Urine arsenic and prevalent albuminuria: evidence from a population-based study

Am J Kidney Dis. 2013 Mar;61(3):385-94. doi: 10.1053/j.ajkd.2012.09.011. Epub 2012 Nov 9.


Background: Long-term arsenic exposure is a major global health problem. However, few epidemiologic studies have evaluated the association of arsenic with kidney measures. Our objective was to evaluate the cross-sectional association between inorganic arsenic exposure and albuminuria in American Indian adults from rural areas of Arizona, Oklahoma, and North and South Dakota.

Study design: Cross-sectional. SETTING & PARTIPANTS: Strong Heart Study locations in Arizona, Oklahoma, and North and South Dakota. 3,821 American Indian men and women aged 45-74 years with urine arsenic and albumin measurements.

Predictor: Urine arsenic.

Outcomes: Urine albumin-creatinine ratio and albuminuria status.

Measurements: Arsenic exposure was estimated by measuring total urine arsenic and urine arsenic species using inductively coupled plasma mass spectrometry (ICPMS) and high-performance liquid chromatography-ICPMS, respectively. Urine albumin was measured by automated nephelometric immunochemistry.

Results: The prevalence of albuminuria (albumin-creatinine ratio ≥30 mg/g) was 30%. Median value for the sum of inorganic and methylated arsenic species was 9.7 (IQR, 5.8-15.6) μg per gram of creatinine. Multivariable-adjusted prevalence ratios of albuminuria (albumin-creatinine ratio ≥30 mg/g) comparing the 3 highest to lowest quartiles of the sum of inorganic and methylated arsenic species were 1.16 (95% CI, 1.00-1.34), 1.24 (95% CI, 1.07-1.43), and 1.55 (95% CI, 1.35-1.78), respectively (P for trend <0.001). The association between urine arsenic and albuminuria was observed across all participant subgroups evaluated and was evident for both micro- and macroalbuminuria.

Limitations: The cross-sectional design cannot rule out reverse causation.

Conclusions: Increasing urine arsenic concentrations were cross-sectionally associated with increased albuminuria in a rural US population with a high burden of diabetes and obesity. Prospective epidemiologic and mechanistic evidence is needed to understand the role of arsenic as a kidney disease risk factor.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Albuminuria / epidemiology
  • Albuminuria / urine*
  • Arsenic / urine*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged


  • Arsenic