Renal effects of low-level environmental cadmium exposure: 5-year follow-up of a subcohort from the Cadmibel study

Cadmium Monitoring at the Workplace: Effectiveness of a Combination of Air- and Biomonitoring

Inhalation exposure to cadmium at the workplace has been associated with an increased risk of lung cancer and non-cancer respiratory effects. To ensure levels of cadmium remain below effect levels, air quality is monitored and regulations specifying an air limit value are implemented. The EU Carcinogens and Mutagens Directive of 2019 recommended values for the inhalable fraction and the respirable fraction but the latter only for a transitional period. Cadmium exposure has also been associated with systemic effects, following its storage in the kidneys and due to its long half-life. The accumulation of cadmium occurs via different exposure routes and from different sources, including workplace dust and fumes, food, and smoking. Biomonitoring (in blood, urine) has been identified as the most appropriate method to follow up cumulative exposure and total cadmium body burden, as it conveniently reflects intakes by all routes. However, it is not systematically implemented. This paper has a double objective: first, proposing a possible limit value for the respirable fraction, using an approach integrating epidemiological data. Secondly, demonstrating that the implementation of both air and biological limit values is key to protecting workers' health in occupational settings. The paper summarizes the current knowledge on cadmium health effects and how biomarkers reflect those. It presents an approach to derive a respirable value, using recent human data, and describes how the combination of air monitoring and biomonitoring is applied by the EU industry to protect the workforce. While a respirable fraction value helps protect workers against local respiratory adverse health effects, air monitoring alone is not sufficient to protect workers against systemic effects of cadmium. Therefore, complementary biomonitoring and the implementation of a biological limit value is recommended.

Heavy metals in soils around non-ferrous smelteries in China: Status, health risks and control measures

Non-ferrous smelting is a primary cause of serious soil pollution. Contamination and health risks of heavy metals in soils around various types of non-ferrous smelteries in China were assessed using data from peer-reviewed papers published between 2000 and 2019. Development in the relevant environmental policy in China was discussed. The studied non-ferrous smelting sites were mainly located in provinces that produced non-ferrous metals on a large scale. The average concentrations of the heavy metals in soils around the non-ferrous smelteries (in mg per kg of soil) were as follows: Cd, 19.8; Cu, 265; Pb, 1536; and Zn, 1371; the concentrations greatly exceeded their corresponding background values. The smelting sites with high soil contamination in terms of metal concentrations, geo-accumulation (I_geo), and pollution index (PI) were mainly distributed in several provinces of China, including Guangxi, Gansu, Hunan, Hubei, Chongqing, and Liaoning. Soils near smelteries that processed copper were the most polluted based on I_geo and PI. The accumulation of Cd and Pb in soils around non-ferrous smelteries would pose potentially high risks to residents. A series of environmental policies have proven successful in lowering the emissions of contaminants from the non-ferrous in China. The findings of the study suggested that the strategies to control soil pollution around non-ferrous smelteries should primarily focus on Cd and Pb.

Association Between Serum Cadmium and Arsenic Levels with Bladder Cancer: A Case-control Study

Background: Bladder cancer is the second most common cancer of the genitourinary system and the eighth cause of cancer death. In addition to known risk factors such as smoking and urinary stones, trace elements are also effective in causing bladder cancer and other cancers. Objectives: This study was conducted to determine the association between bladder cancer and the carcinogens cadmium and arsenic. Methods: This case-control study was conducted on 40 patients with bladder cancer admitted to Shahid Bahonar Hospital and a control group of 40 healthy individuals in Kerman, Iran, in 2018. The serum levels of arsenic and cadmium were measured by atomic absorptiometry. The paired t-test and chi-square tests were employed to assess the difference between cases and controls groups. An unadjusted and 2 multivariable conditional regression models were separately adjusted on sex, family cancer history, residence, occupation, and smoking and were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to assess the association between arsenic and cadmium levels and bladder cancer. The statistical software SPSS version 26 and R software version 3.6.3 were used to perform the statistical analyses. Results: The mean cadmium level was 2.99 ± 1.45 and 2.59 ± 0.46 in the case and control groups, respectively, with no statistically significant difference between the groups (P = 0.100). The mean arsenic level was 2.12 ± 1.04 and 1.43 ± 0.73 in the case and control groups, respectively, demonstrating a statistically significant difference between the groups (P = 0.001). Unadjusted and adjusted conditional logistic regression models indicated significant association between arsenic levels and bladder cancer (unadjusted: odds ratio (OR) (95% CI): 0.66 (0.46 - 0.94), P-value = 0.022; adjusted: OR (95% CI): 0.64 (0.44 - 0.92), P-value = 0.018). Conclusions: Overall, cadmium and arsenic levels are higher in patients with bladder cancer, with a statistically significant difference for arsenic. However, these elements are not interrelated and are not related to other factors.

Dose-response evaluation of urinary cadmium and kidney injury biomarkers in Chinese residents and dietary limit standards

BACKGROUND

Cadmium (Cd) is a common heavy metal that mainly causes renal damage. There is a lack of research on the large-scale and systematic evaluation of the association between urinary Cd (U-Cd) and various effect biomarkers among Chinese residents.

METHODS

Based on the establishment process of dietary Cd limit standards by European Food Safety Authority (EFSA), the dose-response relationships between U-Cd and four biomarkers, β₂-microglobulin (β₂-MG), N-acetyl-β-glucosidase (NAG), microalbumin (mALB), and retinol binding Protein (RBP) were explored, respectively. Toxicokinetic model was used to derive the dietary Cd exposure limit for Chinese residents after critical U-Cd concentration was calculated.

RESULTS

As the sensitive biomarkers of renal injury, β₂-MG and NAG were selected to estimate the 95% confidence interval lower limit of the U-Cd benchmark dose (BMDL₅) to be 3.07 and 2.98 μg/g Cr, respectively. Dietary Cd exposure limit was calculated to be 0.28 μg/kg bw/day (16.8 μg/day, based on the body weight of 60 kg), which was lower than the average Chinese Cd exposure (30.6 μg/day) by the China National Nutrient and Health Survey.

CONCLUSION

This study established an overall association between U-Cd and renal injury biomarkers, and explored the Chinese dietary Cd exposure limits, which helps improve Chinese Cd exposure risk assessment and provides a reference basis for formulating reasonable exposure standards.

Normal variability of 22 elements in 24-hour urine samples - Results from a biobank from healthy non-smoking adults

BACKGROUND

Urine is often used for biomonitoring the exposure to elements. However, most studies report concentrations in spot urine samples, which may not accurately mirror the "gold standard" of complete 24-h (24 h) urine samples. There are relatively few data published for 24 h samples, and little information on the within- and between person variability.

OBJECTIVES

The present study aimed at assessing variability within and between individuals in 24 h excretion for a number of elements in adults from the general population and the typical 24 h excretion of these elements. In addition, we assessed concentrations adjusted for creatinine and specific gravity (SG), and associations between elements.

METHODS

60 healthy non-smokers (31 women and 29 men) from Sweden, aged 21-64 years, collected all urine during 24 h (split into six separate samples) on two occasions, about one week apart. Concentrations of As, Br, Cd, Co, Cr, Cu, Fe, Hg, Li, Mn, Mo, Ni, P, Pb, S, Sb, Se, Sn, U, V, W, and Zn in urine were analyzed by inductively coupled plasma sector-field mass spectrometry (ICP-SF-MS) and 24 h excretion rates were calculated for each day. The ratio of between-individual variance and the total variance, the intra-class correlation (ICC) was calculated based on natural log-transformed 24 h excretion. Correlation coefficients were calculated between excretion rates (mass/24 h), and concentrations adjusted for creatinine and SG.

RESULTS

Geometric means (GM), and 90-percentiles are presented for each element. The 24 h excretion was higher in men than in women for most elements, and the difference was statistically significant for Cr, Cu, Fe, Li, P, Pb, S, Se, U, V, and Zn. However, for Cd and Co, the excretion was higher in women. Variability between days was low for Cd, Co, Hg, Pb, Sn, Se, V, and Zn (ICC 0.75-0.90), highest for Cr (ICC = 0.3) and Sb (ICC = 0.18), and moderate for the other elements. Spearman's rank correlation coefficients were about 0.8-0.9 for 17 elements, and 0.3-0.7 for Br, Cu, P, S, Se. Excretion of P and S were highly correlated, and also associated with excretion of most of the other elements, especially Cu, Se, V, and Zn. A high correlation was also found between As and Hg, between Mo and W, as well as between Cr, Fe and Mn.

CONCLUSIONS

These data present normal variability of 24 h excretion of a number of elements, and can also be used as updated reference levels for elements with no or limited previous literature available. Information on variability within- and between individuals is important to know when designing studies with urine levels of elements used as exposure biomarker in studies of associations with health outcomes.

Human biomonitoring initiative (HBM4EU): Human biomonitoring guidance values (HBM-GVs) derived for cadmium and its compounds

AIMS

The methodology agreed within the framework of the HBM4EU project is used in this work to derive HBM-GVs for the general population (HBM-GV_GenPop) and for workers (HBM-GV_Worker) exposed to cadmium (Cd) and its compounds.

METHODS

For Cd, a significant number of epidemiological studies with dose-response relationships are available, in particular for kidney effects. These effects are described in terms of a relation between urinary Cd (U-Cd) or blood Cd (B-Cd) levels and low molecular weight proteinuria (LMWP) markers like beta-2-microglobulin (β2M) and retinol-binding protein (RBP). In order to derive HBM-GVs for the general population and workers, an assessment of data from evaluations conducted by national or international organisations was undertaken. In this work, it appeared relevant to select renal effects as the critical effect for the both groups, however, differences between general population (including sensitive people) and workers (considered as an homogenous population of adults who should not be exposed to Cd if they suffer from renal diseases) required the selection of different key studies (i.e. conducted in general population for HBM-GV_GenPop and at workplace for HBM-GV_Worker).

RESULTS AND CONCLUSIONS

For U-Cd, a HBM-GV_GenPop of 1 µg/g creatinine (creat) is recommended for adults older than 50 years, based on a robust meta-analysis performed by EFSA (EFSA, 2009a). To take into account the accumulation of Cd in the human body throughout life, threshold or 'alert' values according to age were estimated for U-Cd. At workplace, a HBM-GV_Worker of 2 μg/g creat is derived from the study of Chaumont et al., (2011) for U-Cd, and in addition to this recommendation a HBM-GV_worker for B-Cd of 5 µg/L is also proposed. The HBM-GV_Worker for U-Cd is similar to the biological limit value (BLV) set by the new amendment of the European Carcinogens and Mutagens Directive in June 2019 (2 µg/g creat for U-Cd).

Assessing Cadmium and Chromium Concentrations in Drinking Water to Predict Health Risk in Malaysia

Although toxic Cd (cadmium) and Cr (chromium) in the aquatic environment are mainly from natural sources, human activities have increased their concentrations. Several studies have reported higher concentrations of Cd and Cr in the aquatic environment of Malaysia; however, the association between metal ingestion via drinking water and human health risk has not been established. This study collected water samples from four stages of the drinking water supply chain at Langat River Basin, Malaysia in 2015 to analyze the samples by inductivity coupled plasma mass spectrometry. Mean concentrations of Cd and Cr and the time-series river data (2004–2014) of these metals were significantly within the safe limit of drinking water quality standard proposed by the Ministry of Health Malaysia and the World Health Organization. Hazard quotient (HQ) and lifetime cancer risk (LCR) values of Cd and Cr in 2015 and 2020 also indicate no significant human health risk of its ingestion via drinking water. Additionally, management of pollution sources in the Langat Basin from 2004 to 2015 decreased Cr concentration in 2020 on the basis of autoregression moving average. Although Cd and Cr concentrations were found to be within the safe limits at Langat Basin, high concentrations of these metals have been found in household tap water, especially due to the contamination in the water distribution pipeline. Therefore, a two-layer water filtration system should be introduced in the basin to achieve the United Nations Sustainable Development Goals (SDGs) 2030 agenda of a better and more sustainable future for all, especially via SDG 6 of supplying safe drinking water at the household level.

A nomogram for predicting the renal dysfunction in a Chinese population with reduction in cadmium exposure based on an 8 years follow up study

Cadmium exposure is associated with renal dysfunction. However, the outcome of renal function in subjects who have had a reduction in cadmium exposure for years has not been completely clarified, particularly for individuals with normal baseline renal function. In this study, we used a nomogram model to predict renal dysfunction after a reduction in cadmium exposure in subjects with normal baseline renal function. In 1998, a survey was performed in 790 subjects living in control and cadmium-polluted areas. A total of 497 subjects was followed up in 2006. 404 subjects with normal baseline urinary β₂-microglobulin (UBMG), 373 subjects with normal baseline urinary N-acetyl-β-d-glucosaminidase (UNAG) and 407 subjects with normal baseline urinary albumin (UALB) were included in this analysis. Cadmium in the blood (BCd) and urine (UCd) was detected using graphite-furnace atomic absorption spectrometry. A logistic regression model was used to identify potential predicting factors of renal function at follow-up. Nomograms were developed based on those predictive factors. Bootstrap self-sampling, calibration curves and receiver operating characteristic (ROC) curves were performed to quantify our modeling strategy. Adjusted and unadjusted logistic regression models both showed that age, BCd and UBMG or UNAG at baseline were independent risk factors for renal tubular dysfunction. Baseline age, sex, BCd and UNAG or UBMG or UALB were used to construct the nomogam. The internal validation showed that the C-index was 0.70-0.74 for predicting renal dysfunction. The area under the curve of the nomogram was 0.70-0.74. Decision curve analysis verified the predictive value of the nomogram. A nomogram may be a useful risk assessment tool for predicting the progress of renal function in a cadmium-exposed population with normal baseline kidney function.

The Association Between Alcohol Consumption and Renal Tubular Dysfunction Induced by Cadmium Exposure

Alcohol consumption is inversely associated with the risk of chronic kidney diseases. However, this association has not been reported in populations exposed to cadmium. In the present study, we examined the association between alcohol consumption and renal tubular dysfunction in populations living in cadmium-polluted areas. A total of 446 subjects (170 men and 276 women) were finally included in our analysis. The urinary cadmium (UCd) and cadmium in blood (BCd) were determined as the exposure biomarkers. Urinary N-acetyl-β-D-glucosaminidase (UNAG) and β₂-microgloblin (UBMG) were measured as renal indicators. Alcohol drinking patterns were obtained from a questionnaire and divided into four categories: non-drinking, light drinking (< 3 drinks/week), moderate drinking (3-7 drinks/week), and heavy drinking (> 7 drinks /week). If UNAG was the indicator of renal dysfunction, the prevalence of renal tubular dysfunction was decreased in subjects with alcohol consumption both in men (χ² = 8.5, p < 0.01) and women (χ² = 8.3, p < 0.01). The odds ratio (OR) of subjects with light and moderate alcohol drinking was 0.31 (95% confidence interval (CI), 0.1-0.99) and 0.30 (95%CI, 0.1-0.96), respectively, compared with those of non-drinkers after adjusting with the confounders in men. Similar results were observed in women with light drinking (OR = 0.33, 95%CI, 0.15-0.70). Similar trends were observed in those subjects with high BCd (> 3.0 μg/L) or UCd (> 5.0 μg/g creatinine). Our data show that alcohol consumption is inversely associated with cadmium-induced renal tubular dysfunction.

Risk factors for chronic kidney disease of non-traditional causes: a systematic review

OBJECTIVES

To evaluate the potential associations between chronic kidney disease of uncertain or non-traditional etiology (CKDnT) and agrochemicals, heat stress, heavy metals, and other factors identified in the literature in any region of the world and at any time.

METHODS

This was a systematic review of the most frequent exposures suspected to be possible causes of CKDnT. A search was conducted of PubMed, LILACS, World Wide Science electronic databases, among other sources. Only medium- and high-quality studies were included. The synthesis of evidence included a narrative synthesis, meta-analysis, and meta-regression.

RESULTS

Four systematic reviews and 61 primary studies were included. Results of the meta-analysis suggest that exposure to agrochemicals and working in agriculture increase the risk of CKDnT, but this only reached significance for working in agriculture. When cross-sectional studies were excluded, agrochemical exposure became significant. However, there is substantial heterogeneity in the effect sizes.

CONCLUSIONS

Based on the existing evidence and the precautionary principle, it is important to implement preventive measures to mitigate the damage caused by CKDnT to both agricultural workers and their communities (i.e., improvement of working conditions, cautious management of agrochemicals, etc.). More high-quality research is needed to measure impact and to build the evidence base.

Cadmium Exposure Impairs Cognition and Olfactory Memory in Male C57BL/6 Mice

Cadmium (Cd) is a heavy metal of high interest to the superfund initiative. Recent epidemiology studies have suggested a possible association between Cd exposure and cognitive as well as olfactory impairments in humans. However, studies in animal models are needed to establish a direct causal relationship between Cd exposure and impairments in cognition and olfaction. This study aims to investigate the toxic effect of Cd on cognition and olfactory function in mice. One group of 8-week-old C57BL/6 male mice was exposed to 3 mg/l Cd (in the form of CdCl2) through drinking water for 20 weeks for behavior tests and final blood Cd concentration analysis. The behavior tests were conducted before, during, and after Cd exposure to analyze the effects of Cd on cognition and olfactory function. Upon completion of behavior tests, blood was collected to measure final blood Cd concentration. Two additional groups of mice were similarly exposed to Cd for 5 or 13 weeks for peak blood Cd concentration measurement. The peak blood Cd concentration was 2.125-2.25 μg/l whereas the final blood Cd concentration was 0.18 μg/l. At this exposure level, Cd impaired hippocampus-dependent learning and memory in novel object location test, T-maze test, and contextual fear memory test. It also caused deficits in short-term olfactory memory and odor-cued olfactory learning and memory. Results in this study demonstrate a direct relationship between Cd exposure and cognitive as well as olfactory impairments in an animal model.

An interventional study of rice for reducing cadmium exposure in a Chinese industrial town

BACKGROUND

Reducing cadmium (Cd) exposure in Cd-polluted areas in Asia is urgently needed given the toxic effects of Cd. The short-term and long-term benefits of lowering Cd exposure are unknown because of its long half-life in the body.

OBJECTIVES

We aimed to investigate whether an intervention with low-Cd rice in a contaminated area of China reduced urinary Cd (UCd) levels and improved blood pressure and kidney function outcomes compared to no-intervention in consumers of high-Cd rice in the same region.

METHODS

106 non-smoking subjects were divided into three treatment groups: the intervention group (replacing homegrown high-Cd rice with market low-Cd rice, n = 34), the non-intervention group (continue eating high-Cd rice, n = 36) and the control group (continued eating low-Cd rice they have been eating for years, n = 36). The intervention period lasted for almost 8 months, during which participants were visited on up to 4 occasions and UCd, systolic and diastolic blood pressure (SBP, DBP), kidney function biomarkers (β₂-microglobulin and N-acetyl-β-D-glucosaminidase) were measured.

RESULTS

After 3 months, the geometric mean UCd in the intervention (Int) group decreased significantly by 0.32 μg/g (p = 0.007), while changes were not significant in the non-intervention (non-Int) group (0.13 μg/g, p = 0.95) or the control group (-0.01 μg/g, p = 0.52). UCd in the Int group remained lower than in the non-Int group but higher than in the Control group through the end of follow up. DBP in the Int group decreased significantly from 80 mm Hg at month three (p = 0.03) and stayed around 74 mm Hg for the remainder of the study. SBP also decreased in the Int group but with variations similar to those observed in the other two groups. The two kidney biomarkers showed variations without a clear pattern.

CONCLUSION

This study suggested that UCd reflected both short-term (<3 months) and long-term Cd exposure. In addition, the low-Cd rice intervention showed initial benefits in lowering blood pressure levels, especially DBP, but not kidney biomarkers.

Development and Collaborative Study of a Diluted Acid Mild Extraction Method for Determination of Cadmium in Grain by Graphite Furnace Atomic Absorption Spectrometry

The traditional pretreatment methods for the determination of cadmium in grain are time-consuming, cost-consuming, and unfriendly to human health and the environment. To eliminate these disadvantages, we developed an accurate, time-, energy- and cost-efficient method for determination of Cd in grain coupled with graphite furnace atomic absorption spectrometry (GFAAS). The optimization conditions of the extraction were achieved, the accuracy was verified and a collaborative study was organized to evaluate the methods. The detection limit and quantification limit were 0.016 and 0.048 μg L^-1, respectively. The whole pretreatment time was reduced to 15 min, and there was no significant difference (P >0.05) between the extraction method and the classic pretreatment method. The method proved to be highly consistent with the results of laboratories in different countries, as determined from two international proficiency tests (| Z | ≤0.3). The repeatability, reproducibility, and HorRat values of the collaborative results were 2.7 - 4.9%, 9.4 - 11.7%, and 0.42 - 0.58, respectively. The method of diluted acid mild extraction coupled with GFAAS is efficient, cost-saving, convenient and friendly.

The Association Between Renal Tubular Dysfunction and Zinc Level in a Chinese Population Environmentally Exposed to Cadmium

Studies in vivo and in vitro have shown a protective effect of zinc against renal dysfunction caused by cadmium exposure. However, limited human data is available. In this study, we evaluated the association between renal tubular dysfunction and body zinc burden in a Chinese population exposed to cadmium. A total of 331 subjects (170 women and 161 men) living in control and cadmium-polluted area were included. Blood cadmium (BCd), urinary cadmium (UCd), serum zinc (SZn), zinc in hair (HZn), Zn/Cd ratio, and urinary β₂Microglobulin (UBMG) were measured. The median UCd, BCd, SZn, and HZn were 2.8 and 13.6 μg/g cr, 1.3 and 12.2 μg/L, 1.31 and 1.12 mg/L, and 0.14 and 0.12 mg/g in subjects living in control and polluted areas. The UBMG level of subjects living in the polluted area was significantly higher than that of the control (0.27 vs 0.11 mg/g cr, p < 0.01). SZn, HZn, and Zn/Cd ratios were negatively correlated with UBMG (p < 0.05 or 0.01). Subjects with high SZn concentrations (≥ 1.62 mg/L) had reduced risks of elevated UBMG [(odds ratio (OR) = 0.26, 95% confidence interval (CI) 0.07-0.99)] after controlling for multiple covariates compared with those with lower zinc levels. A similar result was observed in subjects with high HZn (OR = 0.09, 95% CI 0.02-0.48). The ORs of the second, third, and fourth quartiles of Zn/Cd ratio were 0.40 (95% CI 0.19-0.84), 0.14 (95% CI 0.06-0.37), and 0.01 (95% CI 0.02-0.18) for renal dysfunction compared with those of the first quartile, respectively. For those subjects with high level of UCd, high level of SZn and HZn also had reduced risks of elevated UBMG. The results of the present study show that high zinc body burden is associated with a decrease risk of renal tubular dysfunction induced by cadmium. Zinc nutritional status should be considered in evaluating cadmium-induced renal damage.

A statistical approach of zinc remediation using acidophilic bacterium via an integrated approach of bioleaching enhanced electrokinetic remediation (BEER) technology

The aim of the present study was to isolate an indigenous acidophilic bacterium from tannery effluent contaminated sludge (TECS) sample and evaluate its potentiality towards the removal of zinc using an integrated approach of bioleaching enhanced electrokinetic remediation (BEER) technology in zinc spiked soil at an initial concentration of 1000 mg/kg. The isolated acidophilic bacterium was characterized by biochemical and 16S rRNA molecular identification and was named as Serratia marcescens SMAR1 bearing an accession no. MG742410 in NCBI database. The effect of pH and inoculum dosage of SMAR 1 strain showed an optimal growth at pH 5.0 and 4% (v/v) respectively. Based on these experimental data, a statistical analysis was done using Design Expert computer software, v11 to study the interaction between the process parameters with respect to zinc reduction as an output response. Electrokinetic experiments were conducted in a customised EK cell under optimised process conditions, employing titanium electrodes. Experiments for zinc removal were demonstrated for bioleaching, electrokinetic (EK) and BEER technology. On comparing, the integrated process was found to evidence as an excellent metal remediation option with a maximum zinc removal of 93.08% in 72 h than plain bioleaching (72.86%) and EK (56.67%) in 96 h. This is the first report of zinc removal in a short period of time using Serratia marcescens. It is therefore concluded that the BEER approach can be regarded as an effective technology in cleaning up the metal contaminated environment with an easy recovery and reuse option within short period of time.

Statistical optimization for cadmium removal using Ulva fasciata biomass: Characterization, immobilization and application for almost-complete cadmium removal from aqueous solutions

Cadmium is a global heavy metal pollutant. Marine green algae were used as efficient, low cost and eco-friendly biosorbent for cadmium ions removal from aqueous solutions. Plackett-Burman design was applied to determine the most significant factors for maximum cadmium removal from aqueous solutions using dry Ulva fasciata biomass. The most significant factors affecting cadmium removal process were further optimized by the face centered central composite design. The results indicated that 4 g of dry Ulva fasciata biomass was found to successfully remove 99.96% of cadmium from aqueous solution under the conditions of 200 mg/L of initial cadmium concentration at pH 5, 25 °C for 60 min of contact time with static condition. Dry Ulva fasciata biomass samples before and after cadmium biosorption were analyzed using SEM, EDS and FTIR. Furthermore, the immobilized biomass in sodium alginate-beads removed 99.98% of cadmium from aqueous solution at an initial concentration of 200 mg/L after 4 h which is significantly higher than that for control using sodium alginate beads without incorporation of the algal biomass (98.19%). Dry biomass of Ulva fasciata was proven to be cost-effective and efficient to eliminate heavy metals especially cadmium from aquatic effluents and the process is feasible, reliable and eco-friendly.

The references level of cadmium intake for renal dysfunction in a Chinese population

Recent several studies indicated that a more restrictive dietary intake guideline for cadmium should be made for sufficient health protection. In the present study, we showed the references level of food cadmium intake (FCd) and total cadmium intake (TCd) for renal dysfunction by using benchmark dose (BMD) approach. 342 subjects living in a control and a cadmium polluted area were included in this study. The FCd, TCd and cadmium in urine (UCd) and blood (BCd) were calculated or determined. Urinary β₂Microglobulin (UBMG) was determined as indicator of renal function. The median FCd, TCd, UCd and BCd were 1.4 g, 1.4 g, 3.1 μg/g creatinine(cr) and 1.3 μg/L in control and 3.3 g, 3.6 g, 13.5 μg/g cr and 12.1 μg/L in polluted area. The 95% lower confidence bounds of BMD (BMDLs) of FCd for renal dysfunction were 1.36-1.55 g (BMR = 10%) and 0.88-1.11 g (BMR = 5%). The BMDLs of TCd were 1.29-1.46 g (BMR = 10%) and 0.73-0.95 g (BMR = 5%). FCd and TCd are valuable markers for the predication of renal dysfunction induced by cadmium. The BMDLs of FCd were close to previous report in Japan and the BMDLs of TCd were lower than the critical standard previously reported, in particular at BMR of 5% which can be interpreted as representing the influence of smoking.

The association between dietary cadmium exposure and renal dysfunction - the benchmark dose estimation of reference levels: the ChinaCad study

The tolerable dietary intake of cadmium was recommended at provisional tolerable monthly intake of 25 μg kg^-1 body weight. However, several studies indicated that this tolerable level should be re-evaluated for sufficient health protection. In this study, we show the reference levels of dietary cadmium intake for renal dysfunction by using a benchmark dose (BMD) approach. A total of 790 subjects (302 men and 488 women) living in control and cadmium-polluted areas were included. The dietary cadmium intake was estimated by a food survey. Blood cadmium, urinary cadmium and renal function markers (microalbuminuria, N-acetyl-β-d-glucosaminidase [NAG] and its isoform B [NAGB], β₂ -microglobulin and retinol binding protein) in urine were measured. We calculated the 95% lower confidence bounds of BMD (BMDLs) of cumulative cadmium intake. In control and two polluted areas, the median cumulative cadmium intake was 0.5, 2.1 and 11.1 g. The odds ratio of the intermediate (1.0-3.0 g), second highest (3.0-11.0 g) and the highest cumulative cadmium intake (>11.0 g) compared with the lowest cumulative cadmium intake (<1.0 g) were 2.8 (95% CI: 1.4-5.8), 8.1 (95% CI: 3.8-17.2) and 11.4 (95% CI: 6.5-26.4) for urinary NAG and 6.6 (95% CI: 3.2-13.8), 14.8 (95% CI: 6.8-32.2) and 22.5 (95% CI: 10.7-47.5) for urinary NAGB. The BMDLs of cumulative cadmium intake were 1.1-1.2 g (benchmark response [BMR] = 5%) for urinary NAG, and were 0.7-0.9 g (BMR = 5%) for urinary NAGB, and were 1.3-1.4 g (BMR = 5%) for urinary β₂ -microglobulin. The BMDLs of cumulative cadmium intake in a Chinese population were lower than the critical standard previously reported. Further evaluations are needed for sufficient health protection.

Low dose cadmium upregulates the expression of von Willebrand factor in endothelial cells

Cadmium (Cd) is a persistent and widespread environmental pollutant of continuing worldwide concern. Previous studies have suggested that Cd exposure increases the risk of cardiovascular diseases, such as atherosclerosis and hypertension. However, the underlying mechanisms are poorly understood. In this study, we observed that low dose Cd treatment induced von Willebrand factor (vWF) expression in vascular endothelial cells in mouse lung and kidney tissues. In vitro analysis showed that 1 μM Cd specifically upregulated vWF mRNA and protein expression in human umbilical vein endothelial cells (HUVECs), indicating that Cd targets vascular endothelial cells even at relatively low concentrations. Further study demonstrated that nuclear factor kappa B (NF-κB) and GATA3, two established transcription regulators of the vWF gene, were not altered in the presence of Cd. However, ETS-related gene (ERG) was significantly induced by 1 μM Cd. When ERG was knocked down by siRNA, Cd induced upregulation of vWF was totally blocked. Chromatin immunoprecipitation (ChIP) assay showed that Cd increases the binding of ERG on the -56 ETS motif on the human vWF promoter. These results indicated that ERG mediated the increased expression of vWF by Cd. Since vWF is a key regulator for vascular homeostasis, our findings may provide a novel mechanism for understanding low dose Cd induced development of vascular diseases.

Temporal variability of urinary cadmium in spot urine samples and first morning voids

Cadmium is a carcinogenic heavy metal. Urinary levels of cadmium are considered to be an indicator of long-term body burden, as cadmium accumulates in the kidneys and has a half-life of at least 10 years. However, the temporal stability of the biomarker in urine samples from a non-occupationally exposed population has not been rigorously established. We used repeated measurements of urinary cadmium (U-Cd) in spot urine samples and first morning voids from two separate cohorts, to assess the temporal stability of the samples. Urine samples from two cohorts including individuals of both sexes were measured for cadmium and creatinine. The first cohort (Home Observation of Perinatal Exposure (HOPE)) consisted of 21 never-smokers, who provided four first morning urine samples 2-5 days apart, and one additional sample roughly 1 month later. The second cohort (World Trade Center-Health Program (WTC-HP)) consisted of 78 individuals, including 52 never-smokers, 22 former smokers and 4 current smokers, who provided 2 spot urine samples 6 months apart, on average. Intra-class correlation was computed for groups of replicates from each individual to assess temporal variability. The median creatinine-adjusted U-Cd level (0.19 and 0.21 μg/g in the HOPE and WTC-HP, respectively) was similar to levels recorded in the United States by the National Health and Nutrition Examination Survey. The intra-class correlation (ICC) was high (0.76 and 0.78 for HOPE and WTC-HP, respectively) and similar between cohorts, irrespective of whether samples were collected days or months apart. Both single spot or first morning urine cadmium samples show good to excellent reproducibility in low-exposure populations.

Endemic Nephropathy Around the World

There have been several global epidemics of chronic kidney disease of unknown etiology (CKDu). Some, such as Itai-Itai disease in Japan and Balkan endemic nephropathy, have been explained, whereas the etiology of others remains unclear. In countries such as Sri Lanka, El Salvador, Nicaragua, and India, CKDu is a major public health problem and causes significant morbidity and mortality. Despite their geographical separation, however, there are striking similarities between these endemic nephropathies. Young male agricultural workers who perform strenuous labor in extreme conditions are the worst affected. Patients remain asymptomatic until end-stage renal failure. Biomarkers of tubular injury are raised, and kidney biopsy shows chronic interstitial nephritis with associated tubular atrophy. In many of these places access to dialysis and transplantation is limited, leaving few treatment options. In this review we briefly describe the major historic endemic nephropathies. We then summarize the epidemiology, clinical features, histology and clinical course of CKDu in Mesoamerica, Sri Lanka, India, Egypt, and Tunisia. We draw comparisons between the proposed etiologies and supporting research. Recognition of the similarities may reinforce the international drive to establish causality and to effect prevention.

Human biomonitoring of heavy metals in the vicinity of non-ferrous metal plants in Ath, Belgium

BACKGROUND

A previous study revealed an environmental contamination by heavy metals in the vicinity of two non-ferrous metal plants in Ath, Belgium. The purpose of the current cross-sectional study was to estimate exposure of the population to heavy metals in the vicinity of the plants, in comparison with population living further away.

METHODS

We did a random sampling in the general population of Ath in two areas: a central area, including the plants, and a peripheral area, presumably less exposed. We quantified cadmium, lead, nickel, chromium and cobalt in blood and/or urine of children and adults in three age groups: (i) children aged 2.5 to 6 years (n = 98), (ii) children aged 7 to 11 years (n = 74), and (iii) adults aged 40 to 60 years (n = 106). We also studied subclinical health effects by quantifying retinol-binding protein and microalbuminuria, and by means of a Strengths and Difficulties Questionnaire.

RESULTS

We obtained a participation rate of 24 %. Blood lead levels were significantly higher in young children living in the central area (18.2 μg/l ; 95 % CI: 15.9-20.9) compared to the peripheral area (14.8 μg/l ; 95 % CI: 12.6-17.4). We observed no other significant mean difference in metal concentrations between the two areas. In the whole population, blood lead levels were higher in men (31.7 μg/l ; 95 % CI: 27.9-36.1) than in women (21.4 μg/l ; 95 % CI: 18.1-25.3). Urine cadmium levels were 0.06 μg/g creatinine (95 % CI: 0.05-0.07), 0.21 μg/g creatinine (95 % CI: 0.17-0.27), and 0.25 μg/g creatinine (95 % CI: 0.20-0.30) for children, men, and women, respectively.

CONCLUSIONS

Despite higher blood lead levels in young children living close to the plants, observed metal concentrations remain in the range found in other similar biomonitoring studies in the general population and are below the levels of concern for public health.

A longitudinal study on urinary cadmium and renal tubular protein excretion of nickel-cadmium battery workers after cessation of cadmium exposure

PURPOSE

This study aimed to predict the outcome of urinary cadmium (Cd) excretion and renal tubular function by analyzing their evolution through 10 years after Cd exposure ceased.

METHODS

Forty-one female, non-smoking workers were recruited from the year 2004 to 2009 when being removed from a nickel-cadmium battery factory, and they were asked to provide morning urine samples on three consecutive days at enrollment and in every follow-up year until 2014. Urinary Cd and renal tubular function biomarkers including urinary β2-microglobulin (β2-m) and retinol-binding protein (RBP) concentrations were determined with the graphite furnace atomic absorption spectrometry and the enzyme-linked immunosorbent assays, respectively.

RESULTS

The medians of baseline Cd, β2-m and RBP concentrations at enrollment were 6.19, 105.38 and 71.84 μg/g creatinine, respectively. Urinary β2-m and RBP concentrations were both related to Cd concentrations over the years (β absolute-β2-m = 9.16, P = 0.008 and β absolute-RBP = 6.42, P < 0.001, respectively). Cd, β2-m and RBP concentrations in the follow-up years were all associated with their baseline concentrations (β absolute-Cd = 0.61, P < 0.001; β absolute-β2-m = 0.64, P < 0.001; and β absolute-RBP = 0.60, P < 0.001, respectively), and showed a decreasing tendency with the number of elapsed years relative to their baseline concentrations (β relative-Cd = -0.20, P = 0.010; β relative-β2-m = -17.19, P = 0.002; and β relative-RBP = -10.66, P < 0.001, respectively).

CONCLUSIONS

Urinary Cd might eventually decrease to the general population level, and Cd-related tubular function would improve under the baseline conditions of this cohort.

Children with health impairments by heavy metals in an e-waste recycling area

E-waste recycling has become a global environmental health issue. Pernicious chemicals escape into the environment due to informal and nonstandard e-waste recycling activities involving manual dismantling, open burning to recover heavy metals and open dumping of residual fractions. Heavy metals derived from electronic waste (e-waste), such as, lead (Pb), cadmium (Cd), chromium (Cr), manganese (Mn), nickel (Ni), mercury (Hg), arsenic (As), copper (Cu), zinc (Zn), aluminum (Al) and cobalt (Co), differ in their chemical composition, reaction properties, distribution, metabolism, excretion and biological transmission. Our previous studies showed that heavy metal exposure have adverse effects on children's health including lower birth weight, lower anogenital distance, lower Apgar scores, lower current weight, lower lung function, lower hepatitis B surface antibody levels, higher prevalence of attention-deficit/hyperactivity disorder, and higher DNA and chromosome damage. Heavy metals influence a number of diverse systems and organs, resulting in both acute and chronic effects on children's health, ranging from minor upper respiratory irritation to chronic respiratory, cardiovascular, nervous, urinary and reproductive disease, as well as aggravation of pre-existing symptoms and disease. These effects of heavy metals on children's health are briefly discussed.

Confusion about Cadmium Risks: The Unrecognized Limitations of an Extrapolated Paradigm

BACKGROUND

Cadmium (Cd) risk assessment presently relies on tubular proteinuria as a critical effect and urinary Cd (U-Cd) as an index of the Cd body burden. Based on this paradigm, regulatory bodies have reached contradictory conclusions regarding the safety of Cd in food. Adding to the confusion, epidemiological studies implicate environmental Cd as a risk factor for bone, cardiovascular, and other degenerative diseases at exposure levels that are much lower than points of departure used for setting food standards.

OBJECTIVE

The objective was to examine whether the present confusion over Cd risks is not related to conceptual or methodological problems.

DISCUSSION

The cornerstone of Cd risk assessment is the assumption that U-Cd reflects the lifetime accumulation of the metal in the body. The validity of this assumption as applied to the general population has been questioned by recent studies revealing that low-level U-Cd varies widely within and between individuals depending on urinary flow, urine collection protocol, and recent exposure. There is also evidence that low-level U-Cd increases with proteinuria and essential element deficiencies, two potential confounders that might explain the multiple associations of U-Cd with common degenerative diseases. In essence, the present Cd confusion might arise from the fact that this heavy metal follows the same transport pathways as plasma proteins for its urinary excretion and the same transport pathways as essential elements for its intestinal absorption.

CONCLUSIONS

The Cd risk assessment paradigm needs to be rethought taking into consideration that low-level U-Cd is strongly influenced by renal physiology, recent exposure, and factors linked to studied outcomes.

CITATION

Bernard A. 2016. Confusion about cadmium risks: the unrecognized limitations of an extrapolated paradigm. Environ Health Perspect 124:1-5; http://dx.doi.org/10.1289/ehp.1509691.

The structural and functional effects of Hg(II) and Cd(II) on lipid model systems and human erythrocytes: A review

The anthropogenic mobilization of mercury and cadmium into the biosphere has led to an increased and ineludible entry of these metals into biological systems. Here we discuss the impact of Hg(II) and Cd(II) on lipid model systems and human erythrocytes from a biophysical perspective. After a brief introduction to their implications on human health, studies that have investigated the effects of Hg(II) and Cd(II) on lipid model systems and human erythrocytes are discussed. In terms of lipids as toxicological target sites, predominantly variations in lipid head groups have been the source of investigation. However, as research in this field progresses, the effects of Hg(II) and Cd(II) on other structural features, such as acyl chain length and unsaturation, and other important lipid components and complex biomimetic lipid mixtures, will require further examinations. This review provides an analysis of what has been learned collectively from the diverse methodologies and experimental conditions used thus far. Consequently, there is a need for more comprehensive and thorough investigations into the effects of Hg(II) and Cd(II) on lipid membranes under consistent experimental conditions such as pH, ionic strength, temperature, and choice of lipid model system.

Environmental heavy metal exposure and chronic kidney disease in the general population

Lead (Pb), mercury (Hg), and cadmium (Cd) are common heavy metal toxins and cause toxicological renal effects at high levels, but the relevance of low-level environmental exposures in the general population is controversial. A total of 1,797 adults who participated in the KNHANES (a cross-sectional nationally representative survey in Korea) were examined, and 128 of them (7.1%) had chronic kidney disease (CKD). Our study assessed the association between Pb, Hg, Cd exposure, and CKD. Blood Pb and Cd levels were correlated with CKD in univariate logistic regression model. However, these environmental heavy metals were not associated with CKD after adjustment for age, sex, BMI, smoking, hyperlipidemia, hypertension, diabetes, and these metals in multivariate logistic regression models. We stratified the analysis according to hypertension or diabetes. In the adults with hypertension or diabetes, CKD had a significant association with elevated blood Cd after adjustment, but no association was present with blood Pb and Hg. The corresponding odds ratio [OR] of Cd for CKD were 1.52 (95% confidence interval [CI], 1.05-2.19, P=0.026) in adults with hypertension and 1.92 (95% CI, 1.14-3.25, P=0.014) in adults with diabetes. Environmental low level of Pb, Hg, Cd exposure in the general population was not associated with CKD. However, Cd exposure was associated with CKD, especially in adults with hypertension or diabetes. This finding suggests that environmental low Cd exposure may be a contributor to the risk of CKD in adults with hypertension or diabetes.

Benchmark dose estimation for cadmium-induced renal tubular damage among environmental cadmium-exposed women aged 35-54 years in two counties of China

BACKGROUND

A number of factors, including gender, age, smoking habits, and occupational exposure, affect the levels of urinary cadmium. Few studies have considered these influences when calculating the benchmark dose (BMD) of cadmium. In the present study, we aimed to calculate BMDs and their 95% lower confidence bounds (BMDLs) for cadmium-induced renal tubular effects in an age-specific population in south-central China.

METHODS

In this study, urinary cadmium, β2-microglobulin, and N-acetyl-β-D-glucosaminidase levels were measured in morning urine samples from 490 randomly selected non-smoking women aged 35-54 years. Participants were selected using stratified cluster sampling in two counties (counties A and B) in China. Multiple regression and logistic regression analyses were used to investigate the dose-response relationship between urinary cadmium levels and tubular effects. BMDs/BMDLs corresponding to an additional risk (benchmark response) of 5% and 10% were calculated with assumed cut-off values of the 84th and 90th percentile of urinary β2-microglobulin and N-acetyl-β-D-glucosaminidase levels of the controls.

RESULTS

Urinary levels of β2-microglobulin and N-acetyl-β-D-glucosaminidase increased significantly with increasing levels of urinary cadmium. Age was not associated with urinary cadmium levels, possibly because of the narrow age range included in this study. Based on urinary β2-microglobulin and N-acetyl-β-D-glucosaminidase, BMDs and BMDLs of urinary cadmium ranged from 2.08 to 3.80 (1.41-2.18) µg/g cr for subjects in county A and from 0.99 to 3.34 (0.74-1.91) µg/g cr for those in county B. The predetermined benchmark response of 0.05 and the 90th percentiles of urinary β2-microglobulin and N-acetyl-β-D-glucosaminidase levels of the subjects not exposed to cadmium (i.e., the control group) served as cut-off values.

CONCLUSIONS

The obtained BMDs of urinary cadmium were similar to the reference point of 1 µg/g cr, as suggested by the European Food Safety Authority, indicating that cadmium exposure must be reduced to protect human health.

Occupational hazards and safety measures amongst the paint factory workers in lagos, Nigeria

Background

The manufacture of paint involves a variety of processes that present with medical hazards. Safety initiatives are hence introduced to limit hazard exposures and promote workplace safety. This aim of this study is to assess the use of available control measures/initiatives in selected paint factories in Lagos West Senatorial District, Nigeria.

Methods

A total of 400 randomly selected paint factory workers were involved in the study. A well-structured World Health Organization standard questionnaire was designed and distributed to the workers to elicit information on awareness to occupational hazards, use of personal protective devices, and commonly experienced adverse symptoms. Urine samples were obtained from 50 workers randomly selected from these 400 participants, and the concentrations of the heavy metals (lead, cadmium, arsenic, and chromium) were determined using atomic absorption spectroscopy.

Results

The results show that 72.5% of the respondents are aware of the hazards associated with their jobs; 30% have had formal training on hazards and safety measures; 40% do not use personal protective devices, and 90% of the respondents reported symptoms relating to hazard exposure. There was a statistically significant (p < 0.05) increase in the mean heavy metal concentrations in the urine samples obtained from paint factory workers as compared with nonfactory workers.

Conclusion

The need to develop effective frameworks that will initiate the integration and ensure implementation of safety regulations in paint factories is evident. Where these exist, there is a need to promote adherence to these practice guidelines.

Heavy metals toxicity: effect of cadmium ions on amyloid beta protein 1-42. Possible implications for Alzheimer's disease

Cadmium (Cd) is an environmental contaminant, highly toxic to humans. This biologically non-essential element accumulates in the body, especially in the kidney, liver, lung and brain and can induce several toxic effects, depending on the concentration and the exposure time. Cd has been linked to Alzheimer's disease (AD) as a probable risk factor, as it shows higher concentrations in brain tissues of AD patients than in healthy people, its implication in the formation of neurofibrillary tangles and in the aggregation process of amyloid beta peptides (AβPs). AβPs seem to have toxic properties, particularly in their aggregated state; insoluble AβP forms, such as small and large aggregates, protofibrils and fibrils, appear to be implicated in the pathogenesis of AD. In our study, we have evaluated the effect of Cd, at different concentrations, both on the AβP1-42 ion channel incorporated in a planar lipid membrane made up of phosphatidylcholine containing 30 % cholesterol and on the secondary structure of AβP1-42 in aqueous environment. Cadmium is able to interact with the AβP1-42 peptide by acting on the channel incorporated into the membrane as well as on the peptide in solution, both decreasing AβP1-42 channel frequency and in solution forming large and amorphous aggregates prone to precipitate. These experimental observations suggesting a toxic role for Cd strengthen the hypothesis that Cd may interact directly with AβPs and may be a risk factor in AD.

Interplay of calcium and cadmium in mediating cadmium toxicity

The environmentally important toxic metal, cadmium, exists as the Cd(2+) ion in biological systems, and in this state structurally resembles Ca(2+). Thus, although cadmium exerts a broad range of adverse actions on cells by virtue of its propensity to bind to protein thiol groups, it is now well appreciated that Cd(2+) participates in a number of Ca(2+)-dependent pathways, attributable to its actions as a Ca(2+) mimetic, with a central role for calmodulin, and the Ca(2+)/calmodlin-dependent protein kinase II (CaMK-II) that mediates effects on cytoskeletal dynamics and apoptotic cell death. Cadmium interacts with receptors and ion channels on the cell surface, and with the intracellular estrogen receptor where it binds competitively to residues shared by Ca(2+). It increases cytosolic [Ca(2+)] through several mechanisms, but also decreases transcript levels of some Ca(2+)-transporter genes. It initiates mitochondrial apoptotic pathways, and activates calpains, contributing to mitochondria-independent apoptosis. However, the recent discovery of the role CaMK-II plays in Cd(2+)-induced cell death, and subsequent implication of CaMK-II in Cd(2+)-dependent alterations of cytoskeletal dynamics, has opened a new area of mechanistic cadmium toxicology that is a focus of this review. Calmodulin is necessary for induction of apoptosis by several agents, yet induction of apoptosis by Cd(2+) is prevented by CaMK-II block, and Ca(2+)-dependent phosphorylation of CaMK-II has been linked to increased Cd(2+)-dependent apoptosis. Calmodulin antagonism suppresses Cd(2+)-induced phosphorylation of Erk1/2 and the Akt survival pathway. The involvement of CaMK-II in the effects of Cd(2+) on cell morphology, and particularly the actin cytoskeleton, is profound, favouring actin depolymerization, disrupting focal adhesions, and directing phosphorylated FAK into a cellular membrane. CaMK-II is also implicated in effects of Cd(2+) on microtubules and cadherin junctions. A key question for future cadmium research is whether cytoskeletal disruption leads to apoptosis, or rather if apoptosis initiates cytoskeletal disruption in the context of Cd(2+).

Effects of cadmium on the actin cytoskeleton in renal mesangial cells

We provide an overview of our studies on cadmium and the actin cytoskeleton in mesangial cells, from earlier work on the effects of Cd2+ on actin polymerization in vivo and in vitro, to a role of disruption or stabilization of the cytoskeleton in apoptosis and apoptosis-like death. More recent studies implicate cadmium-dependent association of gelsolin and the Ca2+/calmodulin-dependent protein kinase II (CaMK-II) with actin filaments in cytoskeletal effects. We also present previously unpublished data concerning cadmium and the disruption of focal adhesions. The work encompasses studies on rat, mouse, and human mesangial cells. The major conclusions are that Cd2+ acts independently of direct effects on cellular Ca2+ levels to nevertheless activate Ca2+-dependent proteins that shift the actin polymerization–depolymerization in favour of depolymerization. Cadmium-dependent translocation of CaMK-IIδ, gelsolin, and a 50 kDa gelsolin cleavage fragment to the filamentous (F-)actin cytoskeleton appear to be involved. An intact filamentous actin cytoskeleton is required to initiate apoptotic and apoptotic-like death, but F-actin depolymerization is an eventual result.

Renal function after reduction in cadmium exposure: an 8-year follow-up of residents in cadmium-polluted areas

BACKGROUND AND OBJECTIVE

Long-term exposure to cadmium (Cd) causes renal dysfunction, but the change in renal function with exposure is unknown. We assessed the evolution of Cd-induced renal effects after a reduction in dietary exposure to Cd in rice.

METHODS

Four hundred twelve residents in previously Cd-polluted and nonpolluted areas were examined twice, in 1998 and in 2006. Changes in blood Cd, urinary Cd, and kidney function [N-acetyl-β-d-glucosaminidase (NAG), β2-microglobulin, and albumin in urine] were measured.

RESULTS

In the most polluted area, mean blood Cd was 8.9 μg/L and 3.3 μg/L in 1998 and in 2006, respectively, and urinary Cd was 11.6 and 9.0 μg/g creatinine. Urinary albumin in 1998 increased with urinary Cd, but no such exposure-response relation appeared for 2006 albumin versus urinary Cd 1998, indicating recovery. Other biomarkers of kidney function were also elevated in 1998. Partial recovery was observed for NAG among women and was suggested for β2-microglobulin among young individuals. The probability of having β2-microglobulin levels above the 95th percentile in 2006 was high in those with elevated β2-microglobulin in 1998 [odds ratio (OR) = 24.8; 95% confidence interval (CI): 11.2, 55.3] compared with albumin (OR = 3.0; 95% CI: 1.2, 7.5) and NAG (OR = 2.6; 95% CI: 1.6, 4.4).

CONCLUSIONS

Results suggest that a Cd-mediated increase in urinary albumin excretion is reversible upon substantial reduction of exposure. For markers of tubular effects, we observed a tendency toward improvement but not complete recovery. Data from repeated observations suggest that β2-microglobulin may be more informative than NAG as an indicator for an individual's future tubular function.

Progress in cadmium-related health effects in persons with high environmental exposure in northwestern Thailand: a five-year follow-up

Food-borne cadmium was the principal source of exposure for persons living in the 12 cadmium-contaminated villages in Mae Sot District, Tak Province, northwestern Thailand. This report presents progress in cadmium-related health effects among persons with high cadmium exposure. The study included 436 persons who had urinary cadmium levels ≥5 μg/g creatinine and were screened for urinary cadmium, renal function, hypertension, diabetes and urinary stones in 2005 (baseline) and 2010 (5-year follow-up). Study renal biomarkers included urinary excretion of β(2)-microglobulin (β(2)-MG), total protein and calcium, serum creatinine and glomerular filtration rate (GFR). The geometric mean level of urinary cadmium statistically significantly reduced from 9.5±1.6 μg/g creatinine in 2005 to 8.8±1.6 μg/g creatinine in 2010. Compared to baseline, the follow-up examination revealed significant increases in urinary β(2)-MG (tubular effect), urinary total protein and serum creatinine, and a decrease in GFR (glomerular effects). Progressive renal dysfunctions were similarly observed in persons both with and without reduction in cadmium intake. Significant increases in prevalence of hypertension, diabetes and urinary stones were also detected at follow-up. These three disorders were found to markedly impair renal functions in the study persons. Our study indicates that in persons with prolonged excessive cadmium exposure, toxic health effects may progress even after exposure reduction. Renal damage from cadmium can be due to its direct nephrotoxic effect and also through the related disorders causing nephropathy.

Bone-prognostic status after cessation of cadmium exposure for one month in male rats

This study investigated bone status after decreased cadmium (Cd) exposure in male rats. Sprague-Dawley male rats were randomly divided into three groups. One group was injected subcutaneously with sodium chloride as control. The others were given CdCl2 by subcutaneous injection at doses of 0.5 mg Cd/kg body weight (bw) for 2 months (Cd+2m) and for 3 months (Cd+3m). For the Cd+2m group, the rats were shifted to cessation of Cd injection for 1 month after 2 months' exposure. At month 3, micro-computed tomography (micro-CT) analyses were performed on the proximal tibia and lumbar spine, and urine was collected from all rats. Rats were then killed and blood collected for metabolic-marker measurement and Cd assay. Bone tissues were also collected for bone-mass assay, biomechanical test, and bone-histology analysis. Cd burdens of rats in the Cd+2m and Cd+3m groups were both significantly greater than those in the control group. Cd burdens of rats were lower in the Cd+2m group compared with the Cd+3m group. Bone damage occurred in the Cd+2m and Cd+3m groups compared with the control group (p<0.05), but no significant improvement was found in the Cd+2m group compared with the Cd+3m group. Cd damage to bone could not be reversed over the short term. More attention should be paid to Cd's toxic effects on bone after decreased exposure.

Blood cadmium and estimated glomerular filtration rate in Korean adults

BACKGROUND

Cadmium is a nephrotoxicant at high exposure levels. Few studies have evaluated the role of cadmium in kidney function at low-exposure levels.

OBJECTIVE

We evaluated the association of blood cadmium with estimated glomerular filtration rate (eGFR) in the Korean adult population.

METHODS

We evaluated 1,909 adults ≥ 20 years of age who participated in the 2005 Korean National Health and Nutrition Examination Survey and had blood cadmium determinations. eGFR was calculated using the Modification of Diet in Renal Disease equation.

RESULTS

Blood cadmium geometric means were 1.57 μg/L for men and 1.49 μg/L for women. The difference in eGFR levels that compared participants in the highest versus lowest cadmium tertiles, after multivariable adjustment, was -1.85 [95% confidence interval (CI): -3.55, -0.16] mL/min per 1.73 m2 in women and 0.67 (-1.16, 2.50) mL/min per 1.73 m2 in men. Among men, the association between blood cadmium and eGFR was modified by blood lead levels (p-value for interaction = 0.048). The fully adjusted differences in eGFR levels for a 2-fold increase in blood cadmium levels were -1.14 (-3.35, 1.07) and 1.84 (0.54, 3.14) mL/min per 1.73 m2 in men with blood lead levels below and above the median (2.75 μg/dL), respectively.

CONCLUSION

Elevated blood cadmium levels were associated with lower eGFR in women, which supports the role of cadmium as a risk factor for chronic kidney disease. In men, there was no overall association, although elevated blood cadmium levels were associated with higher eGFR levels in men with high blood lead levels and nonstatistically associated with lower eGFR levels in men with low blood lead levels.

Bone mineral density is related with previous renal dysfunction caused by cadmium exposure

Relationship between bone mineral density (BMD) and previous renal dysfunction caused by cadmium exposure was investigated. A total of 457 persons, living in polluted and control areas, were followed up in this study. The inhabitants living in exposure areas ceased ingesting cadmium-contaminated rice in 1996. Blood and urinary cadmium levels and BMD in 1998 and 2006 were measured. Urinary N-acetyl-β-d-glucosaminidase and albumin determined in 1998 and 2006 were used to evaluate kidney status. BMD of subjects with tubular damage was significant lower than those without damage in female (p < 0.05). The prevalence of osteoporosis was significantly different between those with and without kidney damage (p = 0.003, in total population; p = 0.039, in female) and those with and without tubular damage (p = 0.0005, in total population; p = 0.007, in female). The results suggested that BMD was correlated with previous kidney impairment caused by cadmium exposure, especially to tubular damage and especially for female.

The relationship between the bone mineral density and urinary cadmium concentration of residents in an industrial complex

BACKGROUND

An association between cadmium exposure and bone mineral density (BMD) has been demonstrated in elderly women, but has not been well studied in youths and men. Some studies report either no or a weak association between cadmium exposure and bone damage.

OBJECTIVES

This study was designed to investigate the relationship between the urinary cadmium (U-Cd) levels and BMD of females and males of all ages.

METHODS

A total of 804 residents near an industrial complex were surveyed in 2007. U-Cd and BMD on the heel (non-dominant calcaneus) were analyzed with AAS-GTA and Dual-Energy X-ray absorptiometry, respectively. Demographic characteristics were collected by structured questionnaires. Osteoporosis and osteopenia were defined by BMD cut-off values and T-scores set by the WHO; T score>-1, normal; -2.5<T score <-1, osteopenia; and T score <-2.5, osteoporosis. Logistic and multiple linear regressions were applied to estimate the association between U-Cd levels and BMD.

RESULTS

The U-Cd levels in females (0.64 μg/g creatinine) were higher than those in males (0.48 μg/g creatinine) (p<0.001). With the logistic regression model, osteopenia was associated with high U-Cd levels (≥ 1.0 μg/g creatinine) in females (OR=2.92; 95% CI, 1.51-5.64) and in males (OR=3.37; 95% CI, 1.09-10.38). With the multiple linear regression model, the BMD of the adult group was negatively associated with U-Cd (<0.05), gender (female, p<0.001) and age (p<0.001). The BMD of participants who were ≤ 19 years of age was negatively associated with gender (female, p<0.01), whereas it was positively associated with age and BMI (p<0.001). BMD was not associated with exercise, smoking habits, alcohol consumption, job or parental education.

CONCLUSION

Results suggested that U-Cd might be associated with osteopenia as well as osteoporosis in both male and female adults. Age and female gender were negatively associated with BMD in the adult group, whereas age was positively associated with BMD in the youth group. Cadmium exposure may be a potential risk factor for lower-BMD and osteopenia symptoms as well as for osteoporosis symptoms.

Minimal health impact from exposure to diet-sourced cadmium on a population in central Jamaica

Elevated concentrations of naturally occurring Cd have been found mainly in the bauxitic soils of central Jamaica at levels up to 100-1,000 times higher than typical worldwide averages. Some food crops cultivated on these soils absorb significant amounts of Cd. Autopsy studies of kidney Cd concentrations confirm elevated human exposure, and some long-term residents in central Jamaica exceed the general population average by a factor of two. Diet studies have ascertained that a population in central Jamaica is at risk of being exposed to Cd levels in excess of the Provisional Tolerable Weekly Intake (PTWI) set by the WHO of 7 μgCd/kg bodyweight/week, and the EU TWI of 2.5 μgCd/kg bodyweight/week. Elevated levels of urine cadmium (U-Cd) and beta-2 microglobulin (β2-MG) concentrations were confirmed with a strong correlation between soil Cd and the U-Cd. Also, higher β2-MG concentrations (>200μg/g creatinine) were found in the population with U-Cd concentrations greater than 2.5μg/L. While this identification is often taken to indicate impairment in the reabsorption capacity of the renal tubules leading to renal disease, there is no evidence in the mortality records of enhanced deaths in central Jamaica compared with the general population resulting from renal disease or diabetes related complications. The highest median age of death in the island is found in Manchester, the parish with the highest average Cd concentration. While we have identified a possible Cd linked renal dysfunction, significant indications of morbidity are not present in the general population.

Associations of low-level urine cadmium with kidney function in lead workers

OBJECTIVES

Low-level cadmium exposure, resulting in, for example, urinary cadmium <2.0 μg/g creatinine, is widespread; recent data suggest nephrotoxicity even at these low levels. Few studies have examined the impact of low-level cadmium exposure in workers who are occupationally exposed to other nephrotoxicants such as lead.

METHODS

We evaluated associations of urine cadmium, a measure of cumulative dose, with four glomerular filtration measures and N-acetyl-β-D-glucosaminidase (NAG) in lead workers. Recent and cumulative lead doses were assessed via blood and tibia lead, respectively.

RESULTS

In 712 lead workers, mean (SD) blood and tibia lead values, urine cadmium values and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation were 23.1 (14.1) μg/dl, 26.6 (28.9) μg Pb/g bone mineral, 1.15 (0.66) μg/g creatinine and 97.4 (19.2) ml/min/1.73 m(2), respectively. After adjustment for age, sex, body mass index, urine creatinine, smoking, alcohol, education, annual income, diastolic blood pressure, current or former lead worker job status, new or returning study participant, and blood and tibia lead, higher ln-urine cadmium was associated with higher calculated creatinine clearance, eGFR (β = 8.7 ml/min/1.73 m(2); 95% CI 5.4 to 12.1) and ln-NAG but lower serum creatinine.

CONCLUSIONS

Potential explanations for these results include a normal physiological response in which urine cadmium levels reflect renal filtration, the impact of adjustment for urine dilution with creatinine in models of kidney outcomes, and cadmium-related hyperfiltration.