title: Association of blood lead levels with mortality in patients on maintenance hemodialysis.
abstract: BACKGROUND
  The association between blood lead levels and mortality in patients on maintenance hemodialysis remains unclear.
  
  
  METHODS
  A cross-sectional and 18-month prospective study included 927 patients on maintenance hemodialysis. Baseline variables and blood lead levels were measured before hemodialysis and categorized as 3 equal groups: high (>12.64 μg/dL), middle (8.51-12.64 μg/dL), and low (<8.51 μg/dL). Mortality and cause of death were recoded for longitudinal analyses.
  
  
  RESULTS
  At baseline, after related variables were adjusted, logarithmic transformation of blood lead level was negatively related to log ferritin and positively related to the vintage of hemodialysis and the percentage of urban area patients. By the end of the follow-up, 59 patients had died. Kaplan-Meier survival analysis showed that the high blood lead level group had greater mortality than the low blood lead level group (log-rank test, P<.001). After adjustment for potential variables, Cox multivariate analysis demonstrated that by using the low blood lead level as the reference, high blood lead levels were associated with increased hazard ratios (HRs) for all-cause (HR 4.70; 95% confidence interval [CI], 1.92-11.49; P=.003), cardiovascular-cause (HR 9.71; 95% CI, 2.11-23.26; P=.005), and infection-cause (HR 5.35; 95% CI, 1.38-20.83; P=.046) 18-month mortality in patients on maintenance hemodialysis. Moreover, there was a significant trend (P=.032) of HRs for all-cause mortality among the 3 study groups.
  
  
  CONCLUSIONS
  High blood lead level is associated with increased HRs for all-cause, cardiovascular-cause, and infection-cause 18-month mortality in patients on maintenance hemodialysis.
authors: Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Republic of China. jllin99@hotmail.com
authors: Ja-Liang
authors: JL
authors: Lin
authors: Dan-Tzu
authors: DT
authors: Lin-Tan
authors: Ching-Wei
authors: CW
authors: Hsu
authors: Tzung-Hai
authors: TH
authors: Yen
authors: Kuan-Hsing
authors: KH
authors: Chen
authors: Hsiang-Hao
authors: HH
authors: Hsu
authors: Tai-Chin
authors: TC
authors: Ho
authors: Kuang-Hong
authors: KH
authors: Hsu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000378:metabolism; D006801:Humans; D007854:Lead / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D007854:Lead; D005293:Ferritins