Cross-sectional audit of blood lead levels in regular outpatient haemodialysis patients dialysing in north London.
OBJECTIVE
Blood lead was measured and found to be high in one haemodialysis patient with atypical abdominal pain and peripheral neuropathy. This prompted an audit of blood lead concentrations in prevalent haemodialysis patients under the care of a University Teaching hospital.


METHODS
Blood lead was determined in 271 prevalent adult haemodialysis patients regularly dialysing three times a week, in five dialysis centres and/or on the home dialysis programme. All samples were carefully collected into lead-free plastic containers, and measured by graphite furnace atomic absorption spectrometry.


RESULTS
25.5% of haemodialysis patients had abnormal blood lead concentrations (>200 microg/L), compared with 59% with high-normal values of 100-200 microg/L, and only 15.5% with normal values (<100 microg/L). Blood lead increased with haemodialysis vintage (r = 0.38, P < 0.001), the use of a single carbon filter and reverse osmosis water purification device unit (r = 0.29, P < 0.001), but reduced by urine output (r = -0.44, P < 0.001).


CONCLUSIONS
Despite UK government legislation to reduce permissible lead contamination of drinking water, blood lead was increased in 84.5% of prevalent haemodialysis patients. Single reverse osmosis machines and carbon filters may not be as effective at filtering out possible lead contamination compared with large industrial reverse osmosis devices and carbon filters, and thus blood lead testing should be considered for home haemodialysis patients, particularly in those areas where monochloramines are used to sterilize domestic water supplies.
Davenport
Andrew
A
UCL Center for Nephrology, Royal Free and University College Medical School, London, UK. andrew.davenport@royalfree.nhs.uk
Murcutt
Gareth
G
Whiting
Stephen
S
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005374:Filtration; D006801:Humans; D007854:Lead / Q000032:analysis / Q000097:blood*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D006435:Renal Dialysis; D006113:United Kingdom; D014874:Water Pollutants, Chemical / Q000032:analysis; D014881:Water Supply / Q000032:analysis
D014874:Water Pollutants, Chemical; D007854:Lead