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Associations of multiple metals with kidney outcomes in lead workers
  1. Rebecca Shelley1,
  2. Nam-Soo Kim2,
  3. Patrick Parsons3,4,
  4. Byung-Kook Lee2,
  5. Bernard Jaar5,6,7,
  6. Jeffrey Fadrowski7,8,
  7. Jacqueline Agnew1,
  8. Genevieve M Matanoski5,
  9. Brian S Schwartz1,5,6,
  10. Amy Steuerwald3,4,
  11. Andrew Todd9,
  12. David Simon10,
  13. Virginia M Weaver1,6,7
  1. 1Division of Occupational and Environmental Health, Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Institute of Environmental and Occupational Medicine, SoonChunHyang University, Asan, South Korea
  3. 3Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center, New York State Department of Health, Albany, New York, USA
  4. 4Department of Environmental Health Sciences, School of Public Health, University at Albany, Albany, New York, USA
  5. 5Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  6. 6Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  7. 7Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  8. 8Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  9. 9Department of Preventive Medicine, Mount Sinai School of Medicine, New York, USA
  10. 10Biostatistical Consulting, Cincinnati, Ohio, USA
  1. Correspondence to Dr Virginia M Weaver, Division of Occupational & Environmental Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St., Rm. 7041, Baltimore, MD 21205, USA; vweaver{at}


Objectives Environmental exposure to multiple metals is common. A number of metals cause nephrotoxicity with acute and/or chronic exposure. However, few epidemiologic studies have examined the impact of metal coexposure on kidney function. Therefore, the authors evaluated associations of antimony and thallium with kidney outcomes and assessed the impact of cadmium exposure on those associations in lead workers.

Methods Multiple linear regression was used to examine associations between ln-urine thallium, antimony and cadmium levels with serum creatinine- and cystatin-C-based glomerular filtration measures and ln-urine N-acetyl-β-D-glucosaminidase (NAG).

Results In 684 participants, median urine thallium and antimony were 0.39 and 0.36 μg/g creatinine, respectively. After adjustment for lead dose, urine creatinine and kidney risk factors, higher ln-urine thallium was associated with higher serum creatinine- and cystatin-C-based estimates of glomerular filtration rate; associations remained significant after adjustment for antimony and cadmium (regression coefficient for serum creatinine-based estimates of glomerular filtration rate =5.2 ml/min/1.73 m2; 95% CI =2.4 to 8.0). Antimony associations with kidney outcomes were attenuated by thallium and cadmium adjustment; thallium and antimony associations with NAG were attenuated by cadmium.

Conclusions Urine thallium levels were significantly associated with both serum creatinine- and cystatin-C-based glomerular filtration measures in a direction opposite that expected with nephrotoxicity. Given similarities to associations recently observed with cadmium, these results suggest that interpretation of urine metal values, at exposure levels currently present in the environment, may be more complex than previously appreciated. These results also support multiple metal analysis approaches to decrease the potential for inaccurate risk conclusions.

  • Antimony
  • cadmium
  • creatinine
  • kidney function
  • thallium
  • organ system
  • disease
  • disease type
  • asthma
  • general expertise
  • public health
  • hygiene/occupational hygiene
  • epidemiology
  • methodology
  • specialty
  • risk assessment
  • materials
  • exposures and occupational groups
  • environment
  • clinical medicine
  • solvents
  • renal
  • toxicology
  • biological monitoring
  • lead

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  • Funding This research was supported by National Institute of Environmental Health Sciences, grant 2 ES007198; National Institute for Occupational Safety and Health, grant T42 OH0008428, from the Education and Research Center for Occupational Safety and Health at the Johns Hopkins Bloomberg School of Public Health and Korea Research Foundation, grant 2000-00545. The funding sources had no involvement in study design; data collection, analysis and interpretation; manuscript writing or decisions to submit the work for publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The ethics approval was provided by SoonChunHyang University School of Medicine and the Johns Hopkins University Bloomberg School of Public Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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