CHEN Jianli 1,2 , LU Yongbin 1 , HUI Xu 1 , ZHAO Mengde 3 , LU Huqiang 1,4 , LIU Yijun 1,5 , WAN Tingxin 2 , WANG Shizhong 6 , YANG Kehu 1
  • 1. Evidence Based Medicine Center, School of Basic Medicine, Lanzhou University, Lanzhou 730099, P. R. China;
  • 2. Department of Nephrology, Wuwei People's Hospital , Wuwei 733000, P. R. China;
  • 3. Department of General Surgery, Wuwei People's Hospital, Wuwei 733000, P. R. China;
  • 4. Department of Critical Care Medicine, Wuwei People's Hospital, Wuwei 733000, P. R. China;
  • 5. Department of Integrative Medicine, Wuwei People's Hospital, Wuwei 733000, P. R. China;
  • 6. Department of Orthopedics, Wuwei People's Hospital, Wuwei 733000, P. R. China;
WAN Tingxin, Email: wantingxin000@sina.com; WANG Shizhong, Email: 413199705@qq.com; YANG Kehu, Email: yangkh@lzu.edu.cn
Heavy metal exposure; Cadmium exposure; Kidney stones; Dose-response-relationship; Meta-analysis
10.7507/1672-2531.202508031
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Objective To systematically evaluate the correlation between heavy metal exposure, especially Cadmium (Cd), Mercury (Hg), Lead (Pb) and the risk of kidney stone occurrence, and to explore the potential dose-response relationship between them. Methods We conducted a computerized search of Web of Science, PubMed, The Cochrane Library, EMBASE, CNKI, WanFang Data, CBM, and VIP databases,with supplementary searches in Scopus, WHO IRIS, and Google Scholar, to collect studies on the correlation between heavy metal exposure and urolithiasis. the search period ranging from the inception of each database to September 14, 2025. Two researchers independently screened the literature, extracted data, and assessed the quality of the included studies. Traditional meta-analysis and dose–response meta-analysis were performed using Stata 15.1 software. Results A total of 16 studies were included, comprising 13 cross -sectional studies and 3 case-control studies, involving 117 992 participants. The results of the meta-analysis showed a significant positive correlation between urinary Cd levels and the risk of kidney stone occurrence (OR=1.16, 95%CI 1.05 to 1.27, I2=80.3%). Further subgroup analysis and Meta-regression indicated that region,gender,Cd exposure status and eGFR/proteinuria might be sources of heterogeneity. Blood Cd levels were significantly correlated with the risk of kidney stones (OR=1.31, 95%CI 1.03 to 1.65, I2=47.9%). There was an increasing linear dose-response relationship between blood Cd exposure and the risk of kidney stones (χ2=0.35, P>0.05), with each 1 ug/L increase in blood Cd corresponding to a 20% increase in the risk of kidney stones (OR=1.20, 95%CI 1.08 to 1.33). No significant associations were found between the levels of other metal exposures and the risk of kidney stones (PUHg=0.73, PUPb=0.82, PUCr=0.56, PUNi=0.06, PBHg=0.15, PBPb=0.52). Urinary Cd showed a significant nonlinear dose-response relationship with the risk of kidney stones (χ2=4.52, P<0.05). When urinary Cd exposure was 0.2 ug/L, the risk of kidney stones increased by 35% (OR=1.35, 95%CI 1.23 to 1.49), and for each 1ug/L increase in urinary Cd, the risk of kidney stones increased by 44% (OR=1.44, 95%CI 1.30 to 1.59). Conclusion Cd exposure levels are significantly positively correlated with the risk of kidney stone occurrence, suggesting that Cd exposure may be a potential risk factor for kidney stones. No significant association was found between exposure to other metals and the risk of kidney stone occurrence. However, due to limitations in study design, further research is needed in the future to establish the causal relationship of this association.

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