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Elimination and half-time of cadmium
in kidney
Magnus Akerstrom1, Thomas Lundh2, Lars Barregard1, Gerd Sallsten1
1Occupational

and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg

2Occupational

and Environmental Medicine, Lund University, Sweden
Background
•

The general population is exposed to cadmium (Cd) from diet and
smoking, approximately 50% of the total Cd body burden is
accumulated in the kidney

•

Evidence of tubular damage and bone effects at low levels of Cd
exposure in the general population

•

U-Cd is widely used as measure for long-term
Cd exposure or body burden

•

No previous study of the relationships between Cd in kidney, blood
and urine for living subjects with valid analytical methods
1. Study design
•109 living kidney donors
•Questionnaire
(work history, diet, smoking…)
•Biological samples
• 24h urine (UCd/24h)
• Overnight urine (UON)
• Blood
• Kidney cortex biopsy

•Samples analyzed for:
• U-Cd / B-Cd / K-Cd (ICP-MS)

All

Men

Women

Subjects

109

49

60

Age: median
(range)

51
(24-70)

52
(32-70)

50
(24-64)

Never smokers

41

19

22

13
(0.4-51)

12
(0.4-51)

13
(2-36)

Pack-years:
median
(range)

Overnight
U-Cd (µg/gC):
Mean
(Range)

0.29
0.23
0.34
(0.04-1.1) (0.04-0.80) (0.08-1.1)
Research questions
Biological half-time of Cd in the kidney?
Determinants for UCd/24 h?
Relationship between Cd in kidney and
urine (UON) (and blood)?
Relationship between Cd in kidney and urine
k = calculated elimination constant
1.2

Cd in urine per 24h (μg)

Regression line with intercept

1.0

U-Cd/24h=0.07+0.000062×K-Cdtot

0.8

The fraction of K-Cdtot

0.6

excreted in urine per 24h

0.4

was 0.006%
0.2
0.0
0

2000

4000

6000

8000

10000 12000 14000

Cd in kidney (μg)

Akerstrom et al. 2013 TAAP
A nonlinear relationship between Cd in kidney
and urine

Cd in urine per 24h (μg)

1.4
Regression line all data
Regression line K-Cdconc < 15 μg/g
Regression line K-Cdconc >=15 μg/g

1.2

U-Cd/24h=0.000071×K-Cdtot

1.0
0.8

p<0.001 for
difference

0.6
0.4
0.2

U-Cd/24h=0.00011×K-Cdtot

0.0
0

2000

4000

6000

8000

10000 12000 14000

Cd in kidney (μg)
Akerstrom et al. 2013 TAAP
A nonlinear relationship between Cd in kidney
and urine
U-Cd/24h=0.11×10-3×K-Cdtot – 5.8×10-9 × K-Cdtot2

Cd in urine per 24h (μg)

1.2

Regression line all data

1.0

T1/2=28.5
T1/2=43.5

0.8

T1/2= 21.2

0.6
0.4
0.2
0.0
0

2000

4000

6000

8000

10000 12000 14000

Cd in kidney (μg)
Akerstrom et al. 2013 TAAP
Biological half-time of Cd in kidney
T1/2 = ln(2) / k

• Linear model with intercept
•

T1/2=30.4 years (95% CI; 24.3-40.5)

• Linear model without intercept
•

T1/2=21.0 years (95% CI; 18.9-23.6)

• Linear model without intercept
•

K-Cdconc<15 µg/g : T1/2=17.9 years (95% CI; 15.7-20.8)

•

K-Cdconc≥15 µg/g: T1/2=26.7 years (95% CI; 23.4-31.1)

• In a nonlinear model, half-time is 21 – 44 years depending
on the amount of Cd in the kidney
Akerstrom et al. 2013 TAAP
Albumin in urine was also a determinant for U-Cd/24h

Akerstrom et al TAAP 2013
Overnight urinary cadmium concentration
adjusted for creatinine (μg/gC)

Relationship between Cd in kidney and urine
1.2
UON-CdCrea = 0.071 + 0.014 x K-Cdconc
2
R = 0.44

1.0
0.8

U-Cd/K-Cd ratio
• Previous: about 1:20

0.6
0.4

• This study: about 1:60

0.2
0.0
0

10

20

30

40

50

1.2

UON-CdSG = 0.11 + 0.010 x K-Cdconc
R2 = 0.28

1.0
0.8
0.6
0.4
0.2
0.0
0

10

20

30

40

50

Kidney cortex cadmium concentration (μg/g)

Blood cadmium concentration (μg/L)

Overnight urinary cadmium concentration
adjusted for specific gravity (μg/L

Kidney cortex cadmium concentration (μg/g)

3.5
B-Cd = 0.16 + 0.023 x K-Cdconc
R2 = 0.19

3.0
2.5
2.0
1.5
1.0
0.5
0.0
0

10

20

30

40

50

Kidney cortex cadmium concentration (μg/g)
Conclusions
• A strong but nonlinear relationship between U-Cd and KCd with slower elimination of Cd at high kidney Cd

• Previous U-Cd/K-Cd ratio may underestimate K-Cd at low
U-Cd

• The half-time for Cd in the kidney is
18 – 44 years, depending on model used
Association between
U-Cd and U-proteins
for one study
participant

Akerstrom et al. 2013 EHP
Association between U-Cd and U-Proteins for all study
participants

Akerstrom et al. 2013 EHP
Association
between U-Cd
and U-Proteins for
all study
participants

Akerstrom et al. 2013 EHP

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11.4 Sallsten

  • 1. Elimination and half-time of cadmium in kidney Magnus Akerstrom1, Thomas Lundh2, Lars Barregard1, Gerd Sallsten1 1Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg 2Occupational and Environmental Medicine, Lund University, Sweden
  • 2. Background • The general population is exposed to cadmium (Cd) from diet and smoking, approximately 50% of the total Cd body burden is accumulated in the kidney • Evidence of tubular damage and bone effects at low levels of Cd exposure in the general population • U-Cd is widely used as measure for long-term Cd exposure or body burden • No previous study of the relationships between Cd in kidney, blood and urine for living subjects with valid analytical methods
  • 3. 1. Study design •109 living kidney donors •Questionnaire (work history, diet, smoking…) •Biological samples • 24h urine (UCd/24h) • Overnight urine (UON) • Blood • Kidney cortex biopsy •Samples analyzed for: • U-Cd / B-Cd / K-Cd (ICP-MS) All Men Women Subjects 109 49 60 Age: median (range) 51 (24-70) 52 (32-70) 50 (24-64) Never smokers 41 19 22 13 (0.4-51) 12 (0.4-51) 13 (2-36) Pack-years: median (range) Overnight U-Cd (µg/gC): Mean (Range) 0.29 0.23 0.34 (0.04-1.1) (0.04-0.80) (0.08-1.1)
  • 4. Research questions Biological half-time of Cd in the kidney? Determinants for UCd/24 h? Relationship between Cd in kidney and urine (UON) (and blood)?
  • 5. Relationship between Cd in kidney and urine k = calculated elimination constant 1.2 Cd in urine per 24h (μg) Regression line with intercept 1.0 U-Cd/24h=0.07+0.000062×K-Cdtot 0.8 The fraction of K-Cdtot 0.6 excreted in urine per 24h 0.4 was 0.006% 0.2 0.0 0 2000 4000 6000 8000 10000 12000 14000 Cd in kidney (μg) Akerstrom et al. 2013 TAAP
  • 6. A nonlinear relationship between Cd in kidney and urine Cd in urine per 24h (μg) 1.4 Regression line all data Regression line K-Cdconc < 15 μg/g Regression line K-Cdconc >=15 μg/g 1.2 U-Cd/24h=0.000071×K-Cdtot 1.0 0.8 p<0.001 for difference 0.6 0.4 0.2 U-Cd/24h=0.00011×K-Cdtot 0.0 0 2000 4000 6000 8000 10000 12000 14000 Cd in kidney (μg) Akerstrom et al. 2013 TAAP
  • 7. A nonlinear relationship between Cd in kidney and urine U-Cd/24h=0.11×10-3×K-Cdtot – 5.8×10-9 × K-Cdtot2 Cd in urine per 24h (μg) 1.2 Regression line all data 1.0 T1/2=28.5 T1/2=43.5 0.8 T1/2= 21.2 0.6 0.4 0.2 0.0 0 2000 4000 6000 8000 10000 12000 14000 Cd in kidney (μg) Akerstrom et al. 2013 TAAP
  • 8. Biological half-time of Cd in kidney T1/2 = ln(2) / k • Linear model with intercept • T1/2=30.4 years (95% CI; 24.3-40.5) • Linear model without intercept • T1/2=21.0 years (95% CI; 18.9-23.6) • Linear model without intercept • K-Cdconc<15 µg/g : T1/2=17.9 years (95% CI; 15.7-20.8) • K-Cdconc≥15 µg/g: T1/2=26.7 years (95% CI; 23.4-31.1) • In a nonlinear model, half-time is 21 – 44 years depending on the amount of Cd in the kidney Akerstrom et al. 2013 TAAP
  • 9. Albumin in urine was also a determinant for U-Cd/24h Akerstrom et al TAAP 2013
  • 10. Overnight urinary cadmium concentration adjusted for creatinine (μg/gC) Relationship between Cd in kidney and urine 1.2 UON-CdCrea = 0.071 + 0.014 x K-Cdconc 2 R = 0.44 1.0 0.8 U-Cd/K-Cd ratio • Previous: about 1:20 0.6 0.4 • This study: about 1:60 0.2 0.0 0 10 20 30 40 50 1.2 UON-CdSG = 0.11 + 0.010 x K-Cdconc R2 = 0.28 1.0 0.8 0.6 0.4 0.2 0.0 0 10 20 30 40 50 Kidney cortex cadmium concentration (μg/g) Blood cadmium concentration (μg/L) Overnight urinary cadmium concentration adjusted for specific gravity (μg/L Kidney cortex cadmium concentration (μg/g) 3.5 B-Cd = 0.16 + 0.023 x K-Cdconc R2 = 0.19 3.0 2.5 2.0 1.5 1.0 0.5 0.0 0 10 20 30 40 50 Kidney cortex cadmium concentration (μg/g)
  • 11. Conclusions • A strong but nonlinear relationship between U-Cd and KCd with slower elimination of Cd at high kidney Cd • Previous U-Cd/K-Cd ratio may underestimate K-Cd at low U-Cd • The half-time for Cd in the kidney is 18 – 44 years, depending on model used
  • 12.
  • 13.
  • 14. Association between U-Cd and U-proteins for one study participant Akerstrom et al. 2013 EHP
  • 15. Association between U-Cd and U-Proteins for all study participants Akerstrom et al. 2013 EHP
  • 16. Association between U-Cd and U-Proteins for all study participants Akerstrom et al. 2013 EHP