{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T12:39:18Z","timestamp":1761395958899,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Erroneous conclusions may result from normalization of urine cadmium and N-acetyl-\u03b2-D-glucosaminidase concentrations ([Cd]u and [NAG]u) to the urine creatinine concentration ([cr]u). In theory, the sources of these errors are nullified by normalization of excretion rates (ECd and ENAG) to creatinine clearance (Ccr). We hypothesized that this alternate approach would clarify the contribution of Cd-induced tubular injury to nephron loss. We studied 931 Thai subjects with a wide range of environmental Cd exposure. For x = Cd or NAG, Ex\/Ecr and Ex\/Ccr were calculated as [x]u\/[cr]u and [x]u[cr]p\/[cr]u, respectively. Glomerular filtration rate (GFR) was estimated according to the Chronic Kidney Disease (CKD) Epidemiology Collaboration (eGFR), and CKD was defined as eGFR &lt; 60 mL\/min\/1.73m2. In multivariable logistic regression analyses, prevalence odds ratios (PORs) for CKD were higher for log(ECd\/Ccr) and log(ENAG\/Ccr) than for log(ECd\/Ecr) and log(ENAG\/Ecr). Doubling of ECd\/Ccr and ENAG\/Ccr increased POR by 132% and 168%; doubling of ECd\/Ecr and ENAG\/Ecr increased POR by 64% and 54%. As log(ECd\/Ccr) rose, associations of eGFR with log(ECd\/Ccr) and log(ENAG\/Ccr) became stronger, while associations of eGFR with log(ECd\/Ecr) and log(ENAG\/Ecr) became insignificant. In univariate regressions of eGFR on each of these logarithmic variables, R2 was consistently higher with normalization to Ccr. Our tabular and graphic analyses uniformly indicate that normalization to Ccr clarified relationships of ECd and ENAG to eGFR.<\/jats:p>","DOI":"10.3390\/ijms22041762","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:49:26Z","timestamp":1613090966000},"page":"1762","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["The Effect of Cadmium on GFR Is Clarified by Normalization of Excretion Rates to Creatinine Clearance"],"prefix":"10.3390","volume":"22","author":[{"given":"Soisungwan","family":"Satarug","sequence":"first","affiliation":[{"name":"Kidney Disease Research Collaborative, Translational Research Institute, The University of Queensland, Brisbane, QLD 4102, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2856-6650","authenticated-orcid":false,"given":"David A.","family":"Vesey","sequence":"additional","affiliation":[{"name":"Kidney Disease Research Collaborative, Translational Research Institute, The University of Queensland, Brisbane, QLD 4102, Australia"},{"name":"Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD 4075, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muneko","family":"Nishijo","sequence":"additional","affiliation":[{"name":"Department of Public Health, Kanazawa Medical University, Uchinada, Ishikawa 920-0293, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Werawan","family":"Ruangyuttikarn","sequence":"additional","affiliation":[{"name":"Division of Toxicology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glenda C.","family":"Gobe","sequence":"additional","affiliation":[{"name":"Kidney Disease Research Collaborative, Translational Research Institute, The University of Queensland, Brisbane, QLD 4102, Australia"},{"name":"School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia"},{"name":"NHMRC Centre of Research Excellence for CKD, QLD, UQ Health Sciences, Royal Brisbane and Women\u2019s Hospital, Brisbane, QLD 4029, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth R.","family":"Phelps","sequence":"additional","affiliation":[{"name":"Stratton Veterans Affairs Medical Center and Albany Medical College, Albany, NY 12208, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Satarug, S. 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