| Summary: | 博士 === 國立成功大學 === 環境醫學研究所 === 106 === Previous governmental surveys have showed that more than half a million residents in Taiwan had drunk water that contained arsenic levels higher than 0.05 ppm, particularly those residents in the southern part of Taiwan. On the other hand, the incidence of end-stage renal disease (ESRD) in Taiwan is among the highest in the world, and southern Taiwan also has higher incidence nationwild. During its urinary elimination, arsenic concentrates in the kidney and affects the function of proximal convoluted tubules and glomerulus. However, epidemiology studies on the associations between arsenic exposure and chronic kidney disease (CKD) are limited. The objectives of the proposed study are to evaluate the associations of arsenic exposure with the risks of CKD and with the development of CKD to ESRD, and to identify the genetic markers single nucleotide polymorphisms (SNP) of this process as well as other useful biomarkers. We will begin to recruit CKD patients’ fellow-up study at a teaching hospital in southwestern Taiwan, and conduct a nationwide cohort study on MJ Health Management Institution in Taiwan from 2000 to 2009. We will also analyze the longitudinal data on 1,000,000 people from 1996 to 2010, which are available from the National Health Insurance Research Database (NHIRD), to evaluate the associations between arsenic level in drinking water and the risks of CKD / ESRD. Secondly, we will apply geographic information system (GIS) to generate more precise data on arsenic exposure and assess its associations with CKD in greater details. We will perform preliminary analysis on the factors that affect the development of CKD to ESRD. The proposed project aims to identify the role of arsenic in drinking water in the high incidence of ESRD in southern Taiwan and to provide information on predicting of the susceptibility of development ESRD from CKD. The data generated by the proposed project shall help risk stratification of CKD patients and help the planning of individual treatment plans.
Arsenic levels in drinking water were assessed on the basis of a nationwide census survey conducted by the government, of which measurement reports were available for 311 townships.
Using both 50 μg/L (0.05 mg/L) as the cut-offs, we found most of the hot spots were in the southwestern coast and northeastern areas. Furthermore, we found exposure to arsenic in drinking water was associated with the incidence of CKD / ESRD and the rapid progression of CKD (eGFR decline〉5 ml/min/1.73 m2/year) in Taiwan, independent of most documented risk factors; the adjusted odds ratio (AOR) is 1.22, 95% confidence interval [C.I]=1.05-1.42, p〈0.01.
We identified 5,442 newly diagnosed ESRD from 362,505 members age≥ 40 years in 1998 during the study period (from 1998 to 2010) and found that residents of areas with arsenic levels≥ 50 µg/L in the drinking water had a hazard ratio (HR) of 1.14 (95% confidence interval [CI]: 1.08-1.21, p〈0.001) for ESRD. After adjusting for sex, age, income, and comorbidities, we found an adjusted HR of 1.12 (95% CI: 1.06-1.19, p〈0.001), which was still statistically significant. Furthermore, the effect was modified by comorbidities, with more prominent effects on patients with less than three comorbidities (adjusted HR=1.51; 95% CI: 1.22-1.86 for low comorbidity score, p〈0.001). In conclusion, a high arsenic level in drinking water was a risk factor for ESRD, independent of other documented risk factors.
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