Environmental lead exposure is associated with neurocognitive dysfunction in children with chronic kidney disease

Overview of the findings and advances in the neurocognitive and psychosocial functioning of mild to moderate pediatric CKD: perspectives from the Chronic Kidney Disease in Children (CKiD) cohort study

The Chronic Kidney Disease in Children (CKiD) prospective cohort study was designed to address the neurocognitive, growth, cardiovascular, and disease progression of children and adolescents with mild to moderate CKD. The study has had continuous funding from NIDDK for 17 years and has contributed significant advances in pediatric CKD. The goals of this educational review are threefold: (1) to provide an overview of the neurocognitive and psychosocial studies from CKiD to date; (2) to provide best practice recommendations for those working with the neurocognitive and psychosocial aspects of pediatric CKD based on CKiD findings; and (3) to help chart future goals and directives for both research and clinical practice. This collection of 22 empirical studies has produced a number of key findings for children and adolescents with mild to moderate CKD. While various studies suggest a relatively positive presentation for this population as a whole, without evidence of significant impairment or deterioration, findings do indicate the presence of neurocognitive dysfunction, emotional-behavioral difficulties, and lower quality of life for many children with CKD. These findings support the promotion of best practices that are accompanied by additional future clinical and research initiatives with this patient population.

The Similarities and Differences Between Glomerular vs. Non-glomerular Diagnoses on Intelligence and Executive Functions in Pediatric Chronic Kidney Disease: A Brief Report

Pediatric chronic kidney disease (CKD) appears to be a heterogeneous group of conditions, but this heterogeneity has not been explored with respect to its impact on neurocognitive functioning. This study investigated the neurocognitive functioning of those with glomerular (G) vs. non-glomerular (NG) diagnoses. Data from the North American CKiD Study were employed and the current study included 1,003 children and adolescents with mild to moderate CKD. The G Group included 260 participants (median age = 14.7 years) and the NG Group included 743 individuals (median age = 9.0 years). Neurocognitive measures assessed IQ, inhibitory control, attention regulation, problem solving, working memory, and overall executive functioning. Data from all visits were included in the linear mixed model analyses. After adjusting for sociodemographic and CKD-related covariates, results indicated no differences between the diagnostic groups on measures of IQ, problem solving, working memory, and attention regulation. There was a trend for the G group to receive better parent ratings on their overall executive functions (p < 0.07), with a small effect size being present. Additionally, there was a significant G group X hypertension interaction (p < 0.003) for inhibitory control, indicating that those with both a G diagnosis and hypertension performed more poorly than the NG group with hypertension. These findings suggest that the separation of G vs. NG CKD produced minimal, but specific group differences were observed. Ongoing examination of the heterogeneity of pediatric CKD on neurocognition, perhaps at a different time point in disease progression or using a different model, appears warranted.

IQ alteration induced by lead in developed and underdeveloped/developing countries: A systematic review and a meta-analysis

The aim of this study was to evaluate the effects of Pb exposure on full-scale IQ score in pediatric subjects. Following PRISMA guidelines, the data from January 2010 to April 2020 were systematically searched and collected on electronic databases (PubMed, Scopus, and Embase). The eligibility criteria included cross-sectional, cohort, and case-control studies that were published in English, from 2010 to 2020, that analyzed the blood Pb levels of pediatric subjects (0-19 years) and possible changes in the full-scale IQ score. In this study, 2174 scientific papers were collected from three electronic databases. From those, 726 were duplicates and 1421 were excluded because they did not meet the eligibility criteria, resulting in a total of 27 papers, from which, seven were used to perform the meta-analysis. The 27 scientific papers systematically selected for this study were separated by the country where the study was realized in developed and underdeveloped/developing countries. In the underdeveloped/developing countries the blood Pb levels are higher and showed a greater variation (1.30-11.66 μgPb/dL of blood) than in countries with higher development index (0.57-4.80 μgPb/dL of blood). The full-scale IQ score are inversely proportional to the blood Pb values, and it is possible to see that in the underdeveloped/developing countries the full-scale IQ score showed lower values and greater variation (59.2-111) compared to the individuals from developed countries (91.9-114.5). In conclusion, it was observed that blood Pb levels alter the full-scale IQ score. Thus, policies for the prevention of environmental contamination and the reduction of Pb exposure must be taken, mainly, in underdeveloped/developing countries.

Neurocognition in Pediatric Chronic Kidney Disease: A Review of Data From the Chronic Kidney Disease in Children (CKiD) Study

Pediatric chronic kidney disease (CKD) is associated with deficits in neurocognitive functioning, ranging from mild to severe, and correlated with the severity of kidney disease. Clinical variables that are associated with neurocognitive deficits include lower kidney function, hypertension, proteinuria, and metabolic acidosis. Commonly reported neurocognitive difficulties include academic underachievement and deficits in attention regulation and executive function as well as somewhat lower intellectual abilities compared with peer and normative data. Although often mild, these neurocognitive deficits may have broad implications for quality of life and likely contribute to both poorer high school graduation rates and long-term underemployment in the adult CKD population. The presence of neurocognitive deficits in predialytic CKD has been well characterized, but further longitudinal research is warranted to describe cognitive changes as children progress from early stage CKD to kidney replacement therapy. Such studies should include both cognitive and neuroimaging evaluations to better inform the impact of CKD progression on neurocognitive outcomes.

Trend in blood lead levels in Taiwanese adults 2005-2017

This study examined the trend of blood lead levels (BLLs) in Taiwanese adults and analyzed the variations in the BLL between Linkou (northern) and Kaohsiung (southern) hospital branches. Between 2005 and 2017, 3,804 adult participants received blood lead tests at the Linkou (n = 2,674) and Kaohsiung (n = 1,130) branches of Chang Gung Memorial Hospital. The geometric mean of BLL was 2.77 μg/dL. The adult participants from the Kaohsiung branch were not only age older (49.8±14.1 versus 39.4±14.2 years; P<0.001) and male predominant (65.8 versus 41.7%; P<0.001) but also showed a higher BLL (4.45±3.93 versus 2.82±2.42 μg/dL; P<0.001) and lower estimated glomerular filtration rate (87.62±25.94 versus 93.67±23.88; P<0.001) than those from the Linkou branch. Multivariable logistic regression analysis revealed that the Kaohsiung branch [odds ratio (OR): 7.143; 95% confident interval (CI): 5.682–8.929; P<0.001], older age (OR: 1.008; 95% CI: 1.000–1.015; P = 0.043) and reduced estimated glomerular filtration rate (OR: 1.009; 95% CI: 1.004–1.014; P = 0.001) were significant predictors for BLL > 5 μg/dL. Therefore, this study confirmed a continuous decreasing trend in the BLL in Taiwan after banning leaded petrol in 2000.

[Occupational exposures, diet and storing: Recommendations to reduce environmental pollutants in breastfeeding]

The pollution of the planet also reaches the breastfeeding ecosystem, one of the most intimate and inviolable that links us as an animal species to the rest of mammals. Nursing mothers may be concerned about whether the quality of their milk will be adequate for their baby and whether environmental pollutants through work, diet, and storing may adversely affect their child. Breast milk is a source of exposure to environmental pollutants, and at the same time it counteracts much of the effects of these exposures. An approach based on the principles of reality and precaution of environmental health to avoid, reduce or eliminate the production and use of harmful chemicals during pregnancy and lactation would improve the human and planetary health for the offspring.

Protection of lead-induced cytotoxicity using paramagnetic nickel–insulin quantum clusters

Pb-toxicity is associated with inflammation which leads to delay in wound healing. Pb²⁺ utilizes calcium ion channels to enter the cell. Therefore, to achieve effective healing in a Pb-poisoned system, capturing Pb²⁺ from the circulatory system would be an effective approach without hampering the activity of the calcium ion channel. In this work insulin–nickel fluorescent quantum clusters (INiQCs) have been synthesized and used for the specific detection of Pb²⁺ ions in vitro and in cell-free systems. INiQCs (0.09 μM) can detect Pb²⁺ concentrations as low as 10 pM effectively in a cell-free system using the fluorescence turn-off method. In vitro INiQCs (0.45 μM) can detect Pb²⁺ concentrations as low as 1 μM. INiQCs also promote wound healing which can easily be monitored using the bright fluorescence of INiQCs. INiQCs also help to overcome the wound recovery inhibitory effect of Pb²⁺in vitro using lead nitrate. This work helps to generate effective biocompatible therapeutics for wound recovery in Pb²⁺ poisoned individuals.

Receptor targeted ferromagnetic Insulin–Nickel Quantum fluorescence Clusters (INiQCs) can specifically detect Pb²⁺ and prevents Pb²⁺ poisoning.

Dose and duration-dependent toxicological evaluation of lead acetate in chicks

Lead is one of the utmost contaminated and dangerous heavy metals. This toxicant ultimately enters into the human body through the food chain and accumulated in the body because the animal/human body has not an appropriate mechanism to excrete it from the body. The main objective of the present research was to assess the toxicological effects of lead on body weights, biochemical, and hematological parameters of chickens and also to measure its bioaccumulation in the brain. Lead acetate was administrated orally at doses of 0, 71, 142, 213, and 284 mg/kg of body weight of chicken for groups A, B, C, D, and E, respectively. Along with determination of biometry of all experimental chicks, hematological [hemoglobin (Hb), packed cell volume (PCV), mean corpuscular hemoglobin concentration (MCHC), total erythrocyte count (TEC), white blood cells (WBCs), leukocyte differential count (LDC)] and biochemical [low density lipoprotein (LDL), total protein, high-density lipoprotein (HDL), and alanine aminotransferase (ALT)] parameters were measured. The present study showed that the bodyweight of chickens was not affected significantly by lead acetate exposure. The levels of MCHC, PCV, TEC, Hb, LDL, HDL, and total protein were found to be significantly decreased while WBC, LDC, and ALT profile were enhanced due to administration of lead acetate. Bioaccumulation of lead acetate was found to be higher in the brain. We conclude that the chronic administration of lead acetate affected the blood and biochemical profile of exposed chicken. These effects might be due to the accumulation of the chemical in certain vital organ(s). However, further studies in the future are suggested to refine such findings.