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Association of albumin to creatinine ratio with urinary arsenic and metal exposure: evidence from NHANES 2015–2016

  • Nephrology - Original Paper
  • Published:
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Abstract

Purpose

Urinary metals can be used to identify metal exposure in humans from various sources in the environment. Decreased renal function and cardiovascular dysfunction may occur due to low levels of metal exposure in the general population. The purpose of this study is to assess the association between urinary arsenic and metals and a higher albumin to creatinine ratio (ACR) among adults in the general US population.

Methods

We conducted a cross sectional analyses using the 2015–2016 National Health and Nutrition Examination Survey (NHANES) dataset. Multiple linear logistic models were used to examine the association between 21 urinary arsenic and metal concentrations (arsenous acid, arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid, monomethylarsonic acid, total arsenic, mercury, barium, cadmium, cobalt, cesium, molybdenum, manganese, lead, antinomy, tin, strontium, thallium, tungsten, uranium) and increased ACR (≥ 30 mg/g).

Results

The sample included 4122 adults, of whom approximately 9.4% of males and 10.7% females had increased ACRs. The exposure included urinary arsenic compounds (7) and urinary metal compounds (14) at or above the limit of detection. Urinary dimethylarsinic acid [OR 38.9, 95% CI 3.6–414.6], urinary monomethylarsonic acid [OR 18.6, 95% CI 1.1–308.2], urinary cadmium [OR 11.9, 95% CI 1.2–122.0], urinary cesium [OR 17.0, 95% CI 2.7–105.8], and urinary antimony [OR 10.7, 95% CI 2.2–51.3] were associated with an increased ACR. No other urinary metals were significantly associated with increased ACR.

Conclusion

Increased ACR was positively associated with urinary dimethylarsinic acid, monomethylarsonic acid, cadmium, cesium, and antimony.

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Data availability

NHANES data is secondary data provided by the CDC to the public [75].

Code availability

R version 3.6.3, Upon request.

References

  1. Järup L (2003) Hazards of heavy metal contamination. Br Med Bull 68:167–182. https://doi.org/10.1093/bmb/ldg032

    Article  PubMed  Google Scholar 

  2. Tchounwou PB, Yedjou CG, Patlolla AK, Sutton DJ (2012) Heavy metal toxicity and the environment. Exp Suppl 101:133–164. https://doi.org/10.1007/978-3-7643-8340-4_6

    Article  PubMed  Google Scholar 

  3. Rahman HH, Yusuf KK, Niemann D, Dipon SR (2020) Urinary speciated arsenic and depression among US adults. Environ Sci Pollut Res Int 27(18):23048–23053. https://doi.org/10.1007/s11356-020-08858-2

    Article  CAS  PubMed  Google Scholar 

  4. Chowdhury R, Ramond A, O’Keeffe LM et al (2018) Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 362:k3310. https://doi.org/10.1136/bmj.k3310

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nigra AE, Ruiz-Hernandez A, Redon J, Navas-Acien A, Tellez-Plaza M (2016) Environmental metals and cardiovascular disease in adults: a systematic review beyond lead and cadmium. Curr Environ Health Rep 3(4):416–433. https://doi.org/10.1007/s40572-016-0117-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Satarug S, Moore MR (2004) Adverse health effects of chronic exposure to low-level cadmium in foodstuffs and cigarette smoke. Environ Health Perspect 112(10):1099–1103. https://doi.org/10.1289/ehp.6751

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Tellez-Plaza M, Guallar E, Howard BV et al (2013) Cadmium exposure and incident cardiovascular disease. Epidemiology 24(3):421–429. https://doi.org/10.1097/EDE.0b013e31828b0631

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tellez-Plaza M, Navas-Acien A, Menke A, Crainiceanu CM, Pastor-Barriuso R, Guallar E (2012) Cadmium exposure and all-cause and cardiovascular mortality in the US general population. Environ Health Perspect 120(7):1017–1022. https://doi.org/10.1289/ehp.1104352

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Wild P, Bourgkard E, Paris C (2009) Lung cancer and exposure to metals: the epidemiological evidence. Methods Mol Biol 472:139–167. https://doi.org/10.1007/978-1-60327-492-0_6

    Article  CAS  PubMed  Google Scholar 

  10. Soderland P, Lovekar S, Weiner DE, Brooks DR, Kaufman JS (2010) Chronic kidney disease associated with environmental toxins and exposures. Adv Chronic Kidney Dis 17(3):254–264. https://doi.org/10.1053/j.ackd.2010.03.011

    Article  PubMed  Google Scholar 

  11. Rahman HH, Niemann D, Singh D (2020) Arsenic exposure and association with hepatitis E IgG antibodies. J Occup Environ Med 8:111–122. https://doi.org/10.4236/odem.2020.83009

    Article  Google Scholar 

  12. Reyes JL, Molina-Jijón E, Rodríguez-Muñoz R, Bautista-García P, Debray-García Y, Namorado M (2013) Tight junction proteins and oxidative stress in heavy metals-induced nephrotoxicity. Biomed Res Int. https://doi.org/10.1155/2013/730789

    Article  PubMed  PubMed Central  Google Scholar 

  13. Stevens PE, Levin A (2013) Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 158(11):825–830. https://doi.org/10.7326/0003-4819-158-11-201306040-00007

    Article  PubMed  Google Scholar 

  14. Basi S, Fesler P, Mimran A, Lewis JB (2008) Microalbuminuria in type 2 diabetes and hypertension: a marker, treatment target, or innocent bystander? Diabetes Care 31(Suppl 2):S194–S201. https://doi.org/10.2337/dc08-s249

    Article  CAS  PubMed  Google Scholar 

  15. Toto RD (2004) Microalbuminuria: definition, detection, and clinical significance. J Clin Hypertens (Greenwich) 6(11 Suppl 3):2–7. https://doi.org/10.1111/j.1524-6175.2004.4064.x

    Article  CAS  Google Scholar 

  16. CDC (2018a) National Health and Nutrition Examination Survey, 2015–2016 Data Documentation, Codebook, and Frequencies, Speciated Arsenics - Urine (UAS_I). https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/UAS_I.htm

  17. Glassock RJ, Warnock DG, Delanaye P (2017) The global burden of chronic kidney disease: estimates, variability and pitfalls. Nat Rev Nephrol 13(2):104–114. https://doi.org/10.1038/nrneph.2016.163

    Article  CAS  PubMed  Google Scholar 

  18. Zheng L, Kuo CC, Fadrowski J, Agnew J, Weaver VM, Navas-Acien A (2014) Arsenic and chronic kidney disease: a systematic review. Curr Environ Health Rep 1(3):192–207. https://doi.org/10.1007/s40572-014-0024-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Souweine JS, Corbel A, Rigothier C et al (2019) Interest of albuminuria in nephrology, diabetology and as a marker of cardiovascular risk. Intérêt de l’albuminurie en néphrologie, diabétologie et comme marqueur de risque cardiovasculaire. Ann Biol Clin (Paris) 77(1):26–35. https://doi.org/10.1684/abc.2018.1402

    Article  Google Scholar 

  20. Lunyera J, Smith SR (2017) Heavy metal nephropathy: considerations for exposure analysis. Kidney Int 92(3):548–550. https://doi.org/10.1016/j.kint.2017.04.043

    Article  PubMed  Google Scholar 

  21. Fadrowski JJ, Navas-Acien A, Tellez-Plaza M, Guallar E, Weaver VM, Furth SL (2010) Blood lead level and kidney function in US adolescents: the third national health and nutrition examination survey. Arch Intern Med 170(1):75–82. https://doi.org/10.1001/archinternmed.2009.417

    Article  CAS  PubMed  Google Scholar 

  22. Ferraro PM, Costanzi S, Naticchia A, Sturniolo A, Gambaro G (2010) Low level exposure to cadmium increases the risk of chronic kidney disease: analysis of the NHANES 1999–2006. BMC Public Health 10:304. https://doi.org/10.1186/1471-2458-10-304

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kim NH, Hyun YY, Lee KB et al (2015) Environmental heavy metal exposure and chronic kidney disease in the general population. J Korean Med Sci 30(3):272–277. https://doi.org/10.3346/jkms.2015.30.3.272 ([published correction appears in J Korean Med Sci. 2015 Apr;30(4):507. Rhu, Seungho [corrected to Ryu, Seungho]])

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kim R, Rotnitsky A, Sparrow D, Weiss S, Wager C, Hu H (1996) A longitudinal study of low-level lead exposure and impairment of renal function. The Normative Aging Study. JAMA 275(15):1177–1181

    Article  CAS  Google Scholar 

  25. Navas-Acien A, Tellez-Plaza M, Guallar E et al (2009) Blood cadmium and lead and chronic kidney disease in US adults: a joint analysis. Am J Epidemiol 170(9):1156–1164. https://doi.org/10.1093/aje/kwp248

    Article  PubMed  PubMed Central  Google Scholar 

  26. Melnikov P, Zanoni LZ (2010) Clinical effects of cesium intake. Biol Trace Elem Res 135(1–3):1–9. https://doi.org/10.1007/s12011-009-8486-7

    Article  CAS  PubMed  Google Scholar 

  27. Jha V, Garcia-Garcia G, Iseki K et al (2013) Chronic kidney disease: global dimension and perspectives. Lancet 382(9888):260–272. https://doi.org/10.1016/S0140-6736(13)60687-X (published correction appears in Lancet. 2013 Jul 20;382(9888):208)

    Article  PubMed  Google Scholar 

  28. CDC (2017a) About the National Health and Nutrition Examination Survey. https://www.cdc.gov/nchs/nhanes/about_nhanes.htm

  29. CDC (2019b) National Health and Nutrition Examination Survey, 2015–2016 Data Documentation, Codebook, and Frequencies, Albumin & Creatinine - Urine (ALB_CR_I), https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/ALB_CR_I.htm

  30. CDC (2018b) National Health and Nutrition Examination Survey, 2015–2016 Data Documentation, Codebook, and Frequencies, Arsenic - Total - Urine (UTAS_I). https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/UTAS_I.htm

  31. CDC (2018c) National Health and Nutrition Examination Survey, 2015–2016 Data Documentation, Codebook, and Frequencies, Metals - Urine - Special Sample (UMS_I). https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/UMS_I.htm

  32. CDC (2018d) National Health and Nutrition Examination Survey, 2015–2016 Data Documentation, Codebook, and Frequencies, Mercury - Urine (UHG_I). https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/UHG_I.htm

  33. CDC (2017b) National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. https://wwwn.cdc.gov/nchs/nhanes/ContinuousNhanes/Default.aspx?BeginYear=2015]

  34. CDC (2017c) National Health and Nutrition Examination Survey, 2015–2016 Data Documentation, Codebook, and Frequencies, Body Measures (BMX_I). https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/BMX_I.htm

  35. CDC (2017d) National Health and Nutrition Examination Survey, 2015–2016 Data Documentation, Codebook, and Frequencies, Demographic Variables and Sample Weights (DEMO_I). https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/DEMO_I.htm

  36. CDC (2018e) National Health and Nutrition Examination Survey, 2015–2016 Data Documentation, Codebook, and Frequencies, Alcohol Use (ALQ_I). https://wwwn.cdc.gov/Nchs/Nhanes/2015-2016/ALQ_I.htm

  37. CDC (2020a) Defining Adult Overweight and Obesity. https://www.cdc.gov/obesity/adult/defining.html

  38. Jones MR, Tellez-Plaza M, Sharrett AR, Guallar E, Navas-Acien A (2011) Urine arsenic and hypertension in US adults: the 2003–2008 National Health and Nutrition Examination Survey. Epidemiology 22(2):153–161. https://doi.org/10.1097/EDE.0b013e318207fdf2

    Article  PubMed  PubMed Central  Google Scholar 

  39. Buser MC, Ingber SZ, Raines N, Fowler DA, Scinicariello F (2016) Urinary and blood cadmium and lead and kidney function: NHANES 2007–2012. Int J Hyg Environ Health 219(3):261–267. https://doi.org/10.1016/j.ijheh.2016.01.005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Lumley T (2004) Analysis of complex survey samples. J Stat Softw 9(1):1–19. https://doi.org/10.18637/jss.v009.i08

    Article  Google Scholar 

  41. Lumley T (2010) Complex surveys: a guide to analysis using R. Wiley

    Book  Google Scholar 

  42. Lumley T (2020) Package ‘survey’: Analysis of Complex Survey Samples, version 4.0. https://cran.r-project.org/web/packages/survey/survey.pdf. Accessed 25 April 2021

  43. R Core Team (2020) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org. Accessed 25 April 2021

  44. CDC (2019a) Module 3 examples - R code. https://wwwn.cdc.gov/nchs/data/tutorials/module3_examples_R.r

  45. Susmann H (2016) Package ‘RNHANES’: Facilitates Analysis of CDC NHANES, version 1.1.0, https://cran.r-project.org/web/packages/RNHANES/RNHANES.pdf. Accessed 25 April 2021

  46. Prabhakaran S (2016) Package ‘InformationValue’: Performance Analysis and Companion Functions for BinaryClassification Models, version 1.2.3, https://cran.r-project.org/web/packages/InformationValue/InformationValue.pdf. Accessed 25 April 2021

  47. Jain RB (2019) Co-exposures to toxic metals cadmium, lead, and mercury and their impact on unhealthy kidney function. Environ Sci Pollut Res Int 26(29):30112–30118. https://doi.org/10.1007/s11356-019-06182-y

    Article  CAS  PubMed  Google Scholar 

  48. Norris K, Nissenson AR (2008) Race, gender, and socioeconomic disparities in CKD in the United States. J Am Soc Nephrol 19(7):1261–1270. https://doi.org/10.1681/ASN.2008030276

    Article  PubMed  Google Scholar 

  49. Crews DC, Charles RF, Evans MK, Zonderman AB, Powe NR (2010) Poverty, race, and CKD in a racially and socioeconomically diverse urban population. Am J Kidney Dis 55(6):992–1000. https://doi.org/10.1053/j.ajkd.2009.12.032

    Article  PubMed  PubMed Central  Google Scholar 

  50. Johnson AE, Boulware LE, Anderson CA et al (2014) Perceived barriers and facilitators of using dietary modification for CKD prevention among African Americans of low socioeconomic status: a qualitative study. BMC Nephrol 15:194. https://doi.org/10.1186/1471-2369-15-194

    Article  PubMed  PubMed Central  Google Scholar 

  51. Kramer H, Luke A, Bidani A, Cao G, Cooper R, McGee D (2005) Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Dis 46(4):587–594. https://doi.org/10.1053/j.ajkd.2005.06.007

    Article  PubMed  Google Scholar 

  52. Weidemann D, Kuo CC, Navas-Acien A, Abraham AG, Weaver V, Fadrowski J (2015) Association of arsenic with kidney function in adolescents and young adults: results from the National Health and Nutrition Examination Survey 2009–2012. Environ Res 140:317–324. https://doi.org/10.1016/j.envres.2015.03.030

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Hsueh YM, Chung CJ, Shiue HS et al (2009) Urinary arsenic species and CKD in a Taiwanese population: a case-control study. Am J Kidney Dis 54(5):859–870. https://doi.org/10.1053/j.ajkd.2009.06.016

    Article  PubMed  Google Scholar 

  54. Jin R, Zhu X, Shrubsole MJ, Yu C, Xia Z, Dai Q (2018) Associations of renal function with urinary excretion of metals: evidence from NHANES 2003–2012. Environ Int 121(Pt 2):1355–1362. https://doi.org/10.1016/j.envint.2018.11.002

    Article  CAS  PubMed  Google Scholar 

  55. Ginsburg JM (1965) Renal mechanism for excretion and transformation of arsenic in the dog. Am J Physiol 208:832–840. https://doi.org/10.1152/ajplegacy.1965.208.5.832

    Article  CAS  PubMed  Google Scholar 

  56. Peraza MA, Carter DE, Gandolfi AJ (2003) Toxicity and metabolism of subcytotoxic inorganic arsenic in human renal proximal tubule epithelial cells (HK-2). Cell Biol Toxicol 19(4):253–264. https://doi.org/10.1023/b:cbto.0000003970.60896.49

    Article  CAS  PubMed  Google Scholar 

  57. Healy SM, Casarez EA, Ayala-Fierro F, Aposhian H (1998) Enzymatic methylation of arsenic compounds. V. Arsenite methyltransferase activity in tissues of mice. Toxicol Appl Pharmacol 148(1):65–70. https://doi.org/10.1006/taap.1997.8306

    Article  CAS  PubMed  Google Scholar 

  58. Sinha M, Manna P, Sil PC (2008) Arjunolic acid attenuates arsenic-induced nephrotoxicity. Pathophysiology 15(3):147–156. https://doi.org/10.1016/j.pathophys.2008.03.001

    Article  CAS  PubMed  Google Scholar 

  59. Prasad GV, Rossi NF (1995) Arsenic intoxication associated with tubulointerstitial nephritis. Am J Kidney Dis 26(2):373–376. https://doi.org/10.1016/0272-6386(95)90660-6

    Article  CAS  PubMed  Google Scholar 

  60. Sasaki A, Oshima Y, Fujimura A (2007) An approach to elucidate potential mechanism of renal toxicity of arsenic trioxide. Exp Hematol 35(2):252–262. https://doi.org/10.1016/j.exphem.2006.10.004

    Article  CAS  PubMed  Google Scholar 

  61. Winship KA (1987) Toxicity of antimony and its compounds. Adv Drug React Acute Poisoning Rev 6(2):67–90

    CAS  Google Scholar 

  62. Tanu T, Anjum A, Jahan M et al (2018) Antimony-induced neurobehavioral and biochemical perturbations in Mice. Biol Trace Elem Res 186(1):199–207. https://doi.org/10.1007/s12011-018-1290-5

    Article  CAS  PubMed  Google Scholar 

  63. Ekong EB, Jaar BG, Weaver VM (2006) Lead-related nephrotoxicity: a review of the epidemiologic evidence. Kidney Int 70(12):2074–2084. https://doi.org/10.1038/sj.ki.5001809

    Article  CAS  PubMed  Google Scholar 

  64. Evans M, Elinder CG (2011) Chronic renal failure from lead: myth or evidence-based fact? Kidney Int 79(3):272–279. https://doi.org/10.1038/ki.2010.394

    Article  CAS  PubMed  Google Scholar 

  65. Johri N, Jacquillet G, Unwin R (2010) Heavy metal poisoning: the effects of cadmium on the kidney. Biometals 23(5):783–792. https://doi.org/10.1007/s10534-010-9328-y

    Article  CAS  PubMed  Google Scholar 

  66. Zhu XJ, Wang JJ, Mao JH, Shu Q, Du LZ (2019) Relationships of cadmium, lead, and mercury levels with albuminuria in US adults: results from the national health and nutrition examination survey database, 2009–2012. Am J Epidemiol 188(7):1281–1287. https://doi.org/10.1093/aje/kwz070

    Article  PubMed  Google Scholar 

  67. Rastogi SK (2008) Renal effects of environmental and occupational lead exposure. Indian J Occup Environ Med 12(3):103–106. https://doi.org/10.4103/0019-5278.44689

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Mujaj B, Yang WY, Zhang ZY et al (2019) Renal function in relation to low-level environmental lead exposure. Nephrol Dial Transplant 34(6):941–946. https://doi.org/10.1093/ndt/gfy279

    Article  CAS  PubMed  Google Scholar 

  69. Grau-Perez M, Pichler G, Galan-Chilet I et al (2017) Urine cadmium levels and albuminuria in a general population from Spain: a gene-environment interaction analysis. Environ Int 106:27–36. https://doi.org/10.1016/j.envint.2017.05.008

    Article  CAS  PubMed  Google Scholar 

  70. Rogalska J, Pilat-Marcinkiewicz B, Brzóska MM (2011) Protective effect of zinc against cadmium hepatotoxicity depends on this bioelement intake and level of cadmium exposure: a study in a rat model. Chem Biol Interact 193(3):191–203. https://doi.org/10.1016/j.cbi.2011.05.008

    Article  CAS  PubMed  Google Scholar 

  71. Jacobo-Estrada T, Cardenas-Gonzalez M, Santoyo-Sánchez M et al (2016) Evaluation of kidney injury biomarkers in rat amniotic fluid after gestational exposure to cadmium. J Appl Toxicol 36(9):1183–1193. https://doi.org/10.1002/jat.3286

    Article  CAS  PubMed  Google Scholar 

  72. Paßlack N, Mainzer B, Lahrssen-Wiederholt M et al (2014) Liver and kidney concentrations of strontium, barium, cadmium, copper, zinc, manganese, chromium, antimony, selenium and lead in cats. BMC Vet Res 10:163. https://doi.org/10.1186/1746-6148-10-163 (Published 2014 Jul 17)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Jayatilake N, Mendis S, Maheepala P, Mehta FR, CKDu National Research Project Team (2013) Chronic kidney disease of uncertain aetiology: prevalence and causative factors in a developing country. BMC Nephrol 14:180. https://doi.org/10.1186/1471-2369-14-180

    Article  PubMed  PubMed Central  Google Scholar 

  74. Kurttio P, Harmoinen A, Saha H et al (2006) Kidney toxicity of ingested uranium from drinking water. Am J Kidney Dis 47(6):972–982. https://doi.org/10.1053/j.ajkd.2006.03.002

    Article  CAS  PubMed  Google Scholar 

  75. CDC (2020b) NHANES Questionnaires, Datasets, and Related Documentation. https://wwwn.cdc.gov/nchs/nhanes/ContinuousNhanes/Default.aspx?BeginYear=2015

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Authors and Affiliations

  1. New Mexico State University, Las Cruces, NM, 88003, USA

    Humairat H. Rahman

  2. Burrell College of Osteopathic Medicine, Las Cruces, NM, USA

    Danielle Niemann

  3. Data Forward Analytics, LLC, Principal, Las Cruces, NM, USA

    Stuart H. Munson-McGee

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  1. Humairat H. Rahman
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  3. Stuart H. Munson-McGee
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Contributions

HHR conceptualized the study and contributed to the introduction and discussion. SH. M-M conducted data analysis and contributed to the statistical methods and results section of the paper. DN contributed to the methods section and drafting of the paper.

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Correspondence to Humairat H. Rahman.

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Rahman, H.H., Niemann, D. & Munson-McGee, S.H. Association of albumin to creatinine ratio with urinary arsenic and metal exposure: evidence from NHANES 2015–2016. Int Urol Nephrol 54, 1343–1353 (2022). https://doi.org/10.1007/s11255-021-03018-y

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