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Original article
Causes of death and renal tubular dysfunction in residents exposed to cadmium in the environment
  1. M Nishijo1,
  2. Y Morikawa1,
  3. H Nakagawa1,
  4. K Tawara1,
  5. K Miura1,
  6. T Kido2,
  7. A Ikawa3,
  8. E Kobayashi4,
  9. K Nogawa4
  1. 1Department of Public Health, Kanazawa Medical University, Uchinada, Ishikawa, Japan
  2. 2School of Health Sciences, Kanazawa University, Kodatsuno, Kanazawa, Ishikawa, Japan
  3. 3Division of Health and Welfare, Ishikawa Prefecture, Minami-kaga Health and Welfare Center, Komatsu, Ishikawa, Japan
  4. 4Department of Occupational and Environmental Medicine, Graduate School of Medicine, Chiba University, Chuoh-ku, Chiba, Japan
  1. Correspondence to:
 Dr M Nishijo
 Department of Public Health, Kanazawa Medical University, Uchinada, Ishikawa, Japan, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan; ni-koei{at}kanazawa-med.ac.jp

Abstract

Objectives: To clarify the causes of death of residents with renal tubular dysfunction induced by cadmium (Cd) in the environment.

Methods: A 15 year follow up study was performed with the inhabitants living in the Cd polluted Kakehashi River basin in Japan. Standardised mortality ratios (SMRs) for causes of death, classified by ICD-9, were computed using the person-years method to investigate the excess mortality of subjects with urinary β2-MG (microglobulin) ⩾1000 μg/gCr. Mortality risk analysis was performed using Cox’s proportional model to compare mortality between subjects with urinary β2-MG ⩾1000 and <1000 μg/gCr, and to investigate the relationship between the degree of urinary β2-MG and mortality.

Results: Excess mortality due to heart failure and cerebral infarction in both sexes, and nephritis and nephrosis in men, was observed among subjects with urinary β2-MG ⩾1000 μg/gCr. Significant increases in mortality risk for cerebral infarction in men and for malignant neoplasms in women with urinary β2-MG ⩾1000 μg/gCr were observed during the first five year observation period. For nephritis and nephrosis, the mortality risks for men and women with urinary β2-MG ⩾1000 μg/gCr significantly increased over the 15 year observation period. The mortality risks for heart failure and cerebral infarction increased in proportion to the increased urinary β2-MG in both sexes. Increased mortality risks for nephritis and nephrosis were identified in the subjects with urinary β2-MG ⩾10000 μg/gCr in both sexes.

Conclusion: Renal tubular dysfunction induced by Cd affected the causes of death, and mortality for heart failure, cerebral infarction, and nephritis and nephrosis was increased among inhabitants living in a Cd polluted area in Japan. In women, cancer mortality may have been increased while Cd pollution was ongoing.

  • Cd, cadmium
  • ICD-9, International Classification of Diseases, Ninth Revision
  • RBP, retinol binding protein
  • SMR, standardised mortality ratio
  • cadmium
  • mortality
  • causes of death
  • renal tubular dysfunction
  • follow up study

https://doi.org/10.1136/oem.2006.026591

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    Footnotes

    • Published Online First 6 April 2006

    • Competing interests: none.

    • Ethics approval: The Ethics Committee of Kanazawa Medical University in Uchinada, Ishikawa 920-0293, Japan, where the analysis of the data was conducted, approved the study.