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Associations of exposure to heavy metal mixtures with kidney stone among U.S. adults: A cross-sectional study

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Abstract

Assessing the effects of heavy metals (HMs) on kidney stone is often limited to analyzing individual metal exposures, with studies on the effects of exposure to mixtures of HMs being scarce. To comprehensively evaluate the relationship between exposure to mixed HMs and kidney stones, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2007–2016, which included 7809 adults. We used multiple statistical methods, including multiple logistic regression models, weighted quantile sum (WQS) regression, quantile g-computation (qgcomp) and bayesian kernel machine regression (BKMR), to assess the association between single HM and mixed exposure to HMs and kidney stones. Firstly, in single exposure analysis, urinary cadmium (Cd) and cobalt (Co) demonstrated a positive association with the risk of kidney stones. Secondly, various other approaches consistently revealed that mixed exposure to HMs exhibited a positive association with kidney stone risk, primarily driven by Cd, Co, and barium (Ba) in urine, with these associations being particularly notable among the elderly population. Finally, both BKMR and survey-weighted generalized linear models consistently demonstrated a significant synergistic effect between urinary Co and urinary uranium (Ur) in elevating the risk of kidney stones. Overall, this study provides new epidemiological evidence that mixed exposure to HMs is associated with an increased risk of kidney stones. Further prospectively designed studies are needed to confirm these findings.

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Data availability

The dataset used can be found in the NHANES repository.

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Funding

This work was supported by grants from the National Natural Science Foundation of China (82073655) and the funds for academic and technical leaders in Anhui province (2017D140) and Clinical Medicine Discipline construction project of Anhui Medical University(2021lcxk043).

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Rd, Hefei, 230032, Anhui, China

    Hui Zhao, Lanlan Fang, Yuting Chen, Yubo Ma, Shanshan Xu, Jianping Ni, Xuyang Chen, Guosheng Wang & Faming Pan

  2. The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China

    Hui Zhao, Lanlan Fang, Yuting Chen, Yubo Ma, Shanshan Xu, Jianping Ni, Xuyang Chen, Guosheng Wang & Faming Pan

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  1. Hui Zhao
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Contributions

Hui Zhao: conceptualization, methodology, software, writing—original draft, visualization, writing—review and editing. Lanlan Fang: conceptualization, writing—review and editing, methodology, validation. Yuting Chen: software, writing—original draft, visualization, data curation. Yubo Ma: investigation, data curation, validation, conceptualization. Shanshan Xu: software, data curation, investigation. Jianping Ni: investigation, visualization, software. Xuyang Chen: software, visualization. Guosheng Wang: resources, supervision. Faming Pan: resources, writing—review and editing, supervision, project administration, funding acquisition.

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Correspondence to Faming Pan.

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Not applicable. This study uses only secondary data analyses without any personal information identifed using statistical data from NHANES website; no further ethical approval for conducting the present study is required.

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Hui Zhao and Lanlan Fang contributed equally to this work and should be considered co-first authors.

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Zhao, H., Fang, L., Chen, Y. et al. Associations of exposure to heavy metal mixtures with kidney stone among U.S. adults: A cross-sectional study. Environ Sci Pollut Res 30, 96591–96603 (2023). https://doi.org/10.1007/s11356-023-29318-7

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