title: Blood lead levels, malnutrition, inflammation, and mortality in patients with diabetes treated by long-term hemodialysis.
abstract: BACKGROUND
  Blood lead levels (BLLs) are associated with mortality in the general population. The clinical significance of BLLs in long-term hemodialysis (HD) patients with diabetes is unknown.
  
  
  METHODS
  A cross-sectional and 1-year prospective study.
  
  
  METHODS
  211 patients with diabetes on long-term HD therapy at 3 centers.
  
  
  METHODS
  BLLs measured before HD at baseline, categorized as abnormal (>20 microg/dL), high normal (10 to 20 microg/dL), and low normal (<10 microg/dL).
  
  
  METHODS
  Malnutrition, defined as serum albumin level less than 3.6 g/dL, and inflammation, defined as high-sensitivity C-reactive protein level greater than 3 mg/dL, for cross-sectional analyses. Mortality and cause of death for longitudinal analyses.
  
  
  RESULTS
  34, 112, and 65 patients had abnormal, high-normal, and low-normal BLLs at baseline. At baseline, patients with abnormal BLLs had a greater proportion of malnutrition (14.7% versus 1.5% and 11.6%; P = 0.01) and inflammation (76.5% versus 52.3% and 50.9%; P = 0.01) than those with low- and high-normal BLLs. Backward stepwise regression analysis found that high-sensitivity C-reactive protein level correlated positively and albumin level correlated negatively with BLLs after other confounders were adjusted. At the end of follow-up, 16 patients had died. Kaplan-Meier analysis showed that patients with an abnormal BLL had greater mortality than those with low and low-normal BLLs (P = 0.004).
  
  
  CONCLUSIONS
  Small sample size, sparse outcomes, and limited follow-up.
  
  
  CONCLUSIONS
  BLL may contribute to inflammation and nutritional status in long-term HD patients with diabetes on long-term HD therapy and may relate to 1-year mortality in these patients.
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC. jllin99@hotmail.com
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: Chang-Chyi
authors.initials: CC
authors.lastname: Jenq
authors.forename: Kuan-Hsing
authors.initials: KH
authors.lastname: Chen
authors.forename: Kuang-Hung
authors.initials: KH
authors.lastname: Hsu
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000453:epidemiology / Q000401:mortality; D007854:Lead / Q000097:blood*; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000639:trends*; D013995:Time
chemical_list: D007854:Lead