Euro Nephrology 2019: Environmental co-exposure to cadmium and lead and the association with diabetic kidney disease; another reason to avoid smoking and alcohol intake in patients with T2DM?

Introduction:

 

Diabetic kidney disease is a diminishing in kidney work that happens in certain individuals who have diabetes. It implies that your kidneys are not carrying out their responsibility just as they once never really squander items and abundance liquid from your body. These squanders can develop in your body and cause harm to different organs. The reasons for diabetic kidney malady are perplexing and in all probability identified with numerous components. A few specialists feel that adjustments in the flow of blood inside the separating contraption of the kidney (the glomerulus) may assume a significant job. Diabetic kidney infection, likewise called diabetic nephropathy, happens when high glucose harms your kidneys. Your kidneys are loaded with minuscule veins called glomeruli. These veins help clean your blood. A lot of sugar in your blood can hurt these veins. When your kidneys have been harmed by diabetes, they can't be fixed. On the off chance that diabetic kidney ailment isn't dealt with right on time, the harm can deteriorate after some time and it can prompt kidney disappointment. At the point when our bodies digest the protein we eat, the procedure makes squander items. In the kidneys, a large number of little veins (vessels) with much littler openings in them go about as channels. As blood courses through the veins, little atoms, for example, squander items just barely get through the openings. These waste items become some portion of the pee. Helpful substances, for example, protein and red platelets, are too enormous to go through the openings in the channel and remain in the blood. Diabetes can harm this framework. Elevated levels of glucose make the kidneys channel an excessive amount of blood. This additional work is difficult for the channels. After numerous years, they begin to spill and helpful protein is lost in the pee. Having limited quantities of protein in the pee is called micro albuminuria. At the point when kidney infection is analyzed right on time, during micro albuminuria, a few medicines may shield kidney sickness from deteriorating. Having bigger measures of protein in the pee is called macro albuminuria. At the point when kidney malady is looked up some other time during macro albuminuria, end-stage renal ailment, or ESRD, generally follows. In time, the pressure of exhaust makes the kidneys lose their sifting capacity. Squander items at that point begin to develop in the blood. At long last, the kidneys come up short. This disappointment, ESRD, is intense. An individual with ESRD needs to have a kidney transplant or to have the blood separated by machine (dialysis).

 

Background:

 

Environmental factors contributing to diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) are incompletely understood. We investigated whether blood concentrations of cadmium (Cd) and lead (Pb) were associated with prevalent DKD, and to which extent diet and smoking contribute to blood Cd and Pb concentrations.

 

Methods:

 

We performed a cross-sectional analysis in 240 patients with T2DM included in the Diabetes and Lifestyle Cohort Twente (DIALECT-1). Blood Cd and Pb concentrations were determined from EDTA whole blood samples. Cd-Pb co-exposure was calculated by addition of Cd and Pb Z-scores. The association between Cd-Pb and DKD (CKD-epi <60ml/min/1.73m2 and/or albuminuria) was determined using multivariate logistic regression. The association between diet (derived from food frequency questionnaire), smoking and Cd and Pb was determined using multivariate linear regression.

 

Results:

 

Almost half of all participants had DKD (49%). Median blood concentrations were 0.33 ug/l (IQR: 0.21-0.57 ug/l) for Cd and 1.45 ug/dl (IQR: 0.83-1.86 ug/dl) for Pb, all below the values known for acute toxicity. Higher Cd-Pb was associated with a 32% higher risk for DKD (OR: 1.317 (1.071-1.620), p=0.009). Smoking status was positively associated with Cd (β: 0.479, p<0.001) and alcohol intake with Pb (β: 0.299, p <0.001), while there was no association between dietary intake and Cd or Pb.

 

Conclusion:

 

The association between higher Cd-Pb and prevalent DKD might suggest Cd and Pb contribute to progressive DKD. The higher Cd-Pb associated with smoking and alcohol might provide another mechanism by which these intoxications adversely affect renal health in T2DM.

Author(s): G.D. Laverman, I.J.M. Hagedoorn, S. van Huizen, C.M. Gant, R.G.H.J Maatman, G.J. Navis and S.J.L. Bakker

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