Last Modified:05 Apr 2016 19:33
Publisher:Informa Healthcare
ISSN:1040-8444
Publisher DOI:https://doi.org/10.3109/10408444.2015.1076375
PubMed ID:26513605

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