The association between lead and cadmium co-exposure and renal dysfunction

Ecotoxicol Environ Saf. 2019 May 30:173:429-435. doi: 10.1016/j.ecoenv.2019.01.121. Epub 2019 Feb 21.


Both cadmium (Cd) and lead (Pb) exposure can induce kidney damage. However, the effects of combined exposure to Cd and Pb on renal function at environmental levels have not been fully clarified. In this study we investigated the renal function in a Chinese population co-exposed to Cd and Pb. A total of 331 subjects (215 women and 116 men), living in either a control or a polluted area, were included in this study. Cd and Pb in blood and urine (BCd, BPb, UCd, and UPb), and kidney effect markers including urinary N-acetyl-β-D-glucosaminidase (UNAG) and estimated glomerular filtration rate (eGFR), were determined, and the association between exposure markers and renal effect biomarkers were analyzed. The exposure levels in the polluted area were significantly higher than in the control area (all p < 0.01). The eGFR of subjects in the polluted area was decreased compared with that in the control area (p < 0.01). The subjects with high BCd/BPb (BCd ≥ 2 μg/L, BPb ≥ 100 μg/L) or high UCd/UPb (UCd ≥ 3 μg/g creatinine, UPb ≥ 10 μg/g creatinine) showed higher UNAG and UALB levels compared with other subgroups (p < 0.01). The probability of having elevated UNAG in subjects with high BCd/BPb was greater than those with low BCd/BPb [odds ratio (OR) = 2.6, 95% confidence interval (CI): 1.4-4.7), low BCd/high BPb (OR =3.1, 95% CI: 1.4-6.6), and high BCd/low BPb (OR = 1.7, 95% CI: 0.9-3.2). The OR of subjects with low UCd and high UPb, high UCd and low UPb, and high UCd/UPb were 2.9 (95% CI: 1.4-5.7), 3.3 (95% CI: 1.5-7.2), and 7.7 (95% CI: 4.0-14.7), respectively, compared with those with low UCd/UPb. The risk of decrease in eGFR was also higher in subjects with high UCd/UPb than for those with low UCd/UPb (OR = 7.2, 95% CI: 0.8-62.2). Our data demonstrate that Cd and Pb exposure, alone or in combination, are associated with renal impairment. In addition, co-exposure to Pb and Cd propagates the renal tubular dysfunction compared with Cd or Pb exposure alone.

Keywords: Cadmium; Estimated glomerular filtration rate; Lead; Renal function; Urinary N-acetyl-β-D-glucosaminidase; Urinary microalbuminuria.

MeSH terms

  • Acetylglucosaminidase / urine
  • Adult
  • Aged
  • Aged, 80 and over
  • Asian People
  • Biomarkers / urine
  • Cadmium / blood
  • Cadmium / toxicity*
  • Cadmium / urine
  • Environmental Exposure / adverse effects
  • Environmental Pollutants / blood
  • Environmental Pollutants / toxicity*
  • Environmental Pollutants / urine
  • Female
  • Glomerular Filtration Rate / drug effects
  • Humans
  • Kidney / drug effects*
  • Kidney / physiology
  • Lead / blood
  • Lead / toxicity*
  • Lead / urine
  • Male
  • Middle Aged
  • Odds Ratio


  • Biomarkers
  • Environmental Pollutants
  • Cadmium
  • Lead
  • Acetylglucosaminidase