confounders in the assessment of the renal effects associated with low-level urinary cadmium an analysis in industrial workers混杂因素的评估与底层相关的肾影响尿镉分析产业工人.pdfVIP

Haddam et al. Environmental Health 2011, 10:37 /content/10/1/37 RESEARCH Open Access Confounders in the assessment of the renal effects associated with low-level urinary cadmium: an analysis in industrial workers 1,2 1 3 1 3 3 Nahida Haddam , Sekkal Samira , Xavier Dumont , Abdesselem Taleb , Dominique Lison , Vincent Haufroid and Alfred Bernard3* Abstract Background: Associations of proteinuria with low-level urinary cadmium (Cd) are currently interpreted as the sign of renal dysfunction induced by Cd. Few studies have considered the possibility that these associations might be non causal and arise from confounding by factors influencing the renal excretion of Cd and proteins. Methods: We examined 184 healthy male workers (mean age, 39.5 years) from a zinc smelter (n = 132) or a blanket factory (n = 52). We measured the concentrations of Cd in blood (B-Cd) and the urinary excretion of Cd (U-Cd), retinol-binding protein (RBP), protein HC and albumin. Associations between biomarkers of metal exposure and urinary proteins were assessed by simple and multiple regression analyses. Results: The medians (interquartile range) of B-Cd ( μg/l) and U-Cd (μg/g creatinine) were 0.80 (0.45-1.16) and 0.70 (0.40-1.3) in smelter workers and 0.66 (0.47-0.87) and 0.55 (0.40-0.90) in blanket factory workers, respectively. Occupation had no influence on these values, which varied mainly with smoking habits. In univariate analysis, concentrations of RBP and protein HC in urine were significantly correlated with both U-Cd and B-Cd but these associations were substantially weakened by the adjustment for current smoking and the residual influence of diuresis after correction for