Risk factors of renal dysfunction and their interaction in level-low lead exposure paint workers.
ABSTRACT: To explore the effect of low-level lead exposure on renal dysfunction in paint works, and analyze the interaction between low-level lead exposure and other influence factors of renal dysfunction.Seven hundred forty seven workers from Sany Heavy Industry Company and Xiangjiang Kansai Paint Company who have been exposed to paint were chosen by random cluster sampling. Their blood lead level and Urine ?2-micro globulin level (renal dysfunction) were tested,risk factors of renal dysfunction in paint workers and their interactions were analyzed.The prevalence of renal dysfunction was 12.37%. Risk factors of renal dysfunction in paint workers mainly included longer working years (OR?=?1.699, 95% CI: 1.226~?2.355), blood lead positive (OR?=?2.847, 95% CI: 1.577~?5.139) and hypertension (OR?=?2.192, 95% CI: 1.103~?4.359). Positive interaction existed between hypertension and low-level blood lead on renal dysfunction in paint workers, the RERI (Relative excess risk of interaction), API (Attributable proportions of interaction) and S(the synergy index) were 4.758, 54.5% and 2.604 respectively.Low-level lead exposure and hypertension not only have independent effect on renal dysfunction in paint workers, but also had obvious positive interaction in paint workers. Interventions aimed at blood lead and blood pressure at the same time will better prenvent from renal dysfunction.
Project description:Background:Cadmium exposure may induce chronic intoxication with renal damage. Silver soldering may be a source of cadmium exposure. Methods:We analyzed working environment measurement data and periodic health screening data from a small-scale silver soldering company with ten workers. Concentrations of cadmium in air from working environment measurement data were obtained. Concentrations of blood and urinary cadmium, urine protein, and urine ?2-microglobulin (?2M) were obtained. The generalized linear model was used to identify the association between blood and urine cadmium and urine ?2M concentrations. Clinical features of chronic cadmium intoxication focused with toxicological renal effects were described. Results:The mean duration of work was 8.5 years (standard deviation [SD] = 6.9, range = 3-20 years). Cadmium concentrations in air were ranged from 0.006 to 0.015 mg/m3. Blood cadmium concentration was elevated in all ten workers, with a highest level of 34.6 ?g/L (mean = 21.288 ?g/L, SD = 11.304, range = 9.641-34.630 ?g/L). Urinary cadmium concentration was elevated in nine workers, with a highest level of 62.9 ?g/g Cr (mean = 22.151 ?g/g creatinine, SD = 19.889, range = 3.228-62.971 ?g/g creatinine). Urine ?2M concentration was elevated in three workers. Urinary cadmium concentration was positively associated with urine protein concentration (beta coefficient = 10.27, 95% confidence interval = [4.36, 16.18]). Other clinical parameters were compatible with renal tubular damage. Conclusion:Cadmium intoxication may occur at quite low air concentrations. Exposure limit may be needed to be lowered.
Project description:OBJECTIVES:Prevention of hearing impairment (HI) is important because recovery of hearing is typically difficult. Epidemiological studies have examined the risk factors for HI. However, the association between hypertension and HI remains unclear. We aimed to clarify the association between hypertension and HI. DESIGN:Cross-sectional study. SETTING:Japanese workers in an information and communication technologies company. PARTICIPANTS:Of 24 823 employees of the same company, we recruited 13 475 participants who underwent hearing testing by audiometry in annual health check-ups and did not have missing data regarding body measurement, blood test results and drinking/smoking status (mean age: 49.4 years; males: 86.4%). PRIMARY OUTCOMES:Hearing tests were performed at two frequencies (1 kHz, 4 kHz). We defined the inability of participants to respond to 30 dB at 1 kHz and/or 40 dB at 4 kHz as overall moderate HI. We also defined moderate HI at 1 or 4 kHz as an abnormal finding at 1 or 4 kHz. We defined hypertension as ≥140 mm Hg systolic blood pressure and/or ≥90 mm Hg diastolic blood pressure and/or taking medication for hypertension. We examined the association between hypertension and HI after adjusting for age, sex, body mass index, smoking/drinking status, diabetes mellitus, hyperlipidaemia and proteinuria. RESULTS:Moderate HI was identified in 980 participants (7.3%). Of these, 441 participants (3.3%) exhibited moderate HI at 1 kHz, and 787 participants (5.8%) exhibited moderate HI at 4 kHz. Subjects with hypertension showed a higher prevalence of any HI. The prevalence of overall moderate HI, moderate HI at 1 kHz and moderate HI at 4 kHz among subjects with hypertension was 8.7%, 4.3% and 6.8%, while those among subjects without hypertension was 6.9%, 3.0% and 5.6% (p<0.01, p<0.01 and p=0.01, respectively). CONCLUSIONS:Hypertension was associated with moderate HI in Japanese workers.
Project description:BACKGROUND:Exposure to risk factors for hypertension may be influenced by the characteristics of the workplace, where workers spend most of their daily time. OBJECTIVES:To evaluate the association between features of the companies, particularly the presence of facilities to provide meals, and of population characteristics and the prevalence of hypertension, taking into account individual risk factors for hypertension. MATERIAL AND METHODS:This multilevel analysis was based on a cross-sectional study with individual and company data from the SESI (Serviço Social da Indústria-Social Service of Industries) study and population-based data from the national census statistics. Workers aged ?15 years were randomly selected from small (20-99), medium (100-499) and large (?500 employees) companies per state using multistage sampling. Logistic regression was used to analyse the association between hypertension and individual, workplace and population variables, with odds ratios (ORs; 95%?CI) adjusted for three-level variables. RESULTS:4818 Workers from 157 companies were interviewed and their blood pressure, weight and height were measured. Overall, 77% were men, aged 35.4 ±10.7 years, with 8.7 ±4.1 years of schooling and mostly worked in companies with a staff canteen (66%). Besides individual characteristics-being male, ageing, low schooling, alcohol abuse and higher BMI-a workplace with no staff canteen (OR=1.28; 95%?CI 1.08 to 1.52), small companies (OR=1.31; 95%?CI 1.07 to 1.60) and living in cities with higher economic inequality (OR=1.47; 95%?CI 1.23 to 1.76) were associated with a higher risk for hypertension. CONCLUSION:Among Brazilian workers, the prevalence of hypertension is associated with individual risk factors, lack of a canteen at the workplace, small companies and higher economic inequalities of cities. These three-level characteristics help to interpret differences in the prevalence of hypertension between regions or countries.
Project description:Elevated blood pressure (BP) and renal dysfunction are complex traits representing major global health problems. Single nucleotide polymorphisms identified by genome-wide association studies have identified the Alström syndrome 1 (ALMS1) gene locus to render susceptibility for renal dysfunction, hypertension, and chronic kidney disease (CKD). Mutations in the ALMS1 gene in humans causes Alström syndrome, characterized by progressive metabolic alterations including hypertension and CKD. Despite compelling genetic evidence, the underlying biological mechanism by which mutations in the ALMS1 gene lead to the above-mentioned pathophysiology is not understood. We modeled this effect in a KO rat model and showed that ALMS1 genetic deletion leads to hypertension. We demonstrate that the link between ALMS1 and hypertension involves the activation of the renal Na+/K+/2Cl- cotransporter NKCC2, mediated by regulation of its endocytosis. Our findings establish a link between the genetic susceptibility to hypertension, CKD, and the expression of ALMS1 through its role in a salt-reabsorbing tubular segment of the kidney. These data point to ALMS1 as a potentially novel gene involved in BP and renal function regulation.
Project description:Low-level cadmium exposure, resulting in, for example, urinary cadmium <2.0 ?g/g creatinine, is widespread; recent data suggest nephrotoxicity even at these low levels. Few studies have examined the impact of low-level cadmium exposure in workers who are occupationally exposed to other nephrotoxicants such as lead.We evaluated associations of urine cadmium, a measure of cumulative dose, with four glomerular filtration measures and N-acetyl-?-D-glucosaminidase (NAG) in lead workers. Recent and cumulative lead doses were assessed via blood and tibia lead, respectively.In 712 lead workers, mean (SD) blood and tibia lead values, urine cadmium values and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation were 23.1 (14.1) ?g/dl, 26.6 (28.9) ?g Pb/g bone mineral, 1.15 (0.66) ?g/g creatinine and 97.4 (19.2) ml/min/1.73 m(2), respectively. After adjustment for age, sex, body mass index, urine creatinine, smoking, alcohol, education, annual income, diastolic blood pressure, current or former lead worker job status, new or returning study participant, and blood and tibia lead, higher ln-urine cadmium was associated with higher calculated creatinine clearance, eGFR (? = 8.7 ml/min/1.73 m(2); 95% CI 5.4 to 12.1) and ln-NAG but lower serum creatinine.Potential explanations for these results include a normal physiological response in which urine cadmium levels reflect renal filtration, the impact of adjustment for urine dilution with creatinine in models of kidney outcomes, and cadmium-related hyperfiltration.
Project description:Studies about the association between lead exposure and the elevation of blood pressure and risk of hypertension are varied, while available data on blood lead levels (BLL) in workers with lead-exposure are scarce. This research aimed to evaluate associations between BLL and blood pressure in an occupational population-based study in Jiangsu province, China. We enrolled 21,688 workers in this study. Information on socioeconomic and occupational background was obtained with face-to-face interviews. BLL, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and hypertension status was confirmed. We found that workers in mini-factories had the highest average BLL (20.3 ?g/dL; 95% CI, 19.0-21.6 ?g/dL) for overall participants. The employees in private factories had higher BLL (9.6 ?g/dL; 95% CI, 9.5-9.8 ?g/dL). However, BLL was much lower (4.0 ?g/dL; 95%CI, 3.7-4.2 ?g/dL) in state-owned factories. Participants working in the electrical machinery and equipment manufacturing industry had higher BLL (9.1 ?g/dL; 95% CI, 9.0-9.3?g/dL). Compared to those workers with ? 4.6 ?g/dL BLL, workers with > 17.5 ?g/dL BLL presented 1.34 mmHg and 0.70 mmHg average difference in SBP and DBP, respectively. The adjusted OR for hypertension was 1.11 (95%CI, 1.08-1.15) compared to the workers with > 17.5 ?g/dL BLL and to those with ? 4.6 ?g/dL BLL. In summary, we found that BLL was positively associated with SBP and DBP and with the morbidity of hypertension in occupational populations with a high concentration of lead exposure. It is important to formulate new standards of blood lead levels to screen for elevated lead exposure. In addition, a series of new systems of risk assessment should be established to further reduce and prevent lead exposure.
Project description:Mitochondrial injury contributes to renal dysfunction in several models of renal disease, but its involvement in human hypertension remains unknown. Fragments of the mitochondrial genome released from dying cells are considered surrogate markers of mitochondrial injury. We hypothesized that hypertension would be associated with increased urine mitochondrial DNA (mtDNA) copy numbers. We prospectively measured systemic and urinary copy number of the mtDNA genes cytochrome-c oxidase-3 and NADH dehydrogenase subunit-1 by quantitative polymerase chain reaction in essential (n=25) and renovascular (RVH, n=34) hypertensive patients and compared them with healthy volunteers (n=22). Urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin served as indices of renal injury. Renal blood flow and oxygenation were assessed by multidetector computed tomography and blood oxygen level-dependent magnetic resonance imaging. Blood pressure, urinary neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 were similarly elevated in essential hypertension and RVH, and estimated glomerular filtration rate was lower in RVH versus healthy volunteers and essential hypertension. Renal blood flow was lower in RVH compared with essential hypertension. Urinary mtDNA copy number was higher in hypertension compared with healthy volunteers, directly correlated with urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 and inversely with estimated glomerular filtration rate. In RVH, urinary mtDNA copy number correlated directly with intrarenal hypoxia. Furthermore, in an additional validation cohort, urinary mtDNA copy number was higher in RVH compared with healthy volunteers (n=10 each). The change in serum creatinine levels and estimated glomerular filtration rate 3 months after medical therapy without or with revascularization correlated with the change in urinary mtDNA. Therefore, elevated urinary mtDNA copy numbers in hypertensive patients correlated with markers of renal injury and dysfunction, implicating mitochondrial injury in kidney damage in human hypertension.
Project description:While the negative effects of unemployment have been well studied, the consequences of layoffs and downsizing for those who remain employed are less well understood. This study uses human resources and health claims data from a large multi-site fully insured aluminum company to explore the health consequences of downsizing on the remaining workforce. We exploit the variation in the timing and intensity of layoff to categorize 30 plants as high or low layoff plants. Next, we select a stably employed cohort of workers with history of health insurance going back to 2006 to 1) describe the selection process into layoff and 2) explore the association between the severity of plant level layoffs and the incidence of four chronic conditions in the remaining workforce. We examine four health outcomes: incident hypertension, diabetes, asthma/COPD and depression for a cohort of approximately 13,000 employees. Results suggest that there was an increased risk of developing hypertension for all workers and an increased risk of developing diabetes for salaried workers that remain at the plants with the highest level of layoffs. The hypertension results were robust to a several specification tests. In addition, the study design selected only healthy workers, therefore our estimates are likely to be a lower bound and suggest that adverse health consequences of the 2007-2009 recession may have affected a broader proportion of the population than previously expected.
Project description:Hypertension is a major risk factor for chronic kidney disease (CKD) and renal inflammation is an integral part in this pathology. Hydrogen sulfide (H2S) has been shown to mitigate renal damage through reduction in blood pressure and reactive oxygen species; however, the exact mechanisms are not clear. While several studies have underlined the role of epigenetics in renal inflammation and dysfunction, the mechanisms through which epigenetic regulators play role in hypertension are not well defined. We used microarrays to detail the global programme of gene expression underlying hypertension in the kidney and how hydrogen sulfide supplementation alleviates these effects. Overall design: Wild-type mice were treated with Ang-II to induce hypertension for 28 days along with hydrogen sulfide, at the end of which kidneys were collected and processed for arrays.
Project description:Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately.