{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T18:03:16Z","timestamp":1781028196105,"version":"3.54.1"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Cigarette smoke contains numerous toxicants, including cadmium, polycyclic aromatic hydrocarbons (PAHs), tobacco-specific nitrosamines (TSNAs), and volatile organic compounds, all of which may contribute to hepato-renal injury. This study, conducted in Buea (Southwest Region, Cameroon), aimed to assess cadmium inhalation exposure from cigarette smoking as a contributing factor to altered liver and kidney function biomarkers in apparently healthy smokers, while acknowledging that combined exposure to multiple co-toxicants may potentiate organ dysfunction. A survey was used to recruit smokers and collect data on their smoking habits. Cadmium contents in the major cigarette brands selected were used to estimate the cadmium Daily Exposure (DE), Weekly Inhalational Exposure (WIE) and the percentage contribution to the Tolerable Weekly Intake (TWI) of cadmium. Serum alanine aminotransferase (ALT) activity, urea, creatinine contents, and urinary albuminuria and glucosuria were measured in blood and urine samples from smokers and nonsmokers. The 102 smokers enrolled were categorized respectively as light (37.3%; 38\/102), moderate (38.2%; 39\/102), and heavy (24.5%; 25\/102) smokers, smoking an average number of 4.7\u2009\u00b1\u20090.5, 9.1\u2009\u00b1\u20091.5, and 19.1\u2009\u00b1\u20093.0 cigarettes\/day, respectively. Cadmium levels in cigarette brands ranged from 0.72\u20131.08 \u00b5g Cd per gram of tobacco removed from the cigarette. Heavy smokers exceeded the permitted cadmium No Significant Risk Level (NSRL) by up to 28-fold, contributing 4\u20138% to the cadmium TWI. Serum ALT activity and creatinine content were significantly higher (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05) in smokers groups compared to non-smokers. Also, moderate and heavy smokers were at a significantly higher risk (relative risk 6.90\u201313.32;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05) of displaying abnormal elevated serum urea content, positive albuminuria and glucosuria. Our findings demonstrate that healthy active smokers are highly exposed to cadmium (and potentially to other cigarette toxicants) and are at significantly higher risk of displaying abnormally elevated levels of biochemical markers of liver and kidney function, suggesting early signs of organ damage.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0333775","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T17:31:27Z","timestamp":1781026287000},"page":"e0333775","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cadmium exposure as a contributing factor to\u00a0hepato-renal injury in apparently healthy active cigarette smokers in buea-cameroon"],"prefix":"10.1371","volume":"21","author":[{"given":"Jr Nyambi Nkiackmenyi","family":"Ramin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2629-6394","authenticated-orcid":true,"given":"Arnaud Fondjo","family":"Kouam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0878-5020","authenticated-orcid":true,"given":"Elisabeth Menkem","family":"Zeuko\u2019o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armel Jackson","family":"Seukep","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armelle Gaelle Kwesseu","family":"Fepa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fils Armand","family":"Ella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal Dieudonn\u00e9 Chuisseu","family":"Djamen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric Nico","family":"Njayou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul Fewou","family":"Moundipa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel Acha","family":"Asongalem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"issue":"9","key":"pone.0333775.ref001","doi-asserted-by":"crossref","first-page":"8413","DOI":"10.3390\/ijms24098413","article-title":"Current Levels of Environmental Exposure to Cadmium in Industrialized Countries as a Risk Factor for Kidney Damage in the General Population: A Comprehensive Review of Available Data","volume":"24","author":"NM Smerecza\u0144ski","year":"2023","journal-title":"Int J Mol Sci"},{"issue":"23","key":"pone.0333775.ref002","doi-asserted-by":"crossref","first-page":"12581","DOI":"10.3390\/ijerph182312581","article-title":"Tobacco Smoke Exposure and Urinary Cadmium in Women from Northern Mexico","volume":"18","author":"\u00c1 M\u00e9rida-Ortega","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"147","key":"pone.0333775.ref003","doi-asserted-by":"crossref","first-page":"170122","DOI":"10.1183\/16000617.0122-2017","article-title":"Cadmium in tobacco smokers: a neglected link to lung disease?","volume":"27","author":"K Ganguly","year":"2018","journal-title":"Eur Respir Rev"},{"issue":"12","key":"pone.0333775.ref004","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s10661-017-6348-x","article-title":"Toxic metals in cigarettes and human health risk assessment associated with inhalation exposure","volume":"189","author":"NU Benson","year":"2017","journal-title":"Environ Monit Assess"},{"issue":"1","key":"pone.0333775.ref005","doi-asserted-by":"crossref","DOI":"10.1186\/s12982-025-00650-2","article-title":"Cigarettes as a source of heavy metal toxicity: evaluating human health risks","volume":"22","author":"S Sandal","year":"2025","journal-title":"Discov Public Health"},{"issue":"1","key":"pone.0333775.ref006","doi-asserted-by":"crossref","first-page":"202","DOI":"10.3390\/ijerph110100202","article-title":"Toxic metal concentrations in cigarettes obtained from U.S. smokers in 2009: results from the International Tobacco Control (ITC) United States survey cohort","volume":"11","author":"RV Caruso","year":"2013","journal-title":"Int J Environ Res Public Health"},{"issue":"7","key":"pone.0333775.ref007","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/j.chemosphere.2005.09.005","article-title":"Cadmium concentration in tobacco (Nicotiana tabacum L.) from different countries and its relationship with other elements","volume":"63","author":"N Lugon-Moulin","year":"2006","journal-title":"Chemosphere"},{"issue":"11","key":"pone.0333775.ref008","doi-asserted-by":"crossref","first-page":"3782","DOI":"10.3390\/ijerph17113782","article-title":"The Effects of Cadmium Toxicity","volume":"17","author":"G Genchi","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0333775.ref009","unstructured":"WHO. Tobacco: who.int\/news-room\/fact-sheets\/detail\/tobacco. 2023 [cited 4 Oct 2024]. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tobacco"},{"issue":"4","key":"pone.0333775.ref010","doi-asserted-by":"crossref","DOI":"10.17265\/1548-6648\/2020.04.007","article-title":"Prevalence and Socioeconomic Determinants of Tobacco Consumption Patterns across Urban and Rural Settings in Cameroon","volume":"17","author":"Njoumemi Zakariaou","year":"2020","journal-title":"UCMS"},{"issue":"2","key":"pone.0333775.ref011","doi-asserted-by":"crossref","first-page":"253","DOI":"10.56557\/jodagh\/2025\/v18i29850","article-title":"Health and Economic Impacts of Tobacco and Alcohol Bans in Cameroon: Strategies for Enhancing Well-being","volume":"18","author":"FN Richard","year":"2025","journal-title":"J Dis Global Health"},{"key":"pone.0333775.ref012","article-title":"Assessment of the effects of renal impairment and smoking on the pharmacokinetics of a single oral dose of the soluble guanylate cyclase stimulator riociguat (BAY 63-2521)","volume":"6","author":"R Frey","year":"2016","journal-title":"Pulm Circ"},{"issue":"11","key":"pone.0333775.ref013","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2022.e11685","article-title":"Hydro-ethanolic extract of Khaya grandifoliola attenuates heavy metals-induced hepato-renal injury in rats by reducing oxidative stress and metals-bioaccumulation","volume":"8","author":"AF Kouam","year":"2022","journal-title":"Heliyon"},{"issue":"38","key":"pone.0333775.ref014","doi-asserted-by":"crossref","first-page":"6098","DOI":"10.3748\/wjg.v12.i38.6098","article-title":"Heavy smoking and liver","volume":"12","author":"A-R El-Zayadi","year":"2006","journal-title":"World J Gastroenterol"},{"issue":"4","key":"pone.0333775.ref015","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1007\/s12072-009-9158-6","article-title":"Role of free radicals in liver diseases","volume":"3","author":"P Muriel","year":"2009","journal-title":"Hepatol Int"},{"issue":"1","key":"pone.0333775.ref016","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jhep.2022.01.016","article-title":"Cigarette smoking and liver diseases","volume":"77","author":"D Marti-Aguado","year":"2022","journal-title":"J Hepatol"},{"issue":"4","key":"pone.0333775.ref017","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/jebm.12270","article-title":"Cigarette smoking as a risk factor for the development of and mortality from hepatocellular carcinoma: An updated systematic review of 81 epidemiological studies","volume":"10","author":"O Abdel-Rahman","year":"2017","journal-title":"J Evid Based Med"},{"issue":"6","key":"pone.0333775.ref018","doi-asserted-by":"crossref","first-page":"471","DOI":"10.3961\/jpmph.21.435","article-title":"Association Between Cadmium Exposure and Liver Function in Adults in the United States: A Cross-sectional Study","volume":"54","author":"D Hong","year":"2021","journal-title":"J Prev Med Public Health"},{"key":"pone.0333775.ref019","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.ijheh.2011.03.004","article-title":"Smoking status and urine cadmium above levels associated with subclinical renal effects in U.S. adults without chronic kidney disease","volume":"214","author":"ME Mortensen","year":"2011","journal-title":"Int J Hyg Environ Health"},{"key":"pone.0333775.ref020","doi-asserted-by":"crossref","first-page":"75","DOI":"10.5152\/turkjnephrol.2019.3440","article-title":"Smoking and Chronic Kidney Disease","volume":"28","author":"B Yardimci","year":"2019","journal-title":"Turk J Nephrol"},{"issue":"11","key":"pone.0333775.ref021","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.3390\/biom11111575","article-title":"Cadmium-Induced Kidney Injury: Oxidative Damage as a Unifying Mechanism","volume":"11","author":"L-J Yan","year":"2021","journal-title":"Biomolecules"},{"key":"pone.0333775.ref022","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1186\/s12889-018-5828-4","article-title":"Two decades of tobacco use prevention and control policies in Cameroon: results from the analysis of non-communicable disease prevention policies in Africa","volume":"18","author":"C Mapa-Tassou","year":"2018","journal-title":"BMC Public Health"},{"key":"pone.0333775.ref023","volume-title":"Sampling techniques, Third Edition","author":"WG Cochran","year":"1977"},{"key":"pone.0333775.ref024","article-title":"Prevalence and Socioeconomic Determinants of Tobacco Consumption Patterns across Urban and Rural Settings in Cameroon","author":"Z Njoumemi","year":"2020","journal-title":"J US-China Med Sci"},{"issue":"4","key":"pone.0333775.ref025","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1080\/08958378.2021.1912859","article-title":"Toxicological approaches for the quantitative inhalation risk assessment of toxic metals from tobacco smoke: application on the deterministic and probabilistic inhalation risk assessment of cadmium for Austrian smokers","volume":"33","author":"C Vlachou","year":"2021","journal-title":"Inhal Toxicol"},{"key":"pone.0333775.ref026","unstructured":"CalEPA-OEHHA. Cadmium: No Significant Risk Level (NSRL) - Inhalation. (California Environmental Protection AgencyOffice of Environmental Health Hazard Assessment). In: OEHHA [Internet]. 2015 [cited 4 Oct 2024]. Available: https:\/\/oehha.ca.gov\/chemicals\/cadmium"},{"key":"pone.0333775.ref027","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.2903\/j.efsa.2012.2551","article-title":"Cadmium dietary exposure in the European population","volume":"10","author":"EFS EFSA","year":"2012","journal-title":"EFSA J"},{"issue":"5","key":"pone.0333775.ref028","article-title":"Serological evidence and factors associated to liver damage in malaria-typhoid infected patients consulting in two health facilities, Yaound\u00e9-Cameroon","volume":"20","author":"MYN Essam","year":"2025","journal-title":"PLoS One"},{"key":"pone.0333775.ref029","unstructured":"NIH. Roussel Uclaf Causality Assessment Method (RUCAM) in Drug Induced Liver Injury. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012. Available: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548272\/"},{"key":"pone.0333775.ref030","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s41100-024-00533-3","article-title":"Smoking status, cadmium, and chronic kidney disease","volume":"10","author":"SM Lang","year":"2024","journal-title":"Ren Replace Ther"},{"key":"pone.0333775.ref031","doi-asserted-by":"crossref","first-page":"6620","DOI":"10.3390\/molecules28186620","article-title":"Cadmium toxicity and health effects\u2014A brief summary","volume":"28","author":"AE Charkiewicz","year":"2023","journal-title":"Molecules"},{"issue":"1","key":"pone.0333775.ref032","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1002\/jat.4322","article-title":"Environmental exposure of the general population to cadmium as a risk factor of the damage to the nervous system: A critical review of current data","volume":"43","author":"A Ruczaj","year":"2023","journal-title":"J Appl Toxicol"},{"issue":"2","key":"pone.0333775.ref033","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s43188-020-00057-y","article-title":"Hepatic and renal damage by alcohol and cigarette smoking in rats","volume":"37","author":"S Bandiera","year":"2020","journal-title":"Toxicol Res"},{"key":"pone.0333775.ref034","doi-asserted-by":"crossref","first-page":"2969","DOI":"10.2147\/JMDH.S392848","article-title":"The Influence of Smoking on Renal Functions Among Apparently Healthy Smokers","volume":"15","author":"HA Eid","year":"2022","journal-title":"J Multidiscip Healthc"},{"issue":"7","key":"pone.0333775.ref035","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0328974","article-title":"Abnormal serum levels of liver enzyme markers and related risk factors in type 2 diabetes mellitus patients attending the Buea Regional Hospital, Cameroon","volume":"20","author":"AF Kouam","year":"2025","journal-title":"PLoS One"},{"issue":"1","key":"pone.0333775.ref036","doi-asserted-by":"crossref","DOI":"10.1186\/s43066-023-00300-9","article-title":"Liver injury in malaria infected patients in Douala-Cameroon and its association with poor medical practice","volume":"13","author":"AF Kouam","year":"2023","journal-title":"Egypt Liver J"},{"key":"pone.0333775.ref037","doi-asserted-by":"crossref","first-page":"1260352","DOI":"10.3389\/fgene.2023.1260352","article-title":"Liver function indicators and risk of hepatocellular carcinoma: a bidirectional mendelian randomization study","volume":"14","author":"S Qin","year":"2024","journal-title":"Front Genet"},{"issue":"1","key":"pone.0333775.ref038","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.nephro.2008.03.004","article-title":"Exploration des fonctions tubulaires r\u00e9nales","volume":"5","author":"A Blanchard","year":"2009","journal-title":"N\u00e9phrologie Th\u00e9rapeutique"},{"issue":"7","key":"pone.0333775.ref039","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s00420-005-0612-z","article-title":"Smoking-induced increase in urinary cadmium levels among Japanese women","volume":"78","author":"M Ikeda","year":"2005","journal-title":"Int Arch Occup Environ Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333775","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T17:31:35Z","timestamp":1781026295000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333775"}},"subtitle":[],"editor":[{"given":"Iman","family":"Al-Saleh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333775","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]}}}