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Arsenic and Chronic Kidney Disease: A Systematic Review
#MMPMID25221743
Zheng L
; Kuo CC
; Fadrowski J
; Agnew J
; Weaver VM
; Navas-Acien A
Curr Environ Health Rep
2014[Sep]; 1
(3
): 192-207
PMID25221743
show ga
In epidemiologic studies, high arsenic exposure has been associated with adverse
kidney disease outcomes. We performed a systematic review of the epidemiologic
evidence of the association between arsenic and various kidney disease outcomes.
The search period was January 1966 through January 2014. Twenty-five papers
(comprising 24 studies) meeting the search criteria were identified and included
in this review. In most studies, arsenic exposure was assessed by measurement of
urine concentrations or with an ecological indicator. There was a generally
positive association between arsenic and albuminuria and proteinuria outcomes.
There was mixed evidence of an association between arsenic exposure and chronic
kidney disease (CKD), ?-2 microglobulin (?2MG), and N-acetyl-?-D-glucosaminidase
(NAG) outcomes. There was evidence of a positive association between arsenic
exposure and kidney disease mortality. Assessment of a small number of studies
with three or more categories showed a clear dose-response association between
arsenic and prevalent albuminuria and proteinuria, but not with CKD outcomes.
Eight studies lacked adjustment for possible confounders, and two had small study
populations. The evaluation of the causality of the association between arsenic
exposure and kidney disease outcomes is limited by the small number of studies,
lack of study quality, and limited prospective evidence. Because of the high
prevalence of arsenic exposure worldwide, there is a need for additional
well-designed epidemiologic and mechanistic studies of arsenic and kidney disease
outcomes.