Associations of blood lead with estimated glomerular filtration rate using MDRD, CKD-EPI and serum cystatin C-based equations

Research output: Contribution to journalArticle

Abstract

Background. Low-level lead exposure is widespread and has been implicated as a chronic kidney disease (CKD) risk factor. However, studies evaluating associations of lead dose with newer, potentially more accurate, estimates of kidney function, in participants with a wide range of glomerular filtration rates (GFRs), are scarce.Methods. We compared associations of blood lead and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C single variable, multivariable and combined creatinine/cystatin C equations in 3941 adults who participated in the 1999-2002 National Health and Nutrition Examination Survey cystatin C subsample.Results. Geometric mean blood lead was 1.7 μg/dL. After multivariable adjustment, differences [95% confidence interval (CI)] in mean eGFR for a doubling of blood lead were-1.9 (-3.2,-0.7),-1.7 (-3.0,-0.5) and-1.4 (-2.3,-0.5) mL/min/1.73 m 2, using the cystatin C single variable, multivariable and combined creatinine/cystatin C equations, respectively, reflecting lower eGFR with increased blood lead. The corresponding differences (95% CI) were-0.9 (-1.9, 0.02) and-0.9 (-1.8, 0.01) using the creatinine-based MDRD and CKD-EPI equations, respectively. In participants aged ≥60 years, differences in mean eGFR ranged from-3.0 to-4.5 mL/min/1.73 m 2, and odds of reduced eGFR (2) were increased for all estimates of GFR.Conclusions. These results support the inclusion of cystatin C-based eGFR in future lead research and provide additional evidence for environmental lead exposure as a CKD risk factor.

Original languageEnglish (US)
Pages (from-to)2786-2792
Number of pages7
JournalNephrology Dialysis Transplantation
Volume26
Issue number9
DOIs
StatePublished - Sep 2011

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Diet Therapy
Cystatin C
Glomerular Filtration Rate
Chronic Renal Insufficiency
Kidney
Serum
Creatinine
Confidence Intervals
Nutrition Surveys
Environmental Exposure
Lead
Epidemiology

Keywords

  • blood lead
  • kidney function
  • lead exposure
  • NHANES

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

@article{1a4e023c980240a5957dfe67ab07d1ac,
title = "Associations of blood lead with estimated glomerular filtration rate using MDRD, CKD-EPI and serum cystatin C-based equations",
abstract = "Background. Low-level lead exposure is widespread and has been implicated as a chronic kidney disease (CKD) risk factor. However, studies evaluating associations of lead dose with newer, potentially more accurate, estimates of kidney function, in participants with a wide range of glomerular filtration rates (GFRs), are scarce.Methods. We compared associations of blood lead and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C single variable, multivariable and combined creatinine/cystatin C equations in 3941 adults who participated in the 1999-2002 National Health and Nutrition Examination Survey cystatin C subsample.Results. Geometric mean blood lead was 1.7 μg/dL. After multivariable adjustment, differences [95{\%} confidence interval (CI)] in mean eGFR for a doubling of blood lead were-1.9 (-3.2,-0.7),-1.7 (-3.0,-0.5) and-1.4 (-2.3,-0.5) mL/min/1.73 m 2, using the cystatin C single variable, multivariable and combined creatinine/cystatin C equations, respectively, reflecting lower eGFR with increased blood lead. The corresponding differences (95{\%} CI) were-0.9 (-1.9, 0.02) and-0.9 (-1.8, 0.01) using the creatinine-based MDRD and CKD-EPI equations, respectively. In participants aged ≥60 years, differences in mean eGFR ranged from-3.0 to-4.5 mL/min/1.73 m 2, and odds of reduced eGFR (2) were increased for all estimates of GFR.Conclusions. These results support the inclusion of cystatin C-based eGFR in future lead research and provide additional evidence for environmental lead exposure as a CKD risk factor.",
keywords = "blood lead, kidney function, lead exposure, NHANES",
author = "Spector, {June T.} and {Navas Acien}, Ana and Fadrowski, {Jeffrey J.} and Eliseo Guallar and Bernard Jaar and Weaver, {Virginia Marie}",
year = "2011",
month = "9",
doi = "10.1093/ndt/gfq773",
language = "English (US)",
volume = "26",
pages = "2786--2792",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "9",

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TY - JOUR

T1 - Associations of blood lead with estimated glomerular filtration rate using MDRD, CKD-EPI and serum cystatin C-based equations

AU - Spector, June T.

AU - Navas Acien, Ana

AU - Fadrowski, Jeffrey J.

AU - Guallar, Eliseo

AU - Jaar, Bernard

AU - Weaver, Virginia Marie

PY - 2011/9

Y1 - 2011/9

N2 - Background. Low-level lead exposure is widespread and has been implicated as a chronic kidney disease (CKD) risk factor. However, studies evaluating associations of lead dose with newer, potentially more accurate, estimates of kidney function, in participants with a wide range of glomerular filtration rates (GFRs), are scarce.Methods. We compared associations of blood lead and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C single variable, multivariable and combined creatinine/cystatin C equations in 3941 adults who participated in the 1999-2002 National Health and Nutrition Examination Survey cystatin C subsample.Results. Geometric mean blood lead was 1.7 μg/dL. After multivariable adjustment, differences [95% confidence interval (CI)] in mean eGFR for a doubling of blood lead were-1.9 (-3.2,-0.7),-1.7 (-3.0,-0.5) and-1.4 (-2.3,-0.5) mL/min/1.73 m 2, using the cystatin C single variable, multivariable and combined creatinine/cystatin C equations, respectively, reflecting lower eGFR with increased blood lead. The corresponding differences (95% CI) were-0.9 (-1.9, 0.02) and-0.9 (-1.8, 0.01) using the creatinine-based MDRD and CKD-EPI equations, respectively. In participants aged ≥60 years, differences in mean eGFR ranged from-3.0 to-4.5 mL/min/1.73 m 2, and odds of reduced eGFR (2) were increased for all estimates of GFR.Conclusions. These results support the inclusion of cystatin C-based eGFR in future lead research and provide additional evidence for environmental lead exposure as a CKD risk factor.

AB - Background. Low-level lead exposure is widespread and has been implicated as a chronic kidney disease (CKD) risk factor. However, studies evaluating associations of lead dose with newer, potentially more accurate, estimates of kidney function, in participants with a wide range of glomerular filtration rates (GFRs), are scarce.Methods. We compared associations of blood lead and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C single variable, multivariable and combined creatinine/cystatin C equations in 3941 adults who participated in the 1999-2002 National Health and Nutrition Examination Survey cystatin C subsample.Results. Geometric mean blood lead was 1.7 μg/dL. After multivariable adjustment, differences [95% confidence interval (CI)] in mean eGFR for a doubling of blood lead were-1.9 (-3.2,-0.7),-1.7 (-3.0,-0.5) and-1.4 (-2.3,-0.5) mL/min/1.73 m 2, using the cystatin C single variable, multivariable and combined creatinine/cystatin C equations, respectively, reflecting lower eGFR with increased blood lead. The corresponding differences (95% CI) were-0.9 (-1.9, 0.02) and-0.9 (-1.8, 0.01) using the creatinine-based MDRD and CKD-EPI equations, respectively. In participants aged ≥60 years, differences in mean eGFR ranged from-3.0 to-4.5 mL/min/1.73 m 2, and odds of reduced eGFR (2) were increased for all estimates of GFR.Conclusions. These results support the inclusion of cystatin C-based eGFR in future lead research and provide additional evidence for environmental lead exposure as a CKD risk factor.

KW - blood lead

KW - kidney function

KW - lead exposure

KW - NHANES

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U2 - 10.1093/ndt/gfq773

DO - 10.1093/ndt/gfq773

M3 - Article

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SN - 0931-0509

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