{"id":"e28c4ab8a4a5","type":"article","url":"https://hartvaat.nl/2026/09/21/hogere-bloed-seleniumspiegels-gekoppeld-aan-lagere-sterfte-bij-ckm-syndroom-nhan/","title":"Hogere bloed-seleniumspiegels gekoppeld aan lagere sterfte bij CKM-syndroom — NHANES-cohort","title_en":"Association Between Blood Heavy Metals and Selenium with All-Cause Mortality in Cardiovascular-Kidney-Metabolic Syndrome Populations: Exploring the Mediating Effects of Inflammatory Biomarkers.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":[],"journal":"Cardiovascular toxicology","doi":"10.1007/s12012-026-10179-8","source_url":"https://doi.org/10.1007/s12012-026-10179-8","authors":["Hui Niu","Lin Zhang","Yikun Wang","Wenchang He","Rui Wang","Xinhong Li"],"significance":4,"published":"2026-09-29","source_date":"2026-09-21","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/"],"congress":"","summary_en":"In a prospective cohort of 6,072 NHANES participants with cardiovascular-kidney-metabolic (CKM) syndrome, higher blood selenium levels were associated with a 38% lower all-cause mortality risk (HR 0.62; 95% CI 0.45–0.85; p=0.003) compared to the lowest quartile. The dose-response relationship followed an L-shaped curve, with consistent findings across early and advanced CKM stages. Mediation analysis indicated that systemic inflammation markers (NLR, MLR, SIRI) partially explained this association, though the mediated proportion was modest. While observational, the findings highlight the potential clinical relevance of selenium status and inflammatory pathways in managing this high-risk population.","created":"2026-09-22T01:17:30Z","updated":"2026-09-22T01:17:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een prospectief cohort van 6.072 NHANES-deelnemers met het cardiorenale-metabole (CKM)-syndroom bleek een hogere bloed-seleniumspiegel geassocieerd met een 38% lager sterfterisico (HR 0,62; 95% BI 0,45–0,85; p=0,003) vergeleken met de laagste kwartiel. De dosis-responsrelatie volgde een L-vormig patroon en dit effect was consistent in zowel vroege als gevorderde CKM-stadia. Mediatie-analyse suggereert dat systemische ontsteking (gemeten via NLR, MLR en SIRI) een kleine rol speelt in dit verband. Hoewel observatief, benadrukt het onderzoek de potentiële waarde van seleniumstatus en ontstekingsremmende strategieën in de zorg voor deze kwetsbare patiëntengroep.","abstract_original":"Cardiovascular-kidney-metabolic (CKM) syndrome, characterized by the pathophysiological interplay among metabolic disorders, chronic kidney disease (CKD), and cardiovascular disease (CVD), significantly elevates mortality risk. Environmental heavy metal exposure and selenium deficiency are implicated in these conditions, but their combined impact on CKM syndrome is unclear. To investigate the associations of blood heavy metals (lead [Pb], cadmium [Cd], mercury [Hg], manganese [Mn]) and selenium (Se) with all-cause mortality in CKM populations, and examine the mediating role of inflammatory biomarkers. This cross-sectional study with prospective mortality follow-up included 6,072 participants from NHANES (2011-2018). Kaplan-Meier curves, multivariable Cox regression models, and restricted cubic spline (RCS) analyses were employed to assess all-cause mortality associations. Subgroup and interaction analyses evaluated risks across demographic strata. Mediation analysis was employed to explore the mediating effects of inflammatory biomarkers (NLR, MLR, NMLR, and SIRI). The Weighted quantile sum (WQS) model was utilized to estimate the effects of combined blood metal exposures. Among 6,072 participants, 409 deaths occurred during follow-up. In the fully adjusted model, there was a significant negative correlation between blood selenium levels and all-cause mortality in the CKM population. Compared with the lowest quartile (Q1), the highest selenium quartile (Q4) was associated with a 38% reduced mortality risk (HR = 0.62, 95% CI: 0.45-0.85, P = 0.003). RCS analysis revealed an L-shaped dose-response relationship (P for nonlinear = 0.002). Subgroup analyses confirmed consistent associations in both non-advanced CKM (stages 0-2) and advanced CKM (stages 3-4) (all P < 0.05, P for interaction = 0.163). Mediation analysis revealed that NLR, MLR, NMLR, and SIRI partially mediated the association between blood selenium and all-cause mortality, and the mediated proportions were relatively modest (ranging from 3.57 to 5.29%). Higher blood selenium was associated with reduced all-cause mortality in CKM syndrome after adjustment for measured confounders, and mediation analysis suggested a potential partial role of inflammation in this association. These findings underscore the need for targeted interventions to mitigate mortality in this high-risk population."}