This study aimed to determine the interaction of red blood cell cadmium and lead, total urinary arsenic, and plasma selenium in chronic kidney disease (CKD). We recruited 220 CKD patients as well as 438 gender- and age-matched controls, and we defined CKD as <60 mL/min/1.73 m 2 estimated glomerular filtration rate (eGFR)for three or more consecutive months. Plasma selenium and red blood cell cadmium and lead concentrations were measured by ICP-MS. Urinary arsenic species were determined via HPLC-HG-AAS and were summed to determine the total urinary arsenic concentration. Plasma selenium was positively correlated to eGFR, and subjects with high plasma selenium levels (>243.90 μg/L)had a significantly lower odds ratio (OR)and 95% confidence interval (CI)(0.23, 0.13–0.42)for CKD compared to those with low plasma selenium levels (≤ 196.70 μg/L). High plasma selenium and low red blood cell cadmium or lead concentrations interacted to decrease the OR and 95% CI for CKD (0.12, 0.06–0.26; 0.09, 0.04–0.19). High plasma selenium and low red blood cell lead levels also interacted to increase the eGFR (20.70, 15.56–26.01 mL/min/1.73 m 2 ). This study is the first to suggest that selenium modifies the eGFR and OR in CKD induced by environmental toxicants.
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