title: Association of blood lead and mercury with estimated GFR in herbalists after the ban of herbs containing aristolochic acids in Taiwan.
abstract: OBJECTIVE
  This study was undertaken to explore the association of estimated glomerular filtration rate (GFR) with exposure to aristolochic acids (ALAs) and nephrotoxic metals in herbalists after the ban of herbs containing ALAs in Taiwan.
  
  
  METHODS
  This cross-sectional study recruited a total of 138 herbalists without end-stage renal disease or urothelial carcinoma from the Occupational Union of Chinese Herbalists in Taiwan in 2007. Aristolochic acid I (ALA-I) was measured by ultra-high-pressure liquid chromatography/ tandem mass spectrometry (UHPLC-MS/MS) and heavy metals in blood samples were analysed by Agilent 7500C inductively coupled plasma-mass spectrometry. Renal function was assessed by using a simplified Modification of Diet in Renal Disease Study equation to estimate GFR.
  
  
  RESULTS
  Blood lead was higher in herbal dispensing procedures (p=0.053) and in subjects who self-prescribe herbal medicine (p=0.057); mercury was also higher in subjects living in the workplace (p=0.03). Lower estimated GFR was significantly associated with lead (β=-10.66, 95% CI -18.7 to -2.6) and mercury (β=-12.52, 95% CI -24.3 to -0.8) with a significant interaction (p=0.01) between mercury and lead; however, estimated GFR was not significantly associated with high ALA-I level groups, arsenic and cadmium after adjusting for other confounding factors.
  
  
  CONCLUSIONS
  We found that lower estimated GFR was associated with blood lead and mercury in herbalists after the ban of herbs containing ALAs in Taiwan. The ALA-I exposure did not show a significant negative association of estimated GFR, which might due to herbalists having known how to distinguish ALA herbs after the banning policy. Rigorous monitoring is still needed to protect herbalists and the general population who take herbs.
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Hsing-Hua
authors.initials: HH
authors.lastname: Lin
authors.forename: Shan-An
authors.initials: SA
authors.lastname: Chou
authors.forename: Hsiao-Yu
authors.initials: HY
authors.lastname: Yang
authors.forename: Yaw-Huei
authors.initials: YH
authors.lastname: Hwang
authors.forename: Ching-Hua
authors.initials: CH
authors.lastname: Kuo
authors.forename: Tze-Wah
authors.initials: TW
authors.lastname: Kao
authors.forename: Tsai-Chang
authors.initials: TC
authors.lastname: Lo
authors.forename: Pau-Chung
authors.initials: PC
authors.lastname: Chen
mesh_terms: D000328:Adult; D029065:Aristolochiaceae / Q000737:chemistry / Q000633:toxicity; D034341:Aristolochic Acids / Q000633:toxicity*; D001151:Arsenic; D002104:Cadmium; D003430:Cross-Sectional Studies; D005919:Glomerular Filtration Rate; D033161:Government Regulation; D029001:Herbal Medicine / Q000331:legislation & jurisprudence; D006798:Housing; D006801:Humans; D007668:Kidney / Q000502:physiology; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D007854:Lead / Q000097:blood / Q000633:toxicity; D008516:Medicine, Chinese Traditional; D008628:Mercury / Q000097:blood / Q000633:toxicity; D019216:Metals, Heavy / Q000097:blood / Q000633:toxicity*; D008875:Middle Aged; D009784:Occupational Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis / Q000331:legislation & jurisprudence; D009790:Occupations; D008517:Phytotherapy; D010946:Plants, Medicinal / Q000737:chemistry; D055656:Prescriptions; D012648:Self Care; D017132:Workplace
chemical_list: D034341:Aristolochic Acids; D019216:Metals, Heavy; D002104:Cadmium; D007854:Lead; C000228:aristolochic acid I; D008628:Mercury; D001151:Arsenic
keywords: Chinese herbalist; aristolochic acids; chronic kidney disease; heavy metals