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Epidemiology and toxicity of cadmium

Carl-Gustaf Elinder, MD, PhD
Stephen J Traub, MD
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Alice M Sheridan, MD


Cadmium (Cd) is a metal that can cause severe acute or chronic toxicity in humans. Most cases of cadmium toxicity are due to chronic exposure. Chronic, low-level cadmium exposure can affect a variety of organs, with the kidneys and bones being the principal targets [1-3]. Acute cadmium toxicity is less common. Depending upon the route of exposure, acute cadmium toxicity primarily affects the lungs and gastrointestinal tract.

This topic reviews chronic and acute cadmium toxicity. Other heavy metal toxicities are discussed elsewhere. (See "Mercury toxicity" and "Lead nephropathy and lead-related nephrotoxicity" and "Childhood lead poisoning: Clinical manifestations and diagnosis" and "Arsenic exposure and poisoning".)


Source of exposure — Cadmium is a relatively rare heavy metal that occurs naturally in combination with zinc. Environmental contamination and consequent human exposure to cadmium have dramatically increased during the past 100 years [4,5]. Cadmium commonly contaminates the environment via cadmium-containing material in household waste, industrial emissions, and soil. As examples:

Cadmium-containing products are frequently thrown out with the household garbage; the metal is then released into the atmosphere if the waste is burned.

Cadmium emissions are released from mining and nonferrous smelters.


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Literature review current through: Sep 2016. | This topic last updated: Apr 13, 2016.
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  1. WHO. Cadmium. Environmental Health Criteria. WHO, Geneva, 1992. p.280.
  2. Schutte R, Nawrot TS, Richart T, et al. Bone resorption and environmental exposure to cadmium in women: a population study. Environ Health Perspect 2008; 116:777.
  3. Nawrot T, Geusens P, Nulens TS, Nemery B. Occupational cadmium exposure and calcium excretion, bone density, and osteoporosis in men. J Bone Miner Res 2010; 25:1441.
  4. Nriagu JO, Pacyna JM. Quantitative assessment of worldwide contamination of air, water and soils by trace metals. Nature 1988; 333:134.
  5. Elinder CG, Järup L. Cadmium exposure and health risks: Recent findings. Ambio 1996; 25:370.
  6. Elinder CG. Uses, occurrence and intake. In: Cadmium and Health: An Epidemiologic and Toxicological Appraisal, Friberg L, Elinder CG, Nordberg GF, et al (Eds), CRC Press, Boca Raton, FL 1985. Vol 1, p.23.
  7. Järup L, Berglund M, Elinder CG, et al. Health effects of cadmium exposure--a review of the literature and a risk estimate. Scand J Work Environ Health 1998; 24 Suppl 1:1.
  8. Friberg L, Elinder CG, Kjellström T, et al. Cadmium and health: A toxiciological and epidemiologic appraisal, CRC Press, Boca Raton, FL 1985. Vol 1 - Exposure, dose, and metabolism, p.209.
  9. Nogawa K, Kobayashi E, Okubo Y, Suwazono Y. Environmental cadmium exposure, adverse effects and preventive measures in Japan. Biometals 2004; 17:581.
  10. Bernhoft RA. Cadmium toxicity and treatment. ScientificWorldJournal 2013; 2013:394652.
  11. Friberg L, Elinder CG, Kjellström T, et al. Cadmium and Health: A toxicological and epidemiologic appraisal, CRC Press, Boca Raton, FL 1986. Vol Vol II: Effects and Response, p.307.
  12. Vanderpool RA, Reeves PG. Cadmium absorption in women fed processed edible sunflower kernels labeled with a stable isotope of cadmium, (113)Cd. Environ Res 2001; 87:69.
  13. ATSDR. Toxicological Profile for Cadmium. US Department of Health and Human Services, 2008.
  14. FRIBERG L. Health hazards in the manufacture of alkaline accumulators with special reference to chronic cadmium poisoning; a clinical and experimental study. Acta Med Scand Suppl 1950; 240:1.
  15. BUTLER EA, FLYNN FV. The proteinuria of renal tubular disorders. Lancet 1958; 2:978.
  16. Roels H, Djubgang J, Buchet JP, et al. Evolution of cadmium-induced renal dysfunction in workers removed from exposure. Scand J Work Environ Health 1982; 8:191.
  17. Elinder CG, Edling C, Lindberg E, et al. beta 2-Microglobulinuria among workers previously exposed to cadmium: follow-up and dose-response analyses. Am J Ind Med 1985; 8:553.
  18. Mason HJ, Williams N, Armitage S, et al. Follow up of workers previously exposed to silver solder containing cadmium. Occup Environ Med 1999; 56:553.
  19. Van Vleet TR, Schnellmann RG. Toxic nephropathy: environmental chemicals. Semin Nephrol 2003; 23:500.
  20. Xia X, Wang G, Peng Y, et al. The endogenous CXXC motif governs the cadmium sensitivity of the renal Na+/glucose co-transporter. J Am Soc Nephrol 2005; 16:1257.
  21. Hotz P, Buchet JP, Bernard A, et al. Renal effects of low-level environmental cadmium exposure: 5-year follow-up of a subcohort from the Cadmibel study. Lancet 1999; 354:1508.
  22. Järup L, Elinder CG. Incidence of renal stones among cadmium exposed battery workers. Br J Ind Med 1993; 50:598.
  23. Scott R, Patterson PJ, Burns R, et al. Hypercalciuria related to cadmium exposure. Urology 1978; 11:462.
  24. Wu X, Jin T, Wang Z, et al. Urinary calcium as a biomarker of renal dysfunction in a general population exposed to cadmium. J Occup Environ Med 2001; 43:898.
  25. Järup L, Persson B, Elinder CG. Decreased glomerular filtration rate in solderers exposed to cadmium. Occup Environ Med 1995; 52:818.
  26. Hellström L, Elinder CG, Dahlberg B, et al. Cadmium exposure and end-stage renal disease. Am J Kidney Dis 2001; 38:1001.
  27. Nogawa K. Biologic indicators of cadmium nephrotoxicity in persons with low-level cadmium exposure. Environ Health Perspect 1984; 54:163.
  28. Buchet JP, Lauwerys R, Roels H, et al. Renal effects of cadmium body burden of the general population. Lancet 1990; 336:699.
  29. Cai SW, Yue L, Hu ZN, et al. Cadmium exposure and health effects among residents in an irrigation area with ore dressing wastewater. Sci Total Environ 1990; 90:67.
  30. Järup L, Elinder CG. Dose-response relations between urinary cadmium and tubular proteinuria in cadmium-exposed workers. Am J Ind Med 1994; 26:759.
  31. Bernard A, Buchet JP, Roels H, et al. Renal excretion of proteins and enzymes in workers exposed to cadmium. Eur J Clin Invest 1979; 9:11.
  32. Mueller PW, Smith SJ, Steinberg KK, Thun MJ. Chronic renal tubular effects in relation to urine cadmium levels. Nephron 1989; 52:45.
  33. Järup L, Hellström L, Alfvén T, et al. Low level exposure to cadmium and early kidney damage: the OSCAR study. Occup Environ Med 2000; 57:668.
  34. Akesson A, Lundh T, Vahter M, et al. Tubular and glomerular kidney effects in Swedish women with low environmental cadmium exposure. Environ Health Perspect 2005; 113:1627.
  35. Akerstrom M, Sallsten G, Lundh T, Barregard L. Associations between urinary excretion of cadmium and proteins in a nonsmoking population: renal toxicity or normal physiology? Environ Health Perspect 2013; 121:187.
  36. Haddam N, Samira S, Dumont X, et al. Confounders in the assessment of the renal effects associated with low-level urinary cadmium: an analysis in industrial workers. Environ Health 2011; 10:37.
  37. Chaumont A, De Winter F, Dumont X, et al. The threshold level of urinary cadmium associated with increased urinary excretion of retinol-binding protein and beta 2-microglobulin: a re-assessment in a large cohort of nickel-cadmium battery workers. Occup Environ Med 2011; 68:257.
  38. Kido T, Nogawa K, Yamada Y, et al. Osteopenia in inhabitants with renal dysfunction induced by exposure to environmental cadmium. Int Arch Occup Environ Health 1989; 61:271.
  39. Nordberg GF, Nogawa K, Nordberg M, Friberg LT. Cadmium. In: Handbook on the Toxicology of Metals, Nordberg GF, Fowler BA, Nordberg M. (Eds), Academic Press/Elsevier, Amsterdam 2014. Vol 2, p.667.
  40. Järup L, Alfvén T, Persson B, et al. Cadmium may be a risk factor for osteoporosis. Occup Environ Med 1998; 55:435.
  41. Staessen JA, Roels HA, Emelianov D, et al. Environmental exposure to cadmium, forearm bone density, and risk of fractures: prospective population study. Public Health and Environmental Exposure to Cadmium (PheeCad) Study Group. Lancet 1999; 353:1140.
  42. Alfvén T, Elinder CG, Carlsson MD, et al. Low-level cadmium exposure and osteoporosis. J Bone Miner Res 2000; 15:1579.
  43. Alfvén T, Järup L, Elinder CG. Cadmium and lead in blood in relation to low bone mineral density and tubular proteinuria. Environ Health Perspect 2002; 110:699.
  44. Akesson A, Bjellerup P, Lundh T, et al. Cadmium-induced effects on bone in a population-based study of women. Environ Health Perspect 2006; 114:830.
  45. Alfvén T, Elinder CG, Hellström L, et al. Cadmium exposure and distal forearm fractures. J Bone Miner Res 2004; 19:900.
  46. Engström A, Michaëlsson K, Suwazono Y, et al. Long-term cadmium exposure and the association with bone mineral density and fractures in a population-based study among women. J Bone Miner Res 2011; 26:486.
  47. Thomas LD, Michaëlsson K, Julin B, et al. Dietary cadmium exposure and fracture incidence among men: a population-based prospective cohort study. J Bone Miner Res 2011; 26:1601.
  48. Wu Q, Magnus JH, Hentz JG. Urinary cadmium, osteopenia, and osteoporosis in the US population. Osteoporos Int 2010; 21:1449.
  49. Engström A, Michaëlsson K, Vahter M, et al. Associations between dietary cadmium exposure and bone mineral density and risk of osteoporosis and fractures among women. Bone 2012; 50:1372.
  50. Horiguchi H, Oguma E, Sasaki S, et al. Environmental exposure to cadmium at a level insufficient to induce renal tubular dysfunction does not affect bone density among female Japanese farmers. Environ Res 2005; 97:83.
  51. Kjellström T. Mechanism and epidemiology of bone effects of cadium. In: Toxicity and Carcinogenicity of Cadmium in the Human Environment - An International Symposium, Nordberg GF, Herber RFM, Alessio L (Eds), 1992. p.301.
  52. Takenaka S, Oldiges H, König H, et al. Carcinogenicity of cadmium chloride aerosols in W rats. J Natl Cancer Inst 1983; 70:367.
  53. Cadmium and cadmium compounds. IARC Monogr Eval Carcinog Risks Hum 1993; 58:119.
  54. Doll R. Is cadmium a human carcinogen? Ann Epidemiol 1992; 2:335.
  55. Järup L, Bellander T, Hogstedt C, Spång G. Mortality and cancer incidence in Swedish battery workers exposed to cadmium and nickel. Occup Environ Med 1998; 55:755.
  56. Nawrot T, Plusquin M, Hogervorst J, et al. Environmental exposure to cadmium and risk of cancer: a prospective population-based study. Lancet Oncol 2006; 7:119.
  57. Nordberg GF. Lung cancer and exposure to environmental cadmium. Lancet Oncol 2006; 7:99.
  58. Wittman R, Hu H. Cadmium exposure and nephropathy in a 28-year-old female metals worker. Environ Health Perspect 2002; 110:1261.
  59. Barregard L, Elinder CG. Renal effects from exposure to metals. In: Handbook on the Toxicology of Metals, Nordberg GF, Fowler BA, Nordberg M. (Eds), Academic Press, Amsterdam 2014. Vol 1, p.333.
  60. Prozialeck WC, Vaidya VS, Liu J, et al. Kidney injury molecule-1 is an early biomarker of cadmium nephrotoxicity. Kidney Int 2007; 72:985.
  61. Satarug S, Haswell-Elkins MR, Moore MR. Safe levels of cadmium intake to prevent renal toxicity in human subjects. Br J Nutr 2000; 84:791.
  62. Nishijo M, Nakagawa H, Morikawa Y, et al. Prognostic factors of renal dysfunction induced by environmental cadmium pollution. Environ Res 1994; 64:112.
  63. Iwata K, Saito H, Moriyama M, Nakano A. Follow up study of renal tubular dysfunction and mortality in residents of an area polluted with cadmium. Br J Ind Med 1992; 49:736.
  64. Nishijo M, Nakagawa H, Morikawa M, et al. Relationship between urinary cadmium and mortality among inhabitants living in a cadmium polluted area in Japan. Toxicol Lett 1999; 108:321.
  65. Nishijo M, Nakagawa H, Morikawa Y, et al. Mortality in a cadmium polluted area in Japan. Biometals 2004; 17:535.
  66. Nishijo M, Morikawa Y, Nakagawa H, et al. Causes of death and renal tubular dysfunction in residents exposed to cadmium in the environment. Occup Environ Med 2006; 63:545.
  67. Nishijo M, Nakagawa H, Morikawa Y, et al. Mortality of inhabitants in an area polluted by cadmium: 15 year follow up. Occup Environ Med 1995; 52:181.
  68. Fuortes L, Leo A, Ellerbeck PG, Friell LA. Acute respiratory fatality associated with exposure to sheet metal and cadmium fumes. J Toxicol Clin Toxicol 1991; 29:279.
  69. Seidal K, Jörgensen N, Elinder CG, et al. Fatal cadmium-induced pneumonitis. Scand J Work Environ Health 1993; 19:429.
  70. Buckler HM, Smith WD, Rees WD. Self poisoning with oral cadmium chloride. Br Med J (Clin Res Ed) 1986; 292:1559.
  71. Wiśniewska-Knypl J, Jablońska J, Myślak Z. Binding of cadmium on metallothionein in man: an analysis of a fatal poisoning by cadmium iodide. Arch Toxikol 1971; 28:46.
  72. Parikh JM, Dhareshwar S, Sharma A, et al. Acute respiratory distress in a silversmith. Indian J Occup Environ Med 2014; 18:27.
  73. Barnhart S, Rosenstock L. Cadmium chemical pneumonitis. Chest 1984; 86:789.
  74. Anthony JS, Zamel N, Aberman A. Abnormalities in pulmonary function after brief exposure to toxic metal fumes. Can Med Assoc J 1978; 119:586.
  75. Patwardhan JR, Finckh ES. Fatal cadmium-fume pneumonitis. Med J Aust 1976; 1:962.
  76. Townshend RH. Acute cadmium pneumonitis: a 17-year follow-up. Br J Ind Med 1982; 39:411.
  77. Raval G, Straughen JE, McMillin GA, Bornhorst JA. Unexplained hemolytic anemia with multiorgan failure. Clin Chem 2011; 57:1485.