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,
Autor para correspondencia
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" => "xack302208" "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 => "xTab1524921.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 => "xTab1524920.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" => "/02116995/0000003700000005/v2_201709270247/S0211699517300462/v2_201709270247/en/main.assets" "Apartado" => array:4 [ "identificador" => "48186" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/02116995/0000003700000005/v2_201709270247/S0211699517300462/v2_201709270247/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699517300462?idApp=UINPBA000064" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 3 | 5 | 8 |
| 2024 Octubre | 49 | 31 | 80 |
| 2024 Septiembre | 40 | 26 | 66 |
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| 2024 Junio | 53 | 40 | 93 |
| 2024 Mayo | 39 | 36 | 75 |
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| 2024 Febrero | 47 | 38 | 85 |
| 2024 Enero | 39 | 24 | 63 |
| 2023 Diciembre | 36 | 26 | 62 |
| 2023 Noviembre | 48 | 28 | 76 |
| 2023 Octubre | 34 | 30 | 64 |
| 2023 Septiembre | 27 | 20 | 47 |
| 2023 Agosto | 38 | 26 | 64 |
| 2023 Julio | 39 | 27 | 66 |
| 2023 Junio | 65 | 29 | 94 |
| 2023 Mayo | 65 | 29 | 94 |
| 2023 Abril | 24 | 21 | 45 |
| 2023 Marzo | 64 | 24 | 88 |
| 2023 Febrero | 56 | 26 | 82 |
| 2023 Enero | 33 | 25 | 58 |
| 2022 Diciembre | 61 | 39 | 100 |
| 2022 Noviembre | 75 | 46 | 121 |
| 2022 Octubre | 67 | 39 | 106 |
| 2022 Septiembre | 35 | 29 | 64 |
| 2022 Agosto | 38 | 49 | 87 |
| 2022 Julio | 41 | 53 | 94 |
| 2022 Junio | 33 | 33 | 66 |
| 2022 Mayo | 29 | 29 | 58 |
| 2022 Abril | 37 | 47 | 84 |
| 2022 Marzo | 32 | 51 | 83 |
| 2022 Febrero | 48 | 41 | 89 |
| 2022 Enero | 39 | 49 | 88 |
| 2021 Diciembre | 45 | 43 | 88 |
| 2021 Noviembre | 42 | 46 | 88 |
| 2021 Octubre | 46 | 37 | 83 |
| 2021 Septiembre | 25 | 40 | 65 |
| 2021 Agosto | 25 | 34 | 59 |
| 2021 Julio | 32 | 32 | 64 |
| 2021 Junio | 28 | 26 | 54 |
| 2021 Mayo | 39 | 47 | 86 |
| 2021 Abril | 51 | 69 | 120 |
| 2021 Marzo | 41 | 48 | 89 |
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| 2021 Enero | 27 | 21 | 48 |
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| 2020 Noviembre | 36 | 24 | 60 |
| 2020 Octubre | 35 | 25 | 60 |
| 2020 Septiembre | 44 | 24 | 68 |
| 2020 Agosto | 29 | 14 | 43 |
| 2020 Julio | 42 | 23 | 65 |
| 2020 Junio | 34 | 22 | 56 |
| 2020 Mayo | 30 | 14 | 44 |
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| 2020 Marzo | 27 | 22 | 49 |
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| 2019 Noviembre | 43 | 26 | 69 |
| 2019 Octubre | 25 | 24 | 49 |
| 2019 Septiembre | 43 | 20 | 63 |
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| 2018 Diciembre | 197 | 65 | 262 |
| 2018 Noviembre | 315 | 45 | 360 |
| 2018 Octubre | 236 | 18 | 254 |
| 2018 Septiembre | 101 | 23 | 124 |
| 2018 Agosto | 83 | 41 | 124 |
| 2018 Julio | 65 | 23 | 88 |
| 2018 Junio | 79 | 28 | 107 |
| 2018 Mayo | 112 | 23 | 135 |
| 2018 Abril | 149 | 14 | 163 |
| 2018 Marzo | 148 | 22 | 170 |
| 2018 Febrero | 128 | 10 | 138 |
| 2018 Enero | 118 | 11 | 129 |
| 2017 Diciembre | 138 | 14 | 152 |
| 2017 Noviembre | 99 | 16 | 115 |
| 2017 Octubre | 83 | 16 | 99 |
| 2017 Septiembre | 90 | 19 | 109 |
| 2017 Agosto | 87 | 15 | 102 |
| 2017 Julio | 70 | 17 | 87 |
| 2017 Junio | 77 | 11 | 88 |
| 2017 Mayo | 64 | 11 | 75 |
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