The association of urine arsenic with prevalent and incident chronic kidney disease: evidence from the Strong Heart Study

Epidemiology. 2015 Jul;26(4):601-12. doi: 10.1097/EDE.0000000000000313.


Background: Few studies have evaluated associations between low to moderate arsenic levels and chronic kidney disease (CKD). The objective was to evaluate the associations of inorganic arsenic exposure with prevalent and incident CKD in American Indian adults.

Methods: We evaluated the associations of inorganic arsenic exposure with CKD in American Indians who participated in the Strong Heart Study in 3,851 adults ages 45-74 years in a cross-sectional analysis, and 3,119 adults with follow-up data in a prospective analysis. Inorganic arsenic, monomethylarsonate, and dimethylarsinate were measured in urine at baseline. CKD was defined as estimated glomerular filtration rate ≤ 60 ml/min/1.73 m, kidney transplant or dialysis.

Results: CKD prevalence was 10.3%. The median (IQR) concentration of inorganic plus methylated arsenic species (total arsenic) in urine was 9.7 (5.8, 15.7) μg/L. The adjusted odds ratio (OR; 95% confidence interval) of prevalent CKD for an interquartile range in total arsenic was 0.7 (0.6, 0.8), mostly due to an inverse association with inorganic arsenic (OR: 0.4 [0.3, 0.4]). Monomethylarsonate and dimethylarsinate were positively associated with prevalent CKD after adjustment for inorganic arsenic (OR: 3.8 and 1.8). The adjusted hazard ratio of incident CKD for an IQR in sum of inorganic and methylated arsenic was 1.2 (1.03, 1.41). The corresponding HRs for inorganic arsenic, monomethylarsonate, and dimethylarsinate were 1.0 (0.9, 1.2), 1.2 (1.00, 1.3), and 1.2 (1.0, 1.4).

Conclusions: The inverse association of urine inorganic arsenic with prevalent CKD suggests that kidney disease affects excretion of inorganic arsenic. Arsenic species were positively associated with incident CKD. Studies with repeated measures are needed to further characterize the relation between arsenic and kidney disease development.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Arizona / epidemiology
  • Arsenic / urine*
  • Arsenicals / urine
  • Cacodylic Acid / urine
  • Cohort Studies
  • Cross-Sectional Studies
  • Environmental Exposure / statistics & numerical data*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Incidence
  • Indians, North American / statistics & numerical data*
  • Male
  • Middle Aged
  • North Dakota / epidemiology
  • Oklahoma / epidemiology
  • Prevalence
  • Proportional Hazards Models
  • Prospective Studies
  • Renal Insufficiency, Chronic / epidemiology*
  • South Dakota / epidemiology
  • United States / epidemiology


  • Arsenicals
  • Cacodylic Acid
  • monomethylarsonic acid
  • Arsenic