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Even Low Levels of Lead in Drinking Water May Harm ESKD Patients

Hemoglobin levels lower, erythropoietin stimulating agent use higher, even for water lead levels below EPA threshold for regulatory action

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MONDAY, July 19, 2021 (HealthDay News) -- For patients with end-stage kidney disease (ESKD), even low levels of lead in drinking water are associated with adverse health outcomes, according to a study published online July 15 in the Journal of the American Society of Nephrology.

John Danziger, M.D., from the Beth Israel Deaconess Medical Center in Boston, and colleagues examined whether lead levels in community water systems were associated with hemoglobin concentrations and erythropoietin stimulating agent (ESA) use among patients with incident ESKD. The average 90th percentile lead concentrations in community-water systems in the five-year period prior to dialysis initiation were examined among 597,968 patients initiating dialysis in the United States between 2005 and 2017.

The researchers found that for patients in cities with detectable levels of lead in community water, per 0.01-mg/L increase in 90th percentile water lead, pre-ESKD hemoglobin concentrations were significantly lower (0.02 g/dL) and ESA utilization was higher (0.4 percent). For the 208,912 patients with data available from the first month of ESKD therapy, the findings were similar, with lower hemoglobin (0.05 g/dL) and higher ESA use (0.3 percent) per 0.01-mg/L higher lead concentration. These associations were seen at lead levels below the threshold of the Environmental Protection Agency, which mandates regulatory action. Environmental inequities were seen; compared with White patients, Black patients had higher water lead levels and slower decreases over time.

"More rigorous efforts to improve the water system infrastructure may be needed to protect individuals from unrecognized hazard," Danziger said in a statement.

Two authors disclosed financial ties to industry; one author has provided medical-legal consulting.

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