Urine tungsten and chronic kidney disease in rural Colorado

• Published in: Environmental research 2021-04, Vol.195, p.110710-110710, Article 110710
• Main Authors: Fox, Jacob, Macaluso, Francesca, Moore, Camille, Mesenbring, Elise, Johnson, Richard J., Hamman, Richard F., James, Katherine A.
• Format: Article
• Language: English
• Subjects: CKD; CKDu; Colorado; Colorado - epidemiology; Heavy metals; Humans; Kidney; Prospective Studies; Renal Insufficiency, Chronic - epidemiology; Risk Factors; San Luis Valley; Tungsten
• ISSN: 0013-9351; 1096-0953
• DOI: 10.1016/j.envres.2021.110710

Chronic kidney disease (CKD) is a cause of global morbidity and mortality in agricultural communities. The San Luis Valley (SLV) is a rural agricultural community in southern Colorado with geographic and sociodemographic risk factors for CKD, including a water supply contaminated by heavy metals. We obtained pre-existing sociodemographic, clinical, and urine trace metal data for 1659 subjects from the San Luis Valley Diabetes Study, a prospective cohort study. We assessed prospective associations between urine tungsten (W) and time-to-CKD using accelerated failure time models (n = 1659). Additionally, logistic models were used to assess relationships between urine W and renal injury markers (NGAL, KIM1) using Tobit regression (n = 816), as well as epidemiologically-defined CKD of unknown origin (CKDu) using multiple logistic regression (n = 620). Elevated urine W was strongly associated with decreased time-to-CKD, even after controlling for hypertension and diabetes. Depending on how CKD was defined, a doubling of urine W was associated with a 27% (95% CI 11%, 46%) to 31% (14%, 51%) higher odds of developing CKD within 5 years. The relationship between urine W and select renal injury markers was not significant, although urine NGAL was modified by diabetes status. Elevated (>95%ile) urinary W was significantly associated with CKDu (OR 5.93, 1.83, 19.21) while adjusting for known CKD risk factors. Our data suggest that increased exposure to W is associated with decreased time-to-CKD and may be associated with CKDu. Given persistence of associations after controlling for diabetes and hypertension, W may exert a primary effect on the kidney, although this needs to be evaluated further in future studies. [Display omitted] •Elevated urine W strongly associated with decreased time-to CKD.•Doubling of urine W associated with 27–31% higher odds of CKD within 5 years.•No significant relationship between urine W and either urine NGAL or KIM1.•Extreme (95%ile) urine W associated with epidemiologically-defined CKDu.•Tungsten may exert a primary effect on the kidney.