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Shawky SM, Hamid RAAA, Khedr LE. The correlation between uremic pruritus and blood lead levels in prevalent hemodialysis patients and its relation to the severity of pruritus using visual analog score. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pruritus is a common and often distressing symptom in patients with chronic kidney disease. Though the pathogenesis of uremic pruritus remains poorly understood, systemic inflammation has presented itself as one of the possible explanations. High blood lead levels (BLLs) have been noted to be associated with inflammation and poor nutritional status in hemodialysis patients. Our aim is to study the relation between blood lead levels and uremic pruritus. This is a cross-sectional study that enrolled 50 patients; all were on regular hemodialysis 3 times per week for at least 6 months. Patients were divided into 2 groups, group 1 (n =10) with no pruritus and group 2 (n=40) with varying degrees of pruritus. Group 2 was further divided according to intensity of pruritus by visual analog score (VAS) into mild (n=10), moderate (n=20), and severe pruritus (n=10).
Results
There was a significant difference in serum lead levels and ferritin levels between groups 1 and 2 (p value < 0.01 and < 0.05, respectively). There was a statistically significant difference in serum lead levels in the groups with varying intensity of pruritus, having higher serum lead levels in patients who exhibited severe pruritus (p value < 0.005) Moreover, a statistically significant relation between elevated blood lead levels and the duration of dialysis was observed in this study.
Conclusion
Uremic pruritus is a multi-factorial phenomenon, and our study showed that blood lead levels in hemodialysis patients might be associated with increased intensity of pruritus.
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Wang M, Bao T, Yan W, Fang D, Yu Y, Liu Z, Yin G, Wan M, Mao C, Shi D. Nanomotor-based adsorbent for blood Lead(II) removal in vitro and in pig models. Bioact Mater 2020; 6:1140-1149. [PMID: 33134607 PMCID: PMC7588752 DOI: 10.1016/j.bioactmat.2020.09.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 12/24/2022] Open
Abstract
Blood lead (Pb(II)) removal is very important but challenging. The main difficulty of blood Pb(II) removal currently lies in the fact that blood Pb(II) is mainly complexed with hemoglobin (Hb) inside the red blood cells (RBCs). Traditional blood Pb(II) removers are mostly passive particles that do not have the motion ability, thus the efficiency of the contact between the adsorbent and the Pb(II)-contaminated Hb is relatively low. Herein, a kind of magnetic nanomotor adsorbent with movement ability under alternating magnetic field based on Fe3O4 nanoparticle modified with meso-2, 3-dimercaptosuccinic acid (DMSA) was prepared and a blood Pb(II) removal strategy was further proposed. During the removal process, the nanomotor adsorbent can enter the RBCs, then the contact probability between the nanomotor adsorbent and the Pb(II)-contaminated Hb can be increased by the active movement of nanomotor. Through the strong coordination of functional groups in DMSA, the nanomotor adsorbent can adsorb Pb(II), and finally be separated from blood by permanent magnetic field. The in vivo extracorporeal blood circulation experiment verifies the ability of the adsorbent to remove blood Pb(II) in pig models, which may provide innovative ideas for blood heavy metal removal in the future.
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Affiliation(s)
- Meng Wang
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, 210023, PR China
| | - Tianyi Bao
- Department of Orthopaedics the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, PR China
| | - Wenqiang Yan
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, PR China
| | - Dan Fang
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, 210023, PR China
| | - Yueqi Yu
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, 210023, PR China
| | - Zhiyong Liu
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, 210023, PR China
| | - Guoyong Yin
- Department of Orthopaedics the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, PR China
| | - Mimi Wan
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, 210023, PR China
- Corresponding author.
| | - Chun Mao
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing, 210023, PR China
- Corresponding author.
| | - Dongquan Shi
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, PR China
- Corresponding author.
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3
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Brown L, Lynch M, Belova A, Klein R, Chiger A. Developing a Health Impact Model for Adult Lead Exposure and Cardiovascular Disease Mortality. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:97005. [PMID: 32965128 PMCID: PMC7510336 DOI: 10.1289/ehp6552] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Lead (Pb) is a highly toxic pollutant. Evidence suggests it is associated with cardiovascular disease (CVD)-related mortality. OBJECTIVES We present a rigorous approach for identifying concentration-response functions that relate adult Pb exposures to CVD mortality to inform a health impact model (HIM). We then use the model in a proof-of-concept example. METHODS Building on previously conducted government literature reviews and a de novo supplemental literature review, we compiled and evaluated the available data on Pb and CVD mortality in humans. We applied a set of predefined selection criteria to identify studies that would be most useful in understanding the impact of Pb exposure on CVD mortality risk in adults. Once we identified the studies, we derived a HIM and used each study's concentration-response function in a proof-of-concept example. RESULTS Our literature search identified 15 studies for full-text review. Of those 15 studies, 4 fit our criteria for use in the HIM. Using population and CVD mortality rates for 40- to 80-y-olds in 2014, we estimated that 34,000-99,000 deaths have been avoided due to the lowering of blood Pb levels from 1999 to 2014. Based on these values we estimated that approximately 16%-46% of the decreased CVD-related death rate from 1999 to 2014 may be attributable to decreased blood Pb levels. CONCLUSION Our results demonstrate that decreases in Pb exposure can result in large benefits for the adult population. We have provided a HIM that can be used in a variety of applications from burden-of-disease estimates to regulatory impact assessments and have demonstrated its sensitivity to the choice of concentration-response function. https://doi.org/10.1289/EHP6552.
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Affiliation(s)
- Lauren Brown
- Division of Health and Environment, Abt Associates Inc., Rockville, Maryland, USA
| | - Meghan Lynch
- Division of Health and Environment, Abt Associates Inc., Rockville, Maryland, USA
| | - Anna Belova
- Abt Associates Inc., Rockville, Maryland, USA
| | - Ryan Klein
- Division of Health and Environment, Abt Associates Inc., Rockville, Maryland, USA
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4
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Huang WH, Hu CC, Yen TH, Hsu CW, Weng CH. Blood lead level: an overlooked risk of carpal tunnel syndrome in hemodialysis patients. Ren Fail 2020; 41:786-793. [PMID: 31498017 PMCID: PMC6746292 DOI: 10.1080/0886022x.2019.1657894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Carpal tunnel syndrome (CTS) is a severe complication observed in long-term maintenance hemodialysis (MHD) patients. The most common cause of CTS is dialysis-related β2-microglobulin amyloidosis, which is associated with inflammation and oxidative stress in dialysis patients. Patients on MHD have higher blood lead levels (BLLs) than the general population. Lead (Pb) exposure in chronic dialysis patients has been noted to induce oxidative stress and inflammation. Therefore, lead-related inflammation and oxidative stress might contribute to CTS. Methods: The medical records of 866 MHD patients were reviewed. Two hundred and thirty-four patients with symptoms of CTS were surveyed by senior neurologists via physical examinations and nerve conduction studies. Patients in this study were stratified into groups with low-normal (<10 μg/dL), high-normal (10 to 20 μg/dL), and abnormal (>20 μg/dL) BLLs. The associations between CTS and BLLs and the clinical data were analyzed. Results: Multivariate logistic regression analyses showed that Log BLL (OR: 54.810, 95% CI: 13.622-220.54, p < .001), high-normal BLLs (OR: 4.839, 95% CI: 2.262-10.351, p < .001) with low-normal BLL as a reference, high BLLs (OR: 12.952, 95% CI: 5.391-31.119, p < .001) with low-normal BLL as a reference, and a BLL >12.3 μg/dL (OR: 6.827, 95% CI: 3.737-12.472, p < .001) were positively associated with CTS according to three different analyses. Discussion: In conclusion, blood lead levels were positively associated with CTS in patients on MHD. Dialysis patients should pay more attention to their environmental exposure to Pb. Avoidance of environmental Pb may reduce the incidence of CTS in MHD patients. Future studies will address the role of Pb in the pathophysiology of CTS in this patient population.
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Affiliation(s)
- Wen-Hung Huang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Clinical Poison Center, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Chang Gung University College of Medicine , Taoyuan , Taiwan
| | - Ching-Chih Hu
- Chang Gung University College of Medicine , Taoyuan , Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University , Taoyuan , Taiwan.,Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Tzung-Hai Yen
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Clinical Poison Center, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Chang Gung University College of Medicine , Taoyuan , Taiwan
| | - Ching-Wei Hsu
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Clinical Poison Center, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Chang Gung University College of Medicine , Taoyuan , Taiwan
| | - Cheng-Hao Weng
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Clinical Poison Center, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,Chang Gung University College of Medicine , Taoyuan , Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University , Taoyuan , Taiwan
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5
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Dolan LC, Flannery BM, Hoffman-Pennesi D, Gavelek A, Jones OE, Kanwal R, Wolpert B, Gensheimer K, Dennis S, Fitzpatrick S. A review of the evidence to support interim reference level for dietary lead exposure in adults. Regul Toxicol Pharmacol 2020; 111:104579. [PMID: 31945454 DOI: 10.1016/j.yrtph.2020.104579] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/13/2022]
Abstract
FDA developed the interim reference level (IRL) for lead of 3 μg/day in children and 12.5 μg/day in women of childbearing age (WOCBA) to better protect the fetus from lead toxicity. These IRLs correspond to a blood lead level (BLL) of 0.5 μg/dL in both populations. The current investigation was performed to determine if the IRL for WOCBA should apply to the general population of adults. A literature review of epidemiological studies was conducted to determine whether a BLL of 0.5 μg/dL is associated with adverse effects in adults. Some studies reported adverse effects over a wide range of BLLs that included 0.5 μg/dL adding uncertainty to conclusions about effects at 0.5 μg/dL; however, no studies clearly identified this BLL as an adverse effect level. Results also showed that the previously developed PTTDI for adults of 75 μg/day lead may not be health protective, supporting use of a lower reference value for lead toxicity in this population group. Use of the 12.5 μg/day IRL as a benchmark for dietary lead intake is one way FDA will ensure that dietary lead intake in adults is reduced.
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Affiliation(s)
- Laurie C Dolan
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Brenna M Flannery
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA.
| | - Dana Hoffman-Pennesi
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Alexandra Gavelek
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Olivia E Jones
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Richard Kanwal
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Beverly Wolpert
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Kathleen Gensheimer
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Sherri Dennis
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Suzanne Fitzpatrick
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
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6
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Tonelli M, Wiebe N, Bello A, Field CJ, Gill JS, Hemmelgarn BR, Holmes DT, Jindal K, Klarenbach SW, Manns BJ, Thadhani R, Kinniburgh D. Concentrations of Trace Elements and Clinical Outcomes in Hemodialysis Patients: A Prospective Cohort Study. Clin J Am Soc Nephrol 2018; 13:907-915. [PMID: 29599300 PMCID: PMC5989679 DOI: 10.2215/cjn.11451017] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/05/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Deficiency of essential trace elements and excess of potentially toxic trace elements are common in patients on hemodialysis. Whether these abnormalities are associated with poor outcomes is unknown but worth investigating, because they are potentially treatable. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We did a prospective longitudinal study of 1278 patients on incident hemodialysis, assessing blood concentrations of 25 trace elements at baseline. We used adjusted logistic regression to evaluate the association between trace element status and four outcomes (death, cardiovascular events, systemic infection, and hospitalization). A priori hypotheses concerned (1) deficiency of zinc, selenium, and manganese and (2) excess of lead, arsenic, and mercury. Concentrations of the other 19 elements were tested in hypothesis-generating analyses. RESULTS Over 2 years of follow-up, 260 (20%) patients died, 285 (24%) experienced a cardiovascular event, 117 (10%) were hospitalized for systemic infection, and 928 (77%) were hospitalized for any cause. Lower concentrations of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not independently associated with higher risk of clinical outcomes. Lower concentrations of selenium were strongly and independently associated with death (odds ratio, 0.86 per decile; 99.2% confidence interval, 0.80 to 0.93) and all-cause hospitalization (odds ratio, 0.92 per decile; 99.2% confidence interval, 0.86 to 0.98). In exploratory analyses, higher copper concentrations were significantly associated with higher risk of death (odds ratio, 1.07 per decile; 99.2% confidence interval, 1.00 to 1.15), and cadmium levels in the highest decile were associated with higher risk of death (odds ratio, 1.89; 99.2% confidence interval, 1.06 to 3.38). CONCLUSIONS Lower levels of zinc or manganese and higher concentrations of lead, arsenic, or mercury were not associated with higher risk of clinical outcomes, but lower concentrations of selenium were strongly and independently associated with the risks of death and hospitalization.
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Affiliation(s)
| | | | | | - Catherine J. Field
- Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | | | | | - Daniel T. Holmes
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; and
| | | | | | | | - Ravi Thadhani
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - David Kinniburgh
- Physiology and Pharmacology, University of Calgary, Calgary, Canada
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7
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Weng CH, Hsu CW, Hu CC, Yen TH, Chan MJ, Huang WH. Blood lead level is a positive predictor of uremic pruritus in patients undergoing hemodialysis. Ther Clin Risk Manag 2017; 13:717-723. [PMID: 28652758 PMCID: PMC5476754 DOI: 10.2147/tcrm.s135470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although uremic pruritus (UP) is a common and annoying symptom for end-stage renal disease patients on hemodialysis (HD) and peritoneal dialysis, its pathogenesis is poorly understood. However, systemic inflammation is one of the possible pathogenesis of UP, and blood lead level (BLL) has been noted to be associated with inflammation and nutritional status in long-term HD patients. There might be an interaction or association, therefore, between BLL and UP through systemic inflammation. We analyzed cross-sectional data among 866 participants. All of the 866 patients in this study were stratified into groups with low-normal (<10 μg/dL), high-normal (10-20 μg/dL), and abnormal BLLs (>20 μg/dL). The associations between UP and BLL and the clinical data were analyzed. Multivariate logistic regression demonstrated that HD duration, non-anuria, log ferritin, serum low-density lipoprotein, log BLL, high-normal BLL, and high BLL were associated with UP. In conclusion, BLL was positively associated with UP.
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Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ching-Chih Hu
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan.,Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ming-Jen Chan
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
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8
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Chen CY, Liu MH, Hsu CW, Weng CH, Yen TH, Huang WH. Positive correlation between environmental PM 2.5 and blood lead levels in patients undergoing maintenance hemodialysis. Ther Clin Risk Manag 2017; 13:555-564. [PMID: 28479856 PMCID: PMC5411403 DOI: 10.2147/tcrm.s131565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients undergoing hemodialysis (HD) have significantly higher mean blood lead levels (BLLs) than those in healthy individuals. Because elementary lead can be found in particulate matter with a diameter of <2.5 μm (PM2.5), this cross-sectional study was conducted to assess the effect of environmental PM2.5 exposure and other clinical variables on BLLs in patients receiving HD. We recruited 921 patients on maintenance HD (MHD) who had undergone HD for at least 6 months and who had previously participated in a BLL study. Mean PM2.5 concentrations in living environments in the previous 12 and 24 months were analyzed using a blood lead test. From a multivariate analysis, after adjustment for related factors, the mean PM2.5 concentrations in the previous 12 and 24 months were positively associated with log BLLs. In addition, days with PM2.5 levels exceeding the standard level during the previous 12 and 24 months were positively associated with log BLLs. Patients exposed to higher PM2.5 concentrations and more days with PM2.5 levels exceeding the standard level exhibited a higher prevalence of high and high-normal BLLs and a lower prevalence of low-normal BLLs. After adjustment for related variables, the BLLs exhibited a significantly positive association with environmental PM2.5 in patients undergoing MHD.
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Affiliation(s)
- Chao-Yu Chen
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Ming-Hui Liu
- Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
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9
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Negative Relationship between Erythropoietin Dose and Blood Lead Level in Patients Undergoing Maintenance Hemodialysis. Sci Rep 2016; 6:34313. [PMID: 27680289 PMCID: PMC5041155 DOI: 10.1038/srep34313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022] Open
Abstract
The adverse effects of increased blood lead levels have been well discussed. Several antioxidant agents have been reported to offer protection from lead toxicity and to reduce blood lead levels (BLL). Given that erythropoietin (EPO) also has antioxidant properties, the aim of this cross-sectional study was to assess the role of EPO and other clinical variables on BLL in hemodialysis (HD) patients. We recruited 931 maintenance hemodialysis (MHD) patients who had undergone HD for at least 6 months and who had ever received blood lead level (BLL) study. Use of erythropoiesis-stimulating agents followed the The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) Clinical Practice Guideline. We estimated demographic, hematological, nutritional, inflammatory, biochemical, and dialysis-related data based on this study. In the group with EPO, 7% had high BLL. In the group without EPO, 22% had high BLL. From the stepwise liner regression, urban areas, hemodialysis duration, and clearance of urea (KT/Vurea) were positively associated with log BLL. In contrast, diabetes (DM), and monthly EPO dose were negatively associated with log BLL. This study showed that EPO dose might be negatively associated with blood lead levels in patients on maintenance hemodialysis.
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10
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Mortada WI, Nabieh KA, Donia AF, Ismail AM, Kenawy IMM. Impact of dialyzer membrane flux on metal clearance in hemodialysis patients. J Trace Elem Med Biol 2016; 36:52-6. [PMID: 27259352 DOI: 10.1016/j.jtemb.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/16/2022]
Abstract
Deficiency of essential trace elements (such as Cu or Zn) and accumulation of potentially toxic trace elements (as Cd or Pb) are both known to have adverse effects in hemodialysis (HD) patients. Up to our knowledge, no studies about the permeability of low and high flux polysulfone membranes on metal ions during hemodialysis are available. Therefore, the aim of the present study was to address this issue. Forty one hemodialysis patients (19 were using high flux polysulfone membrane while the remaining were using low flux one) participated in the study. Blood levels of Cu, Zn, Cd and Pb were determined by graphite furnace atomic absorption spectrometry among HD patients, before and after dialysis session, as well as among matched 40 healthy persons. Blood concentrations of Cu and Zn in the whole hemodialysis group was significantly lower than those of the healthy control group, on the other hand the toxic metals (Cd and Pb) levels were observed to be significantly higher among HD patients compared to the normal persons. Among the hemodialysis group, there were no significant differences between the low and high flux dialyzer groups in terms of pre-dialysis blood levels of Cu, Zn, Cd and Pb. In addition, significantly decreased levels of all metal ions were observed after dialysis sessions using either low or high flux membranes. An exception was Pb which did not show any difference between pre-dialysis and post-dialysis values in the low flux groupIn conclusion Zn and Cu deficiencies should be considered in the treatment of these patients. High flux membranes are more efficient than low flux ones in removing excess Cd and Pb. Therefore, when high flux membranes are used, chelation therapy might not be required for Cd and Pb overload.
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Affiliation(s)
- Wael I Mortada
- Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt.
| | - Kareem A Nabieh
- Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed F Donia
- Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Amani M Ismail
- Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Ibrahim M M Kenawy
- Chemistry Department, Faculty of Science, Mansoura University, Mansoura 35516, Egypt
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11
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Gómez de Oña C, Martínez-Morillo E, Gago González E, Vidau Argüelles P, Fernández Merayo C, Álvarez Menéndez FV. Variation of trace element concentrations in patients undergoing hemodialysis in the north of Spain. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:492-9. [PMID: 27362816 DOI: 10.1080/00365513.2016.1201852] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Trace elements are essential substances for the proper physiological and biochemical functioning of the organism. Hemodialysis patients are potentially at risk of deficiency or excess of these elements. The application of inductively coupled plasma mass spectrometry (ICP-MS) allows the simultaneous quantification of very small amounts of multiple trace elements. The aim was to measure the serum concentration of copper (Cu), zinc (Zn), selenium (Se), and nickel (Ni), and the whole blood concentration of arsenic (As), lead (Pb), and manganese (Mn), in patients undergoing hemodialysis as well as in controls. METHODS The study was carried out in 57 hemodialysis patients compared with 57 controls with normal renal function. Serum and whole blood samples from the dialysis group were collected before and after hemodialysis sessions and Cu, Zn, Se, Ni, As, Pb and Mn levels were determined using ICP-MS. RESULTS Hemodialysis patients showed significantly lower blood levels of Cu, Zn and Se than controls (p < 0.001) and higher concentrations of Ni, As and Pb (p < 0.0001). The levels of Mn were similar in both groups. After performing hemodialysis, Cu, Zn, Se and Ni concentrations were significantly higher than the pre-hemodialysis levels (p < 0.0001). However, the concentration of As decreased (p < 0.0001) and Pb and Mn levels were not significantly altered after the dialysis session. CONCLUSION Hemodialysis patients are at increased risk of trace elements deficiency (especially for Zn and Se) or excess (Ni) in respect to healthy subjects. Monitoring of blood levels and supplementation of some trace elements may be indicated in patients undergoing hemodialysis.
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Affiliation(s)
- Constanza Gómez de Oña
- a Department of Clinical Biochemistry, Laboratory of Medicine, Trace Elements Laboratory , Hospital Universitario Central De Asturias , Oviedo , Spain
| | - Eduardo Martínez-Morillo
- a Department of Clinical Biochemistry, Laboratory of Medicine, Trace Elements Laboratory , Hospital Universitario Central De Asturias , Oviedo , Spain
| | - Emilio Gago González
- b Hemodialysis Unit, Clinical Management Area of Nephrology , Hospital Universitario Central De Asturias , Oviedo , Spain
| | - Pedro Vidau Argüelles
- b Hemodialysis Unit, Clinical Management Area of Nephrology , Hospital Universitario Central De Asturias , Oviedo , Spain
| | - Carmen Fernández Merayo
- b Hemodialysis Unit, Clinical Management Area of Nephrology , Hospital Universitario Central De Asturias , Oviedo , Spain
| | - Francisco V Álvarez Menéndez
- a Department of Clinical Biochemistry, Laboratory of Medicine, Trace Elements Laboratory , Hospital Universitario Central De Asturias , Oviedo , Spain
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Hsu CW, Yen TH, Chen KH, Lin-Tan DT, Lin JL, Weng CH, Huang WH. Effect of Blood Cadmium Level on Mortality in Patients Undergoing Maintenance Hemodialysis. Medicine (Baltimore) 2015; 94:e1755. [PMID: 26496294 PMCID: PMC4620787 DOI: 10.1097/md.0000000000001755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Previous studies of general populations indicated environmental exposure to low-level cadmium increases mortality. However, the effect of cadmium exposure on maintenance hemodialysis (MHD) patients is unclear.A total of 937 MHD patients from 3 centers in Taiwan were enrolled in this 36-month observational study. Patients were stratified by baseline blood cadmium level (BCL) into 3 groups: high BCL (>0.521 μg/L; n = 312), intermediate BCL (0.286-0.521 μg/L; n = 313), and low BCL (<0.286 μg/L; n = 312). The mortality rates and causes of death were analyzed.The analytic results demonstrated patients in the high BCL group had a significantly higher prevalence of malnutrition and inflammation than patients in the low and intermediate BCL groups. After 3 years of follow-up, 164 (17.5%) patients died and the major cause of death was cardiovascular disease. A Cox multivariate analysis indicated the high BCL group had increased hazard ratios (HRs) for all-cause mortality (HR = 1.72; 95% confidence interval [CI]: 1.14-2.63; P = 0.018), cardiovascular-related mortality (HR = 1.85; 95% CI: 1.09-3.23; P = 0.032), and infection-related mortality (HR = 2.27; 95% CI: 1.12-4.55; P = 0.035). A Cox multivariate analysis of MHD patients who never smoked (n = 767) indicated the high BCL group had increased HRs for all-cause mortality (HR = 1.67; 95% CI: 1.04-2.63; P = 0.048) and cardiovascular-related mortality (HR = 2.08; 95% CI: 1.08-4.00; P = 0.044).In conclusion, BCL is an important determinant of mortality in MHD patients. Therefore, MHD patients should avoid cadmium exposure as much as possible, such as tobacco smoking and eating cadmium-containing foods.
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Affiliation(s)
- Ching-Wei Hsu
- From the Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei (CWH, THY, KHC, DTLT, JLL, CHW, WHH); Department of Nephrology and Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan (CWH, THY, KHC, DTLT, JLL, CHW, WHH); and Chang Gung University and School of Medicine, Taipei, Taiwan, ROC (CWH, THY, KHC, DTLT, JLL, CHW, WHH)
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Oral tori in chronic hemodialysis patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:897674. [PMID: 25918724 PMCID: PMC4396140 DOI: 10.1155/2015/897674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 03/16/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study investigated the epidemiology of torus palatinus (TP) and torus mandibularis (TM) in hemodialysis patients and analyzed the influences of hyperparathyroidism on the formation of oral tori. METHOD During 2013, 119 hemodialysis patients were recruited for dental examinations for this study. RESULTS The prevalence of oral tori in our sample group was high at 33.6% (40 of 119). The most common location of tori was TP (70.0%), followed by TM (20.0%), and then both TP and TM (10.0%). Of the 40 tori cases, most (67.5%) were <2 cm in size; moreover, the majority (52.5%) were flat in shape. In symmetry, most (70.0%) occurred in the midline, followed by bilateral sides (20.0%). Notably, the levels of intact parathyroid hormone did not differ in patients with or without tori (P = 0.611). Furthermore, patients with tori did not differ from patients without tori in inflammatory variables such as log high-sensitivity C-reactive protein (P = 1.000) or nutritional variables such as albumin (P = 0.247). Finally, there were no differences between patients with and without tori in adequacy of dialysis (P = 0.577). CONCLUSIONS Neither hyperparathyroidism nor inflammation malnutrition syndrome was found to contribute to the formation of oral tori in chronic hemodialysis patients. Further studies are warranted.
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Huang WH, Lin JL, Lin-Tan DT, Chen KH, Hsu CW, Yen TH. Education level is associated with mortality in male patients undergoing maintenance hemodialysis. Blood Purif 2013; 35:316-26. [PMID: 23920269 DOI: 10.1159/000351613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies of the correlation between education levels and mortality in hemodialysis (HD) patients are rare. The aim of this multi-center study was to investigate the relationship between education levels and 3-year mortality rates in HD patients. METHODS A total of 935 HD patients from 3 HD centers participated in this 3-year prospective observational study. Education levels were categorized as either less than senior high school and above or equal to senior high school. The causes of death and mortality rates were also analyzed for each subgroup. RESULTS At the end of the 3-year follow-up period, 164 patients had died. In the male group, forward stepwise Cox regression analysis revealed that age, HD duration, hypertension, creatinine level, serum albumin level ≥3.6 g/dl, anuria, Kt/Vurea, and high education level were significant predictive factors for 3-year mortality rates. CONCLUSION This prospective observational study demonstrated that education level was associated with mortality in men undergoing HD.
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Affiliation(s)
- Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei and Lin-Kou Medical Center, Taoyuan, and Chang Gung University and School of Medicine, Taipei, Taiwan, ROC
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Filler G, Roach E, Yasin A, Sharma AP, Blake PG, Yang L. High prevalence of elevated lead levels in pediatric dialysis patients. Pediatr Nephrol 2012; 27:1551-6. [PMID: 22527529 DOI: 10.1007/s00467-012-2150-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 02/24/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND After parents raised concerns about potential lead (Pb) contamination of calcium carbonate for treatment of hyperphosphatemia in chronic kidney disease (CKD), we measured blood Pb using high-resolution sector field inductively coupled mass spectrometry in a quality-assurance investigation of ten pediatric dialysis patients (nine on hemodialysis) and six patients before dialysis. METHODS We assessed the kidney function as cystatin C estimated glomerular filtration rate (eGFR), blood Pb levels, calcium carbonate dose, and standard laboratory parameters, as well as Pb levels in the dialysis feed water. RESULTS Mean blood Pb concentration in the 16 pediatric CKD patients was 21.1 ± 15.8 µg/l with a maximum of 58 µg/l, which was significantly higher than that of 467 apparently healthy controls (median 6.35 µg/l, interquartile range 4.47, 8.71) and comparable to that of ten adult peritoneal dialysis (PD) patients. Lead levels correlated with red blood cell distribution width, eGFR, and calcium carbonate dose. Pb in dialysate feed water was always <0.00018 mg/l, which is below the accepted limit for water for dialysis of 0.005 mg/l. CONCLUSIONS We found a high prevalence of elevated Pb levels in pediatric CKD patients that correlated with the calcium carbonate dose and GFR. Lead levels should be monitored in these patients.
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Affiliation(s)
- Guido Filler
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, ON, Canada.
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Pouresmaeil R, Razeghi E, Ahmadi F. Correlation of serum lead levels with inflammation, nutritional status, and clinical complications in hemodialysis patients. Ren Fail 2012; 34:1114-7. [PMID: 22889119 DOI: 10.3109/0886022x.2012.713281] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The aim of this study was to determine blood lead level (BLL) in hemodialysis (HD) patients and their relation with high-sensitivity C-reactive protein (hsCRP) and albumin which are inflammatory and nutritional biomarkers, respectively, and clinical complications. A total of 93 patients, who were dialyzed at least for 3 months, were included in the study. Blood samples were collected before HD and BLL was measured and categorized as three equal groups: low normal (BLL < 8 μg/dL), middle normal (BLL = 8-10.6 μg/dL), and high normal (BLL > 10.6 μg/dL). All patients had normal BLL, 9.7 ± 3.4 g/dL. Patients with abnormal hsCRP level (>3 mg/L) had higher BLL than other patients (16.4 ± 0.8 vs. 11.5 ± 2.7 mg/L, p = 0.003). Patients with BLL > 10.6 μg/dL had significantly lower hemoglobin, ferritin, iron, and albumin levels and higher hsCRP and intact parathyroid hormone (iPTH) levels than the patients with BLL < 8 μg/dL. In addition, BLL revealed a significant positive correlation with duration of dialysis. We concluded that BLL associated to inflammation, malnutritional status, iron-deficiency condition, and high iPTH level in HD patients.
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Affiliation(s)
- Rahmat Pouresmaeil
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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