Associations of 24-h urinary excretion of heavy metals and trace elements with estimated glomerular filtration rate and chronic kidney disease

Abstract

Abstract Chronic kidney disease (CKD) is a growing global health concern. Although certain elements have been implicated in CKD, evidence based on 24-h urinary excretion and kidney outcomes remains limited. Cross-sectional data from the SKIPOGH cohort (2008–2013) were used to assess 24-h urinary element excretion, estimated glomerular filtration rate (eGFR), and CKD. Associations were evaluated using multivariable regression, nonlinear modeling, mixture analysis, and fractional excretion. Among 923 participants (mean age 47.8 years, 52.0% female), higher 24-h urinary excretion of vanadium, chromium, cobalt, palladium, silver, cadmium, and mercury was positively associated with eGFR in multivariable analyses. Fractional excretion analyses showed associations consistent with differences in kidney handling. In addition, CKD was present in 67 participants (7.3%). Higher 24-h urinary excretion of copper and zinc was associated with increased odds of CKD, whereas urinary excretion of selenium, palladium, cadmium, and mercury was inversely associated with CKD, including after adjustment for plasma concentrations. After correction for multiple testing, associations for vanadium, chromium, and palladium with eGFR, and for copper and mercury with CKD, remained statistically significant. Several 24-h urinary element excretion measures were statistically associated with kidney function. Longitudinal studies are needed to clarify temporal relationships and underlying mechanisms.