title: Survival patterns of lead-exposed workers with end-stage renal disease from Adult Blood Lead Epidemiology and Surveillance program.
abstract: BACKGROUND
  One previous study has shown that patients with end-stage renal disease (ESRD) with higher blood lead levels (BLLs) have shorter survival, in a cohort without occupational exposure where follow-up began an average of 5 years after dialysis (a survivor population).
  
  
  METHODS
  The authors studied individuals with at least 1 blood lead test who were part of an occupational lead surveillance program sponsored by the National Institute for Occupational Safety and Health and were diagnosed with ESRD. The authors studied the effect of BLL on survival from time of ESRD diagnosis after adjusting for potential confounders. Cox proportional hazards models were run, in which death was the end point and follow-up time was the time variable.
  
  
  RESULTS
  There were 434 ESRD cases with 82% males, 65% white and 31% African American; 51% had 1 blood test, whereas the remainder had a median of 5 tests. The median years of follow-up were 2.7 years with 219 deaths in the cohort. After adjusting for covariates (eg, transplantation status, age at diagnosis, glomerular filtration rate, comorbidities and ethnicity), the authors found no significant association between highest measured BLL and mortality across categories; 0 to <5 μg/dL (hazard ratio [HR] = 1.00), 5 to <25 μg/dL (HR = 1.09; 95% confidence interval [CI]: 0.70-1.70), 25 to <40 μg/dL (HR = 1.28; 95% CI: 0.81-2.02), 40 to <50 μg/dL (HR = 0.89; 95% CI: 0.48-1.63) and 50+ μg/dL (HR = 1.09; 95% CI: 0.66-1.81).
  
  
  CONCLUSIONS
  The authors found no association between BLL and survival after ESRD diagnosis. The authors' finding differs from earlier findings, possibly because the cohort had higher blood leads (25 versus 10 μg/dL), follow-up began at the time of ESRD diagnosis, and BLLs were measured before ESRD incidence.
authors.affiliation: Department of Epidemiology (RC, WM, LD, KS), James T. Laney School of Graduate Studies, Emory University, Atlanta, Georgia; Department of Biostatistics (RC), Harvard School of Public Health, Boston, Massachusetts; Department of Community Medicine (AM), Bangalore Medical College and Research Institute, Bangalore, India; and Department of Environmental Health (SS, KS), Rollins School of Public Health and James T. Laney School of Graduate Studies, Emory University, Atlanta, Georgia.
authors.forename: Ritam
authors.initials: R
authors.lastname: Chowdhury
authors.forename: Amita
authors.initials: A
authors.lastname: Mukhopadhyay
authors.forename: William
authors.initials: W
authors.lastname: McClellan
authors.forename: Stefanie
authors.initials: S
authors.lastname: Sarnat
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Darrow
authors.forename: Kyle
authors.initials: K
authors.lastname: Steenland
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality*; D007854:Lead / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D011159:Population Surveillance; D014481:United States / Q000453:epidemiology
chemical_list: D007854:Lead