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The Third National Health and Nutrition Examination Survey

Jeffrey J. Fadrowski, MD, MHS; Ana Navas-Acien, MD, PhD; Maria Tellez-Plaza, MD, MPH; Eliseo Guallar, MD, DrPH; Virginia M. Weaver, MD, MPH; Susan L. Furth, MD, PhD

Arch Intern Med. 2010;170(1):75-82.

Background  Chronic, high-level lead exposure is a known risk factor for kidney disease. The effect of current low-level environmental lead exposure is less well known, particularly among children, a population generally free from kidney disease risk factors such as hypertension and diabetes mellitus. Therefore, in this study, we investigated the association between lead exposure and kidney function in a representative sample of US adolescents.

Methods  Participants included 769 adolescents aged 12 to 20 years for whom whole blood lead and serum cystatin C were measured in the Third National Health and Nutrition Examination Survey, conducted from 1988-1994. The association between blood lead level and level of kidney function (glomerular filtration rate [GFR]), determined by cystatin C–based and creatinine-based estimating equations, was examined.

Results  Median whole blood lead level was 1.5 µg/dL (to convert to micromoles per liter, multiply by 0.0483), and median cystatin C–estimated GFR was 112.9 mL/min/1.73 m². Participants with lead levels in the highest quartile (3.0 µg/dL) had 6.6 mL/min/1.73 m²–lower estimated GFR (95% confidence interval, –0.7 to –12.6 mL/min/1.73 m²) compared with those in the first quartile (<1 µg/dL). A doubling of blood lead level was associated with a 2.9 mL/min/1.73 m²–lower estimated GFR (95% confidence interval, –0.7 to –5.0 mL/min/1.73 m²). Lead levels were also associated with lower creatinine-based estimated GFR levels, but the association was weaker than with cystatin C–based GFR and not statistically significant.

Conclusions  Higher blood lead levels in a range below the current Centers for Disease Control and Prevention–designated level of concern (10 µg/dL) were associated with lower estimated GFRs in a representative sample of US adolescents. This finding contributes to the increasing epidemiologic evidence indicating an adverse effect of low-level environmental lead exposure.

Author Affiliations: Welch Center for Prevention, Epidemiology and Clinical Research (Drs Fadrowski, Navas-Acien, Tellez-Plaza, Guallar, Weaver, and Furth); Departments of Pediatrics (Drs Fadrowski and Furth) and Medicine (Dr Guallar), School of Medicine; and Departments of Environmental Health Sciences (Drs Navas-Acien, Tellez-Plaza, and Weaver) and Epidemiology (Drs Navas-Acien, Tellez-Plaza, Guallar, and Furth), Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland; and Department of Epidemiology and Population Genetics, National Center for Cardiovascular Research, Madrid, Spain (Drs Tellez-Plaza and Guallar).

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