title: Incident ESRD among participants in a lead surveillance program.
abstract: BACKGROUND
  Very high levels of lead can cause kidney failure; data about renal effects at lower levels are limited.
  
  
  METHODS
  Cohort study, external (vs US population) and internal (by exposure level) comparisons.
  
  
  METHODS
  58,307 men in an occupational surveillance system in 11 US states.
  
  
  METHODS
  Blood lead levels.
  
  
  RESULTS
  Incident end-stage renal disease determined by matching the cohort with the US Renal Data System (n=302).
  
  
  METHODS
  Blood lead categories were 0-<5, 5-<25, 25-<40, 40-51, and >51 μg/dL, defined by highest blood lead test result. One analysis for those with data for race (31% of cohort) and another for the whole cohort after imputing race.
  
  
  RESULTS
  Median follow-up was 12 years. Among those with race information, the end-stage renal disease standardized incidence ratio (SIR; US population as referent) was 1.08 (95% CI, 0.89-1.31) overall. The SIR in the highest blood lead category was 1.47 (95% CI, 0.98-2.11), increasing to 1.56 (95% CI, 1.02-2.29) for those followed up for 5 or more years. For the entire cohort (including those with race imputed), the overall SIR was 0.92 (95% CI, 0.82-1.03), increasing to 1.36 (95% CI, 0.99-1.73) in the highest blood lead category (SIR of 1.43 [95% CI, 1.01-1.85] in those with ≥5 years' follow-up). In internal analyses by Cox regression, rate ratios for those with 5 or more years' follow-up in the entire cohort were 1.0 (0-<5 and 5-<25 μg/dL categories combined) and 0.92, 1.08, and 1.96 for the 25-<40, 40-51, and >51 μg/dL categories, respectively (P for trend=0.003). The effect of lead was strongest in nonwhites.
  
  
  CONCLUSIONS
  Lack of detailed work history, reliance on only a few blood lead tests per person to estimate level of exposure, lack of clinical data at time of exposure.
  
  
  CONCLUSIONS
  Data suggest that current US occupational limits on blood lead levels may need to be strengthened to avoid kidney disease.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Ritam
authors.initials: R
authors.lastname: Chowdhury
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Darrow
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Sarnat
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: nsteenl@emory.edu.
authors.forename: Kyle
authors.initials: K
authors.lastname: Steenland
mesh_terms: D000328:Adult; D015331:Cohort Studies; D062665:Epidemiological Monitoring; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D007854:Lead / Q000009:adverse effects* / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D007854:Lead
keywords: Adult Blood Lead Epidemiology and Surveillance (ABLES); End-stage renal disease (ESRD); kidney disease; lead; occupational exposure