Blood cadmium level's association with 18-month mortality in diabetic patients with maintenance haemodialysis

BACKGROUND: Cadmium exposure is related to severity of diabetes and diabetes-related organ damage in diabetic patients. Elevated blood cadmium levels (BCLs) are well known in maintenance haemodialysis (MHD) patients but the clinical significance in diabetic MHD patients remains unknown. METHODS: A total of 212 diabetic MHD patients were enrolled in this 18-month prospective study and were categorized into three equal groups according to the basal BCL: high (> 0.889 μg/L; n = 71), middle (0.373-0.889 μg/L; n = 70) and low (< 0.373 μg/L; n = 71) BCL groups. The mortality and cause of death were recorded and analysed longitudinally. RESULTS: Patients with high BCL had trends of higher white blood cell counts, glycosylated haemoglobin, phosphate and blood lead levels than other group patients. At the end of the follow-up, 31 patients had died. Kaplan-Meier analysis showed that the high BCL group patients had a higher mortality than other group patients (log-rank test, P = 0.036). Cox multivariate analysis demonstrated that logarithmic BCL was associated with increased hazard ratios (HR) for the all-cause mortality (HR = 2.336, 95% confidence intervals [CI] = 1.099-4.964, P = 0.027) in diabetic MHD patients. Similarly, if the low BCL group was the reference, the high BCL was associated with increased HR for all-cause mortality (HR = 2.865, 95% CI = 1.117-7.353, P = 0.043) in these patients. CONCLUSIONS: The study results first demonstrated that BCL is associated with increased HR for 18-month all-cause mortality in diabetic MHD patients. Avoiding smoking and high cadmium-containing food may be important in these patients.