Burden of chronic kidney disease from dietary cadmium exposure by educational level in Europe
Abstract
Background: Cadmium (Cd) exposure is associated with chronic kidney disease (CKD), with diet as the main exposure route in non-smokers. Current estimates of Cd-related CKD burden do not account for socioeconomic differences. This study estimates the CKD burden from dietary exposure to Cd by educational level in five European countries.
Methods: Dietary Cd exposure was estimated using national food consumption data with Cd concentrations in foods or total diet studies, then converted into urinary Cd (UCd) using toxicokinetic modelling. This was combined with an exposure-response function linking UCd to CKD to estimate national-, age-, and education-specific attributable incidence. Disease burden was expressed in disability-adjusted life years (DALYs), combining mortality and morbidity. Estimates were stratified by educational level in five European countries (Belgium, Denmark, France, Portugal, and the Netherlands) and computed using varying toxicological UCd thresholds (0.5 µg/g creatinine as base scenario, 0.3 and 1.0 as sensitivity analyses).
Results: Overall, dietary Cd exposure increased with educational level across countries, except in France, where no significant difference was observed. Mean exposure per education group and country ranged from 0.101 to 0.167 µg/kg bw/day. Under the base scenario, DALY rates ranged from 0.009 (95% Uncertainty Interval (UI): 0.008-0.010) to 0.073 (95% UI: 0.070-0.079) per 100,000 population across countries, with France showing the highest burden and Portugal the lowest. Estimates were highly sensitive to toxicological thresholds, with up to a ten-fold increase at 0.3 µg/g and negligible burden at 1.0 µg/g.
Conclusions: We found that the burden of CKD due to Cd exposure was higher among people with higher levels of education in most countries studied. Results were sensitive to input data; for instance, limited cross-country comparability due to heterogeneous methods used in disease burden and food consumption surveys.
Key messages: • CKD burden rate attributable to dietary Cd exposure generally increases with education level, except in France.
• CKD burden estimates are highly sensitive to toxicological threshold assumptions.
Related
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BibTeX
@article{vermeulen2026burden,
title = {{Burden of chronic kidney disease from dietary cadmium exposure by educational level in Europe}},
author = {V R Vermeulen and M Andjelkovic and RMA Assunção and R Bhoonah and W Chen and E M De Clercq and C T Martins and S M Pires and S T Thomsen and N Waegeneers},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1082},
url = {https://doi.org/10.1093/eurpub/ckag169.1082},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Burden of chronic kidney disease from dietary cadmium exposure by educational level in Europe
AU - V R Vermeulen
AU - M Andjelkovic
AU - RMA Assunção
AU - R Bhoonah
AU - W Chen
AU - E M De Clercq
AU - C T Martins
AU - S M Pires
AU - S T Thomsen
AU - N Waegeneers
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1082
UR - https://doi.org/10.1093/eurpub/ckag169.1082
AB - Background: Cadmium (Cd) exposure is associated with chronic kidney disease (CKD), with diet as the main exposure route in non-smokers. Current estimates of Cd-related CKD burden do not account for socioeconomic differences. This study estimates the CKD burden from dietary exposure to Cd by educational level in five European countries. Methods: Dietary Cd exposure was estimated using national food consumption data with Cd concentrations in foods or total diet studies, then converted into urinary Cd (UCd) using toxicokinetic modelling. This was combined with an exposure-response function linking UCd to CKD to estimate national-, age-, and education-specific attributable incidence. Disease burden was expressed in disability-adjusted life years (DALYs), combining mortality and morbidity. Estimates were stratified by educational level in five European countries (Belgium, Denmark, France, Portugal, and the Netherlands) and computed using varying toxicological UCd thresholds (0.5 µg/g creatinine as base scenario, 0.3 and 1.0 as sensitivity analyses). Results: Overall, dietary Cd exposure increased with educational level across countries, except in France, where no significant difference was observed. Mean exposure per education group and country ranged from 0.101 to 0.167 µg/kg bw/day. Under the base scenario, DALY rates ranged from 0.009 (95% Uncertainty Interval (UI): 0.008-0.010) to 0.073 (95% UI: 0.070-0.079) per 100,000 population across countries, with France showing the highest burden and Portugal the lowest. Estimates were highly sensitive to toxicological thresholds, with up to a ten-fold increase at 0.3 µg/g and negligible burden at 1.0 µg/g. Conclusions: We found that the burden of CKD due to Cd exposure was higher among people with higher levels of education in most countries studied. Results were sensitive to input data; for instance, limited cross-country comparability due to heterogeneous methods used in disease burden and food consumption surveys. Key messages: • CKD burden rate attributable to dietary Cd exposure generally increases with education level, except in France. • CKD burden estimates are highly sensitive to toxicological threshold assumptions.
SN - 1101-1262
SN - 1464-360X
ER -