Exploring the Association Between Potentially Toxic Elements and Chronic Kidney Disease of Unknown Etiology in...

Chronic kidney disease of unknown etiology (CKDu) is highly prevalent in agricultural communities of rural areas. Environmental risks such as potentially toxic elements (PTEs) are hypothesized to be the primary contributors; however, existing research is inconsistent. This study aimed to explore the association between various PTEs (Al, Ni, As, Cd, Hg, and Pb) and their interactions in CKDu in eastern Uttar Pradesh. This was a tertiary hospital-based case-control study recruiting 211 CKDu patients along with 214 age and gender-matched controls from the same region. Urea and creatinine levels were measured using the Cobas 6000. Estimated Glomerular Filtration Rate (eGFR) was calculated based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation. PTEs were measured in the serum and urine using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Single and multi-element exposures were explored using regression model analysis. PTE levels in both serum and urine were higher in the CKDu group than in the control group and were correlated with eGFR. Multivariate regression identified that serum Cd (β =  - 0.382, p < 0.001), As (β =  - 0.332, p < 0.001), Hg (β =  - 0.250, p < 0.001), and Al (β =  - 0.222, p < 0.001) were independently associated with CKDu. From Weighted Quartile Square (WQS) regression analysis, the maximum weight in disease prevalence was Cd (41%, β = 0.78) followed by As (32%, β = 0.42) and Al (17%, β = 0.32). A Gaussian process classifier and Bayesian kernel machine regression were used to measure the overall effect of PTEs as mixtures on CKDu. Al, As, Cd, and Hg levels were independently associated with eGFR and CKDu prevalence. However, all PTEs correlated with eGFR, signifying their bioaccumulation with or without causation.