Association between multiple metal(loid)s exposure and renal function: a cross-sectional study from southeastern China

In the real world, humans are exposed to multiple metal(loid)s (designated hereafter metals) that contain essential metals as well as toxic metals. Exposure to the metal mixture was assumed to be associated with renal function impairment; however, there is no consensus on available studies. Therefore, we here explored the association between multiple metals exposure and indicators of renal function in the general population from southeastern China. A total of 11 metals with 6 human essential metals and 5 toxic metals were determined in the selected 720 subjects. In addition, serum uric acid (SUA), serum creatinine (SCR), and the estimated glomerular filtration rate (eGFR) were measured or calculated as indicators of renal function. Using multiple flexible statistical models of generalized linear model, elastic net regression, and Bayesian kernel machine regression, the joint as well as the individual effect of metals within the mixture, and the interactions between metals were explored. When exposed to the metal mixture, the statistically non-significantly increased SUA, the significantly increased SCR, and the significantly declined eGFR were observed. In addition, the declined renal function may be primarily attributed to lead (Pb), arsenic (As), and nickel (Ni) exposure. Finally, interactions, such as the synergistic effect between Pb and Mo on SUA, whereas the antagonistic effect between Ni and Cd on SCR and eGFR were identified. Our finding suggests that combined exposure to multiple metals would impair renal function. Therefore, reducing exposure to toxic heavy metals of Pb, As, and Cd and limiting exposure to the human essential metal of Ni would protect renal function.