Response to letter to the editor from Elinder and Nordberg concerning Byber et al. 2016. Cadmium or cadmium compounds and chronic kidney disease in workers and the general population: a systematic review, Crit Rev Toxicol. 46(3):191-240. DOI: 0.3109/10408444.2015.1076375

摘要

Sir, We are grateful for the opportunity to answer the letter by C.G. Elinder and G.F. Nordberg (2017) that raises interesting points. To meet the requested format of this response, we included here below the reference to the pages of the published paper rather than reproducing extracts. It is quite right that the criteria for classifying chronic kidney disease (CKD) into categories as defined nowadays [categories G1 to G5 and A1 to A3] were not in use when the first publications about cadmium-induced kidney disease were published. However, these current categories should not be confused with the definition of the disease characteristics or markers currently considered robust for diagnosing CKD (hematuria and hypertension, markers of glomerular filtration, proteinuria or albuminuria, histopathology) (Byber et al. 2016, p. 192-194). In other words, the literature search has not been restricted to publications applying the current CKD categorizing criteria, but used disease characteristics or markers currently considered robust for diagnosing CKD (Byber et al. 2016, p. 195). This was indispensable to avoid the problem of "chronic renal confusion" resulting from using different CKD definitions and a disturbing plethora of laboratory markers with ambiguous or unknown clinical significance (Byber et al. 2016, p. 192-193). The objective of our review was not to assess whether authors used the best criteria at the time their study was conducted, but to assess whether the evidence of a link with CKD (defined with criteria considered as robust and sound) and Cd exposure is currently available.