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ORIGINAL RESEARCH article

Front. Public Health
Sec. Environmental health and Exposome
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1403878

Uric acid mediates the relationship between mixed heavy metal exposure and renal function in elderly people

Provisionally accepted
Pan Sai Pan Sai 1*Yue Niu Yue Niu 2Shuwei Duan Shuwei Duan 2Delong Zhao Delong Zhao 2Qian Wang Qian Wang 2Zheyi Dong Zheyi Dong 2*GUANGYAN CAI GUANGYAN CAI 2*Xiangmei Chen Xiangmei Chen 2*
  • 1 Department of Nephrology, Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, China
  • 2 Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, China

The final, formatted version of the article will be published soon.

    Background: Population aging is a pivotal trend observed globally, and the exposure to heavy metals can exacerbate the aging process and lead to kidney damage. However, the impact of combined heavy metal exposure on renal function among older individuals remains elusive. Our study employs machine learning techniques to delve into the effects and underlying mechanisms of mixed exposure to heavy metals on the renal function of the aging population.Methods: This study extracted comprehensive data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2020. A total of 3175 participants aged 60 years and above, with complete information on six metals -lead, cadmium, manganese, cobalt, mercury, and selenium, along with relevant covariates, were included in the study. To assess the impact of single or mixed metal exposure on the renal function of elderly individuals, various statistical techniques were employed: multiple logistic regression, weighted quantitative sum (WQS) regression, Bayesian kernel machine regression (BKMR), and mediation effects analysis.Results: Multiple logistic regression revealed that selenium and manganese were protective factors for chronic kidney disease (CKD). Cobalt was a risk factor for CKD. High concentrations of lead, cadmium, and cobalt were risk factors for urinary albumin creatinine ratio (ACR). WQS analyses revealed that mixed metal exposure was positively correlated with estimated glomerular filtration rate (eGFR) but negatively correlated with CKD. Selenium and manganese can neutralize the effects of other metals on eGFR. Mixed metal exposure was positively correlated with ACR, with lead and cadmium having a substantial effect. Mediation analysis showed that uric acid (UA) had a mediating effect of 9.7% and -19.7% in the association between mixed metals exposure and proteinuria and CKD, respectively. The impact of heavy metals on renal function in the elderly differs from that of adolescents and adults. This study suggests that elevated levels of mixed metals exposure are linked to proteinuria and CKD, with UA serving as a mediating factor.

    Keywords: Kidney function, Uric Acid, Aging, heavy metals, machine learning

    Received: 22 Mar 2024; Accepted: 04 Jul 2024.

    Copyright: © 2024 Sai, Niu, Duan, Zhao, Wang, Dong, CAI and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Pan Sai, Department of Nephrology, Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, China
    Zheyi Dong, Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, China
    GUANGYAN CAI, Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, China
    Xiangmei Chen, Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Beijing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.