Letter to the Editor
Non-critical urinary cadmium excretion as a risk factor associated with tubular markers of early kidney injury in Central Mexico
Niveles no-críticos de excreción urinaria de cadmio como factor de riesgo asociado con marcadores tubulares de daño renal temprano en la región central de México
Ma. Ludivina Robles-Osorioa, Pablo García-Solísa, Juan Carlos Solís-Sainza, Diana Montero-Pereab, Itzel Avilés-Romob, Elizabeth Sabath-Silvac, Angeles Ochoa-Martínezd, Iván Pérez-Maldonadod, Ernesto Sabatha,e,
Corresponding author
a Endocrinology and Metabolism Laboratory, Universidad Autónoma de Querétaro, Mexico
b Medical School, Universidad Autónoma de Querétaro, Mexico
c Cellular Biology and Physiology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico
d Department of Environmental Toxicology Laboratory, Medical School, Universidad Autónoma de San Luis Potosí, Mexico
e Renal Department, Hospital General de Querétaro, Mexico
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We evaluated 90 voluntary healthy subjects (≥20 years old), using a simple probabilistic sampling procedure on every of the communities studied. Those with current urinary tract infection, previous diagnosis of kidney disease, liver disease, cancer, or other chronic disease, as well as pregnant women were excluded.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A questionnaire was used to obtain information on personal health history, and risk factors to Cd exposure. Blood pressure measurements were obtained with an aneroid sphygmomanometer after a 5<span class="elsevierStyleHsp" style=""></span>min resting in sitting position, and blood samples were taken after a fasting ≥8<span class="elsevierStyleHsp" style=""></span>h during the same visit.</p><p id="par0030" class="elsevierStylePara elsevierViewall">GFR was calculated with the CKD-Epi formula and spot urine samples for albumin, α1-microglobulin and cadmium analysis were collected in cadmium-free containers. Albumin and α1M were creatinine adjusted.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Cd measurements were done at the Department of Environmental Toxicology Laboratory (San Luis Potosi Medical School); and quantification was carried out with a Perkin-Elmer 3110 atomic absorption spectrometer.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We categorized urinary Cd excretion in two groups according to CdU excretion and multivariate analysis was performed to identify risk factors for high Cd levels, albuminuria and higher urinary α1M. A <span class="elsevierStyleItalic">p</span> value ≤0.05 was considered as statistically significant and data were analyzed using the SPSS 23.0 software.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The overall analysis included 90 adults with no antecedent of occupational exposure to Cd, 66.6% of all participants were women and the mean age was 41<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12 years; CdU median levels were 0.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.41<span class="elsevierStyleHsp" style=""></span>μg/gCr and few patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) had CdU ≥1<span class="elsevierStyleHsp" style=""></span>μg/gCr.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Those subjects with CdU<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>0.37<span class="elsevierStyleHsp" style=""></span>μg/gCr had higher levels of α1M (9.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9 vs 3.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>μg/gCr, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001) and albumin excretion (13.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>24 vs 3.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>g/gCr, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001). Those patients with higher CdU excretion had a higher risk for α1M<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>10 (OR 5.0, CI95 1.4–18.6, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) and micro-albuminuria (OR 20, CI95 1.0–39, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04).</p><p id="par0055" class="elsevierStylePara elsevierViewall">In multivariate analysis, CdU was the most important risk factor associated with higher α1M excretion and albuminuria after adjustments for age, BMI, smoking status, blood pressure, lead concentration and GFR.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In non-smoking subjects, those with CdU<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>0.37<span class="elsevierStyleHsp" style=""></span>μg/gCr had higher urinary excretion of α1M (7.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.2 vs 3.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.7<span class="elsevierStyleHsp" style=""></span>μg/gCr, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002) and albumin (11.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18 vs 3.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>g/gCr, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003); CdU was associated with a higher risk for α1M<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>μg/gCr (OR 4.1, CI95 1.1–19, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03), and CdU was the most important factor associated with higher α1M excretion.</p><p id="par0065" class="elsevierStylePara elsevierViewall">This is the first study done in Mexico to evaluate the effects of Cd on kidney injury markers such as albumin and α1M, and in this study we showed that in this population living in central Mexico the non-critical levels of urinary Cd excretion had an important effect on markers of tubular injury, though association with low GFR was not found.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Cadmium levels in this study were just above to those reported in other countries such as the United States (media 0.26<span class="elsevierStyleHsp" style=""></span>μg/gCr), Spain (media 0.28<span class="elsevierStyleHsp" style=""></span>μg/gCr), or Korea (media 0.30<span class="elsevierStyleHsp" style=""></span>μg/gCr)<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a>; however, comparing the results with other studies that had shown nephrotoxicity associated to CdU, the threshold reported for CdU is higher (0.8–1.0<span class="elsevierStyleHsp" style=""></span>μg/gCr),<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> so our finding is of interest because the CdU levels analyzed in our study are in a range considered as non-nephrotoxic.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Tubular injury and urinary excretion of tubular injury markers are the first clinical manifestations of Cd nephrotoxicity, and some studies have found association between urinary α1M and tubular atrophy, GFR decline, and higher mortality; however its role in progressive kidney disease is controversial.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Some limitations of this study are the small number of patients, the high representation of women, the lack of Cd environmental levels and of reliable epidemiological data about the prevalence of low GFR in the communities studied.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion, our study shows that non-critical Cd excretion is a risk factor associated with an increased excretion of markers of tubular injury and further work need to be done to test Cd as a possible toxin in the occurrence of CKD of unknown etiology in Mexico (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1–2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they do not have conflicting interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:2 [ "identificador" => "xack304751" "titulo" => "Acknowledgements" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; α1M: α1-microglobuline; AUE: albumin urinary excretion; GFR: glomerular filtration rate.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cd<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.37 (μg/gCr)<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>64 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cd<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>37 (μg/gCr)<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Females (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smokers (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">122<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">α1M (μg/gCr) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AUE (g/gCr) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucose (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">eGFR (ml/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uric acid (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1536016.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of demographic and laboratory characteristics according to CdU excretion.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">α1M: α1-microglobuline; AUE: albumin urinary excretion; BMI: body mass index; GFR: glomerular filtration rate.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">α1M</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AUE</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">β</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">β</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.172 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.059 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.065 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.184 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">GFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.091 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.094 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glucose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.057 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CdU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.381 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CdU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.472 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1536015.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis of variables associated with α1M and albumin urinary excretion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current status of cadmium as an environmental health problem" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. 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The authors wish to thank Dr. Alberto Vázquez-Mellado for albumin determinations.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000005/v2_201710131456/S2013251417301359/v2_201710131456/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000005/v2_201710131456/S2013251417301359/v2_201710131456/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301359?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 7 | 10 |
| 2024 October | 37 | 37 | 74 |
| 2024 September | 36 | 32 | 68 |
| 2024 August | 55 | 63 | 118 |
| 2024 July | 31 | 29 | 60 |
| 2024 June | 48 | 37 | 85 |
| 2024 May | 36 | 22 | 58 |
| 2024 April | 43 | 60 | 103 |
| 2024 March | 28 | 29 | 57 |
| 2024 February | 32 | 32 | 64 |
| 2024 January | 25 | 36 | 61 |
| 2023 December | 27 | 28 | 55 |
| 2023 November | 26 | 38 | 64 |
| 2023 October | 27 | 27 | 54 |
| 2023 September | 32 | 35 | 67 |
| 2023 August | 22 | 30 | 52 |
| 2023 July | 42 | 49 | 91 |
| 2023 June | 68 | 19 | 87 |
| 2023 May | 52 | 29 | 81 |
| 2023 April | 34 | 15 | 49 |
| 2023 March | 43 | 19 | 62 |
| 2023 February | 38 | 23 | 61 |
| 2023 January | 28 | 21 | 49 |
| 2022 December | 53 | 33 | 86 |
| 2022 November | 41 | 29 | 70 |
| 2022 October | 54 | 42 | 96 |
| 2022 September | 33 | 37 | 70 |
| 2022 August | 34 | 47 | 81 |
| 2022 July | 36 | 53 | 89 |
| 2022 June | 26 | 32 | 58 |
| 2022 May | 26 | 26 | 52 |
| 2022 April | 33 | 45 | 78 |
| 2022 March | 34 | 38 | 72 |
| 2022 February | 41 | 34 | 75 |
| 2022 January | 36 | 42 | 78 |
| 2021 December | 36 | 32 | 68 |
| 2021 November | 36 | 40 | 76 |
| 2021 October | 35 | 50 | 85 |
| 2021 September | 30 | 30 | 60 |
| 2021 August | 26 | 43 | 69 |
| 2021 July | 31 | 30 | 61 |
| 2021 June | 19 | 29 | 48 |
| 2021 May | 37 | 43 | 80 |
| 2021 April | 94 | 55 | 149 |
| 2021 March | 56 | 55 | 111 |
| 2021 February | 42 | 45 | 87 |
| 2021 January | 37 | 15 | 52 |
| 2020 December | 31 | 25 | 56 |
| 2020 November | 27 | 13 | 40 |
| 2020 October | 17 | 28 | 45 |
| 2020 September | 26 | 18 | 44 |
| 2020 August | 37 | 17 | 54 |
| 2020 July | 25 | 13 | 38 |
| 2020 June | 24 | 25 | 49 |
| 2020 May | 36 | 9 | 45 |
| 2020 April | 48 | 24 | 72 |
| 2020 March | 32 | 13 | 45 |
| 2020 February | 26 | 24 | 50 |
| 2020 January | 35 | 15 | 50 |
| 2019 December | 52 | 33 | 85 |
| 2019 November | 40 | 17 | 57 |
| 2019 October | 40 | 14 | 54 |
| 2019 September | 31 | 14 | 45 |
| 2019 August | 27 | 17 | 44 |
| 2019 July | 26 | 18 | 44 |
| 2019 June | 45 | 20 | 65 |
| 2019 May | 39 | 15 | 54 |
| 2019 April | 70 | 39 | 109 |
| 2019 March | 42 | 26 | 68 |
| 2019 February | 28 | 25 | 53 |
| 2019 January | 31 | 24 | 55 |
| 2018 December | 93 | 41 | 134 |
| 2018 November | 166 | 13 | 179 |
| 2018 October | 118 | 17 | 135 |
| 2018 September | 69 | 22 | 91 |
| 2018 August | 29 | 10 | 39 |
| 2018 July | 26 | 9 | 35 |
| 2018 June | 39 | 15 | 54 |
| 2018 May | 45 | 15 | 60 |
| 2018 April | 52 | 10 | 62 |
| 2018 March | 49 | 8 | 57 |
| 2018 February | 69 | 7 | 76 |
| 2018 January | 23 | 6 | 29 |
| 2017 December | 71 | 7 | 78 |
| 2017 November | 29 | 9 | 38 |
| 2017 October | 39 | 11 | 50 |
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