Effects of Environmental Heavy Metals in Soil on Estimated Glomerular Filtration Rate Variability

土壤中的重金屬對於腎絲球過濾率變異量的影響

張晉鏵(Chin-Hua Chang) ； 邱炳芳(Ping-Fang Chiu) ； 吳家麟(Chia-Lin Wu) ； 許秋婷(Chew-Teng Kor) ； 連怡斌(Ie-Bin Lian) ； 張登翔(Teng-Hsiang Chang) ； 蔡俊傑(Chun-Chieh Tsai) ； 張家築(Chia-Chu Chang)

《The Changhua Journal of Medicine》 14卷4期 (2016/12) Pp. 159-167

https://doi.org/10.6501/CJM.1404.002

摘要

Background: Chronic kidney disease (CKD) is a common disease in Taiwan. Recently, numerous studies have shown that heavy metals can induce CKD. Accumulated evidence has shown that estimated glomerular filtration rate (eGFR) variability predicts renal prognosis and mortality rate in CKD patients. We speculated that environmental metals have an impact on variation of eGFR and further cause adverse renal outcomes. Methods: We retrospectively collected study data of patients in a CKD care program from the Division of Nephrology and Chronic Kidney Disease Education Center in Changhua Christian Hospital. We used residency data from the study data linked to data of soil metal concentrations from the nationwide systematic survey of farm soil conducted by the Environmental Protection Administration (EPA). The EPA provided the concentrations of heavy metals arsenic, mercury, cadmium, chromium, copper, nickel, lead and zinc in soil. Results: We found that four heavy metals, including Cr, Cu, Ni and Pb, were marginally significantly associated with high variation in the eGFR. According to the results of a multivariate linear regression model, there were significant associations between heavy metals and eGFR variability, especially in patients with diabetes mellitus or cerebral vascular accident. Conclusion: The results of this study demonstrated that environmental heavy metal levels have impacts on eGFR variability, especially in patients with diabetes mellitus or cerebral vascular accident. We suggest that CKD patients residing in areas with high concentrations of heavy metals in soil should attend more frequent clinical follow-ups owing to the possibility of instability in eGFR variability.

關鍵字

chronic kidney disease ； environmental heavy ； metal ； estimated glomerular ； filtration rate

並列摘要

背景知識：慢性腎臟病在臺灣是常見的疾病。已經有許多研究指出，重金屬會誘發慢性腎臟病。越來越多的證據顯示，腎絲球過濾率變異量可以預測慢性腎臟病病人的腎功能預後以及死亡率。我們推測環境中的重金屬會影響腎絲球過濾率的變異量進而造成腎臟的不良影響。方法：病人來源為彰化基督教醫院腎臟科所屬慢性腎臟病照護中心的病人們。我們透過病人的住址並連結環保署所提供的全國土壤中重金屬濃度的資料作為研究的來源。環保署提供的土壤中重金屬的濃度包含：砷、汞、鎘、鉻、銅、鎳、鉛、鋅。結果：我們發現鉻、銅、鎳、鉛與腎絲球過濾率的變異量有相關。透過多變數線性回歸的統計，土壤中的重金屬與腎絲球過濾率的變異量有顯著相關，尤其是在糖尿病以及中風的病人族群。結論：我們的研究發現，環境中的重金屬對於腎絲球過濾率的變異量有顯著的影響，尤其是對糖尿病患及中風患者。因此我們建議，居住在土壤中含重金屬濃度較高的區域的慢性腎臟病的患者應該更頻繁地追蹤腎功能。

並列關鍵字

慢性腎臟病 ； 重金屬 ； 腎絲球過濾率