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Early-Life Dietary Cadmium Exposure and Kidney Function in 9-Year-Old Children from the PROGRESS Cohort

Cadmium and Lead Exposure, Nephrotoxicity, and Mortality

Kidney Disease Research Collaborative, The University of Queensland Faculty of Medicine and Translational Research Institute, Woolloongabba, Brisbane 4102, Australia
School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia
NHMRC Centre of Research Excellence for CKD.QLD, UQ Faculty of Medicine, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
Department of Nephrology, Princess Alexandra Hospital, Brisbane 4075, Australia
Stratton Veteran Affairs Medical Center and Albany Medical College, Albany, NY 12208, USA
Author to whom correspondence should be addressed.
Toxics 2020, 8(4), 86;
Received: 12 August 2020 / Revised: 7 October 2020 / Accepted: 11 October 2020 / Published: 13 October 2020
(This article belongs to the Special Issue Toxic Metals, Chronic Diseases and Related Cancers)
The present review aims to provide an update on health risks associated with the low-to-moderate levels of environmental cadmium (Cd) and lead (Pb) to which most populations are exposed. Epidemiological studies examining the adverse effects of coexposure to Cd and Pb have shown that Pb may enhance the nephrotoxicity of Cd and vice versa. Herein, the existing tolerable intake levels of Cd and Pb are discussed together with the conventional urinary Cd threshold limit of 5.24 μg/g creatinine. Dietary sources of Cd and Pb and the intake levels reported for average consumers in the U.S., Spain, Korea, Germany and China are summarized. The utility of urine, whole blood, plasma/serum, and erythrocytes to quantify exposure levels of Cd and Pb are discussed. Epidemiological studies that linked one of these measurements to risks of chronic kidney disease (CKD) and mortality from common ailments are reviewed. A Cd intake level of 23.2 μg/day, which is less than half the safe intake stated by the guidelines, may increase the risk of CKD by 73%, and urinary Cd levels one-tenth of the threshold limit, defined by excessive ß2-microglobulin excretion, were associated with increased risk of CKD, mortality from heart disease, cancer of any site and Alzheimer’s disease. These findings indicate that the current tolerable intake of Cd and the conventional urinary Cd threshold limit do not provide adequate health protection. Any excessive Cd excretion is probably indicative of tubular injury. In light of the evolving realization of the interaction between Cd and Pb, actions to minimize environmental exposure to these toxic metals are imperative. View Full-Text
Keywords: cadmium; chronic kidney disease; lead; mortality; nephrotoxicity; threshold limit; tolerable intake level cadmium; chronic kidney disease; lead; mortality; nephrotoxicity; threshold limit; tolerable intake level
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MDPI and ACS Style

Satarug, S.; C. Gobe, G.; A. Vesey, D.; Phelps, K.R. Cadmium and Lead Exposure, Nephrotoxicity, and Mortality. Toxics 2020, 8, 86.

AMA Style

Satarug S, C. Gobe G, A. Vesey D, Phelps KR. Cadmium and Lead Exposure, Nephrotoxicity, and Mortality. Toxics. 2020; 8(4):86.

Chicago/Turabian Style

Satarug, Soisungwan, Glenda C. Gobe, David A. Vesey, and Kenneth R. Phelps 2020. "Cadmium and Lead Exposure, Nephrotoxicity, and Mortality" Toxics 8, no. 4: 86.

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