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Abstract: TH-PO1021

Association of Co-Exposure to Cadmium and Lead with CKD and Cardiovascular Disease (CVD) Comorbidity in US Adults: NHANES 2003-2018

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Lewin, Michael David, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States
  • Alli, Babatunde Y., McGill University, Montreal, Quebec, Canada
  • Sowell, Anne L., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Shim, Youn K., Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States

Environmental exposure to cadmium (Cd) and lead (Pb) have been implicated in both CKD and CVD. The two metals can be detected together at or above the respective population medians in 45% of the US population 6 years and older. Although both metals exhibit similar renal pathology and toxic mechanisms, the relationship between the metal mixture and the CKD and CVD comorbidity is not clear. The objective of this cross-sectional study was to examine the associations of Cd and Pb exposure with CKD and CVD outcomes and to see if the two metals are independently associated with the outcomes.


We included data from the National Health and Examination Survey (NHANES) 2003-2018 participants 20 years and older with urine Cd, blood Pb, serum creatinine, and urine albumin/creatinine measurements (n=12,851). Pregnant women and participants with CKD stage 5 were excluded. We used generalized logistic regression to calculate adjusted odds ratios for CVD, CKD, or both CKD and CVD relative to none of these co-morbidities. We tested for interactions, both on multiplicative and additive scales, between the two metals with and without other covariates (gender, race/ethnicity, attained education, smoking, alcohol use, body mass index (BMI), and quadratic age).


Both multiplicative and additive interaction effects were not statistically significant at the p-value of 0.05 level. It is possible that our sample size was too small to detect the effect. The final model included urine Cd, blood Pb, gender, race/ethnicity, education, smoking, alcohol use, BMI, and quadratic age. The Cd effect was statistically significantly associated with CKD+CVD (OR=1.19, 95%CI=1.03-1.38, p=0.02) after adjusting for the effect of Pb and other covariates, whereas Pb was significantly associated with CKD (OR=1.22, 95%CI=1.07-1.39, p=0.003) and CVD+CKD (OR=1.39, 95%CI=1.16-1.65, p=0.0004) after adjusting for the effect of Cd and other covariates.


These results suggest that the effects of Cd and Pb are independent each other, and more pronounced in participants who had both CKD and CVD, supporting their role as risk factors even at exposures below the levels typically associated with occupational hazards. However, reverse causation because of underlying kidney damage cannot be ruled out.


  • Other U.S. Government Support