Abstract
This chapter highlights key issues related to accumulation of toxic metals and trace elements in chronic dialysis patients, with special emphasis on lead and cadmium, but excluding aluminum. In a meta-analysis study, it has been demonstrated that blood levels of lead, cadmium, chromium, copper, and vanadium were higher in maintenance hemodialysis patients than control counterparts. Clinical evidences have suggested that elevated blood lead levels were associated with hypertension-related morbidity and mortality, and accelerated age-related renal function impairment in the general population. In earlier studies, we have showed that environmental exposure to lead was related to progressive renal insufficiency in patients with and without diabetes, and that chelation therapy may retard the progression of renal insufficiency in these patients. In a large-scale, cross-sectional, prospective study, we have showed that blood lead levels were associated with inflammation, malnutrition, and 1-year mortality in 211 diabetic patients treated with maintenance hemodialysis. In another 18-month study, we have revealed that high blood lead level was associated with increased hazard ratios for allcause, cardiovascular-cause, and infection-cause 18-month mortality in 927 maintenance hemodialysis patients. In a peritoneal dialysis population, we also revealed that blood lead levels were associated with residual renal function and hyperparathyroidism, and were related to increased hazard ratio for all-cause 18-month mortality. Cadmium can cause kidney damage even at very low levels of exposure. In patients with end-stage renal disease, cadmium may accumulate in bone tissue, increasing the bone cadmium content in these patients. In a study, we have demonstrated that environmental cadmium exposure was significantly associated with inflammation and malnutrition in maintenance hemodialysis patients. Following adjustment for potential confounders, blood cadmium levels were negatively correlated with serum albumin levels, but were positively correlated with high sensitivity-C reactive protein. Overall, a 10-fold increase in blood cadmium levels was associated with a 0.06 g/dL decrease in serum albumin levels. This is of particular importance in diabetics, because there may exist a positive association between cadmium exposure and the severity of diabetes, as well as diabetes-related organ damage. In another study, we have confirmed that elevated blood cadmium levels were associated with increased hazard ratio for 18-month all-cause mortality in diabetic patients undergoing maintenance hemodialysis.
Original language | English |
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Title of host publication | Issues in Dialysis |
Publisher | Nova Science Publishers, Inc. |
Pages | 251-264 |
Number of pages | 14 |
ISBN (Print) | 9781624175763 |
State | Published - 2013 |
Externally published | Yes |