Association of Environmental Lead Toxicity and Hematologic Outcomes in Patients with Advanced Kidney Disease

Details

• Personal Author:
  Danziger J ; Geetha P ; Hu H ; Kyriazis P ; Paudel S ; Specht A
• Description:
  Despite regulatory advances over the past two decades, low levels of environmental heavy metal contamination remain widespread. Because lead is predominantly excreted by the kidney, patients with chronic kidney disease (CKD) may be particularly susceptible to lead toxicity. We have recently used regulatory data to demonstrate associations between higher levels of lead exposure in community drinking water and lower hemoglobin concentrations and higher erythropoietin stimulating agent (ESA) utilization among those with end-stage kidney disease (ESKD). To further investigate these findings, we used portable X-ray fluorescence (XRF) to measure levels of tibial lead in 69 patients seen for routine nephrology care. Tibial lead is widely regarded to reflect total lead accumulation. While standard K-shell fluorescence remains the standard for measuring bone lead, recent advances in portable XRF techniques offer a more clinically feasible methodology which is under clinical evaluation. We compared tibial lead levels to hemoglobin concentrations taken at the time of the clinic visit. Gender-specific thresholds [<11.2 g/dL (women) and 13.7 g/dL (men)] were used to define anemia. We hypothesized that tibial lead levels would be indirectly associated with hemoglobin concentrations, particularly for those with more severe CKD, among whom the myelosuppressive effects of lead would be synergized by the decreased erythropoietin functionality that accompanies anemia of CKD. [Description provided by NIOSH]
• Subjects:
  Environmental Pollution Hematologic Diseases Hematologic Tests Lead Occupational Health Safety
• Keywords:
  Anemia Environmental Contamination Hematology Kidney Disorders X-ray Fluorescence Analysis
• ISSN:
  0931-0509
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; Indiana ; Massachusetts ; OSHA Region 1 ; OSHA Region 5 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  38
• Issue:
  5
• NIOSHTIC Number:
  nn:20069895
• Citation:
  Nephrol Dial Transplant 2023 May; 38(5):1337-1339
• Contact Point Address:
  Subhash Paudel, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
• Email:
  Subhash.900@gmail.com
• CAS Registry Number:
  Lead (CAS RN 7439-92-1)
• Federal Fiscal Year:
  2023
• Performing Organization:
  Purdue University
• Peer Reviewed:
  True
• Start Date:
  20210901
• Source Full Name:
  Nephrology Dialysis Transplantation
• End Date:
  20220731
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:95bb8578e74993e84c4a82ea0a0339816208223e822df64c6406266353569b1b0a3b7af33342b16f1566cea46f33d0f4794f4d4f843ec27a40edcbc2892e323d
• Download URL:
  https://stacks.cdc.gov/view/cdc/208231/cdc_208231_DS1.pdf
• File Type:
  [PDF - 221.91 KB ]