TY - JOUR
T1 - Urine arsenic and prevalent albuminuria
T2 - Evidence from a population-based study
AU - Zheng, Laura Y.
AU - Umans, Jason G.
AU - Tellez-Plaza, Maria
AU - Yeh, Fawn
AU - Francesconi, Kevin A.
AU - Goessler, Walter
AU - Silbergeld, Ellen K.
AU - Guallar, Eliseo
AU - Howard, Barbara V.
AU - Weaver, Virginia M.
AU - Navas-Acien, Ana
N1 - Funding Information:
Support: Supported by grants from the National Heart, Lung and Blood Institute ( HL090863 and SHS grants HL41642 , HL41652 , HL41654 , and HL65521 ) and the National Institute of Environmental Health Sciences ( P30ES03819 ). Ms Zheng was supported by a T32 training grant from the National Institute of Environmental Health Sciences ( ES103650 ).
Funding Information:
In this study, our objective was to investigate the relationship between arsenic exposure, as measured in urine, with the presence of albuminuria in the Strong Heart Study (SHS). The SHS is a population-based study funded by the National Heart, Lung and Blood Institute to evaluate cardiovascular disease and its risk factors in American Indian communities from Arizona, Oklahoma, and North and South Dakota. 18,19 Albuminuria, the excess of serum albumin in urine due to increased filtration through damaged glomeruli or decreased reabsorption in proximal tubules, 20,21 is an important risk factor for cardiovascular disease in this population. 22 In the SHS communities, the primary source of arsenic exposure is through drinking water, and we recently confirmed long-term exposure at low to moderate arsenic levels. 19 In this setting, it is essential to assess the potential for arsenic as a novel preventable risk factor for albuminuria.
PY - 2013/3
Y1 - 2013/3
N2 - Background: Long-term arsenic exposure is a major global health problem. However, few epidemiologic studies have evaluated the association of arsenic with kidney measures. Our objective was to evaluate the cross-sectional association between inorganic arsenic exposure and albuminuria in American Indian adults from rural areas of Arizona, Oklahoma, and North and South Dakota. Study Design: Cross-sectional. Setting & Partipants: Strong Heart Study locations in Arizona, Oklahoma, and North and South Dakota. 3,821 American Indian men and women aged 45-74 years with urine arsenic and albumin measurements. Predictor: Urine arsenic. Outcomes: Urine albumin-creatinine ratio and albuminuria status. Measurements: Arsenic exposure was estimated by measuring total urine arsenic and urine arsenic species using inductively coupled plasma mass spectrometry (ICPMS) and high-performance liquid chromatography-ICPMS, respectively. Urine albumin was measured by automated nephelometric immunochemistry. Results: The prevalence of albuminuria (albumin-creatinine ratio ≥30 mg/g) was 30%. Median value for the sum of inorganic and methylated arsenic species was 9.7 (IQR, 5.8-15.6) μg per gram of creatinine. Multivariable-adjusted prevalence ratios of albuminuria (albumin-creatinine ratio ≥30 mg/g) comparing the 3 highest to lowest quartiles of the sum of inorganic and methylated arsenic species were 1.16 (95% CI, 1.00-1.34), 1.24 (95% CI, 1.07-1.43), and 1.55 (95% CI, 1.35-1.78), respectively (P for trend <0.001). The association between urine arsenic and albuminuria was observed across all participant subgroups evaluated and was evident for both micro- and macroalbuminuria. Limitations: The cross-sectional design cannot rule out reverse causation. Conclusions: Increasing urine arsenic concentrations were cross-sectionally associated with increased albuminuria in a rural US population with a high burden of diabetes and obesity. Prospective epidemiologic and mechanistic evidence is needed to understand the role of arsenic as a kidney disease risk factor.
AB - Background: Long-term arsenic exposure is a major global health problem. However, few epidemiologic studies have evaluated the association of arsenic with kidney measures. Our objective was to evaluate the cross-sectional association between inorganic arsenic exposure and albuminuria in American Indian adults from rural areas of Arizona, Oklahoma, and North and South Dakota. Study Design: Cross-sectional. Setting & Partipants: Strong Heart Study locations in Arizona, Oklahoma, and North and South Dakota. 3,821 American Indian men and women aged 45-74 years with urine arsenic and albumin measurements. Predictor: Urine arsenic. Outcomes: Urine albumin-creatinine ratio and albuminuria status. Measurements: Arsenic exposure was estimated by measuring total urine arsenic and urine arsenic species using inductively coupled plasma mass spectrometry (ICPMS) and high-performance liquid chromatography-ICPMS, respectively. Urine albumin was measured by automated nephelometric immunochemistry. Results: The prevalence of albuminuria (albumin-creatinine ratio ≥30 mg/g) was 30%. Median value for the sum of inorganic and methylated arsenic species was 9.7 (IQR, 5.8-15.6) μg per gram of creatinine. Multivariable-adjusted prevalence ratios of albuminuria (albumin-creatinine ratio ≥30 mg/g) comparing the 3 highest to lowest quartiles of the sum of inorganic and methylated arsenic species were 1.16 (95% CI, 1.00-1.34), 1.24 (95% CI, 1.07-1.43), and 1.55 (95% CI, 1.35-1.78), respectively (P for trend <0.001). The association between urine arsenic and albuminuria was observed across all participant subgroups evaluated and was evident for both micro- and macroalbuminuria. Limitations: The cross-sectional design cannot rule out reverse causation. Conclusions: Increasing urine arsenic concentrations were cross-sectionally associated with increased albuminuria in a rural US population with a high burden of diabetes and obesity. Prospective epidemiologic and mechanistic evidence is needed to understand the role of arsenic as a kidney disease risk factor.
KW - Albuminuria
KW - American Indian
KW - arsenic
KW - kidney disease
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U2 - 10.1053/j.ajkd.2012.09.011
DO - 10.1053/j.ajkd.2012.09.011
M3 - Article
C2 - 23142528
AN - SCOPUS:84874082135
SN - 0272-6386
VL - 61
SP - 385
EP - 394
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -