The modifying effect of kidney function on the association of cadmium exposure with blood pressure and cardiovascular mortality: NHANES 1999–2010

Yi Gao, Xiangzhu Zhu, Martha J. Shrubsole, Lei Fan, Zhaolin Xia, Raymond C. Harris, Lifang Hou, Qi Dai*

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: We hypothesized that the associations of urinary Cd with blood pressure and cardiovascular disease (CVD) mortality may be modified by renal function. Methods: We tested these hypotheses using data from the National Health and Nutrition Examination Survey (NHANES, 1999–2010). Results: Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively associated with blood Cd. DBP was positively related to urinary Cd whereas SBP was inversely associated with urinary Cd. In the stratified analyses by level of eGFR, the associations between SBP and urinary Cd were not statistically significant among those with normal renal function and those with mildly reduced renal function whereas SBP significantly positively associated with urinary Cd among those with moderately or severely decreased renal function (p for trend, 0.0004). Renal function appeared to be a modifying factor of the association between urinary Cd and mortality. CVD mortality risks (p for trend, 0.04) were significantly increased with increasing urinary Cd with hazard ratios (HRs) (95% CIs) of 2.18 (0.68–7.01) for the highest quartile of urinary Cd compared to the lowest. The association between urinary Cd and CVD mortality became stronger in the stratified analyses by renal function and these associations became more consistent in those who never smoked. Conclusions: The inverse association between urinary Cd and blood pressure observed in previous studies may be due to lack of consideration of renal function as an effect modifier. The strength of the association between urinary Cd and CVD mortality may be underestimated without considering renal function.

Original languageEnglish (US)
Pages (from-to)15-22
Number of pages8
JournalToxicology and Applied Pharmacology
Volume353
DOIs
StatePublished - Aug 15 2018

Fingerprint

Nutrition Surveys
Blood pressure
Cadmium
Blood Pressure
Kidney
Mortality
Cardiovascular Diseases
Nutrition
Hazards
Blood
Health
Hematologic Diseases

Keywords

  • Blood pressure
  • Cadmium
  • Cardiovascular mortality
  • NHANES
  • Renal function

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology

Cite this

Gao, Yi ; Zhu, Xiangzhu ; Shrubsole, Martha J. ; Fan, Lei ; Xia, Zhaolin ; Harris, Raymond C. ; Hou, Lifang ; Dai, Qi. / The modifying effect of kidney function on the association of cadmium exposure with blood pressure and cardiovascular mortality : NHANES 1999–2010. In: Toxicology and Applied Pharmacology. 2018 ; Vol. 353. pp. 15-22.
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abstract = "Objective: We hypothesized that the associations of urinary Cd with blood pressure and cardiovascular disease (CVD) mortality may be modified by renal function. Methods: We tested these hypotheses using data from the National Health and Nutrition Examination Survey (NHANES, 1999–2010). Results: Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively associated with blood Cd. DBP was positively related to urinary Cd whereas SBP was inversely associated with urinary Cd. In the stratified analyses by level of eGFR, the associations between SBP and urinary Cd were not statistically significant among those with normal renal function and those with mildly reduced renal function whereas SBP significantly positively associated with urinary Cd among those with moderately or severely decreased renal function (p for trend, 0.0004). Renal function appeared to be a modifying factor of the association between urinary Cd and mortality. CVD mortality risks (p for trend, 0.04) were significantly increased with increasing urinary Cd with hazard ratios (HRs) (95{\%} CIs) of 2.18 (0.68–7.01) for the highest quartile of urinary Cd compared to the lowest. The association between urinary Cd and CVD mortality became stronger in the stratified analyses by renal function and these associations became more consistent in those who never smoked. Conclusions: The inverse association between urinary Cd and blood pressure observed in previous studies may be due to lack of consideration of renal function as an effect modifier. The strength of the association between urinary Cd and CVD mortality may be underestimated without considering renal function.",
keywords = "Blood pressure, Cadmium, Cardiovascular mortality, NHANES, Renal function",
author = "Yi Gao and Xiangzhu Zhu and Shrubsole, {Martha J.} and Lei Fan and Zhaolin Xia and Harris, {Raymond C.} and Lifang Hou and Qi Dai",
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The modifying effect of kidney function on the association of cadmium exposure with blood pressure and cardiovascular mortality : NHANES 1999–2010. / Gao, Yi; Zhu, Xiangzhu; Shrubsole, Martha J.; Fan, Lei; Xia, Zhaolin; Harris, Raymond C.; Hou, Lifang; Dai, Qi.

In: Toxicology and Applied Pharmacology, Vol. 353, 15.08.2018, p. 15-22.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The modifying effect of kidney function on the association of cadmium exposure with blood pressure and cardiovascular mortality

T2 - NHANES 1999–2010

AU - Gao, Yi

AU - Zhu, Xiangzhu

AU - Shrubsole, Martha J.

AU - Fan, Lei

AU - Xia, Zhaolin

AU - Harris, Raymond C.

AU - Hou, Lifang

AU - Dai, Qi

PY - 2018/8/15

Y1 - 2018/8/15

N2 - Objective: We hypothesized that the associations of urinary Cd with blood pressure and cardiovascular disease (CVD) mortality may be modified by renal function. Methods: We tested these hypotheses using data from the National Health and Nutrition Examination Survey (NHANES, 1999–2010). Results: Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively associated with blood Cd. DBP was positively related to urinary Cd whereas SBP was inversely associated with urinary Cd. In the stratified analyses by level of eGFR, the associations between SBP and urinary Cd were not statistically significant among those with normal renal function and those with mildly reduced renal function whereas SBP significantly positively associated with urinary Cd among those with moderately or severely decreased renal function (p for trend, 0.0004). Renal function appeared to be a modifying factor of the association between urinary Cd and mortality. CVD mortality risks (p for trend, 0.04) were significantly increased with increasing urinary Cd with hazard ratios (HRs) (95% CIs) of 2.18 (0.68–7.01) for the highest quartile of urinary Cd compared to the lowest. The association between urinary Cd and CVD mortality became stronger in the stratified analyses by renal function and these associations became more consistent in those who never smoked. Conclusions: The inverse association between urinary Cd and blood pressure observed in previous studies may be due to lack of consideration of renal function as an effect modifier. The strength of the association between urinary Cd and CVD mortality may be underestimated without considering renal function.

AB - Objective: We hypothesized that the associations of urinary Cd with blood pressure and cardiovascular disease (CVD) mortality may be modified by renal function. Methods: We tested these hypotheses using data from the National Health and Nutrition Examination Survey (NHANES, 1999–2010). Results: Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively associated with blood Cd. DBP was positively related to urinary Cd whereas SBP was inversely associated with urinary Cd. In the stratified analyses by level of eGFR, the associations between SBP and urinary Cd were not statistically significant among those with normal renal function and those with mildly reduced renal function whereas SBP significantly positively associated with urinary Cd among those with moderately or severely decreased renal function (p for trend, 0.0004). Renal function appeared to be a modifying factor of the association between urinary Cd and mortality. CVD mortality risks (p for trend, 0.04) were significantly increased with increasing urinary Cd with hazard ratios (HRs) (95% CIs) of 2.18 (0.68–7.01) for the highest quartile of urinary Cd compared to the lowest. The association between urinary Cd and CVD mortality became stronger in the stratified analyses by renal function and these associations became more consistent in those who never smoked. Conclusions: The inverse association between urinary Cd and blood pressure observed in previous studies may be due to lack of consideration of renal function as an effect modifier. The strength of the association between urinary Cd and CVD mortality may be underestimated without considering renal function.

KW - Blood pressure

KW - Cadmium

KW - Cardiovascular mortality

KW - NHANES

KW - Renal function

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