title: Environmental lead exposure accelerates progressive diabetic nephropathy in type II diabetic patients.
abstract: Whether environmental lead exposure has a long-term effect on progressive diabetic nephropathy in type II diabetic patients remains unclear. A total of 107 type II diabetic patients with stage 3 diabetic nephropathy (estimated glomerular filtration rate (eGFR) range, 30-60 mL/min/1.73 m(2)) with normal body lead burden (BLB) (<600  μ g/72 hr in EDTA mobilization tests) and no history of exposure to lead were prospectively followed for 2 years. Patients were divided into high-normal BLB (>80  μ g) and low-normal BLB (<80  μ g) groups. The primary outcome was a 2-fold increase in the initial creatinine levels, long-term dialysis, or death. The secondary outcome was a change in eGFR over time. Forty-five patients reached the primary outcome within 2 years. Although there were no differences in baseline data and renal function, progressive nephropathy was slower in the low-normal BLB group than that in the high-normal BLB group. During the study period, we demonstrated that each 100  μ g increment in BLB and each 10  μ g increment in blood lead levels could decrease GFR by 2.2 mL/min/1.72 m(2) and 3.0 mL/min/1.72 m(2) (P = 0.005), respectively, as estimated by generalized equations. Moreover, BLB was associated with increased risk of achieving primary outcome. Environmental exposure to lead may have a long-term effect on progressive diabetic nephropathy in type II diabetic patients.
authors.affiliation: Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University and School of Medicine, 199 Tung-Hwa North Road, Taipei 10548, Taiwan.
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: Kuan-Hsing
authors.initials: KH
authors.lastname: Chen
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
mesh_terms: D000328:Adult; D000368:Aged; D001822:Body Burden; D048909:Diabetes Complications / Q000097:blood / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D003928:Diabetic Nephropathies / Q000097:blood* / Q000139:chemically induced / Q000150:complications / Q000473:pathology; D004781:Environmental Exposure; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications; D007854:Lead / Q000097:blood / Q000633:toxicity*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
chemical_list: D007854:Lead
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