Negative Relationship between Erythropoietin Dose and Blood Lead Level in Patients Undergoing Maintenance Hemodialysis

Wen-Hung Huang,Dan-Tzu Lin-Tan,Tzung-Hai Yen,Ching-Wei Hsu,Cheng-Hao Weng

doi:10.1038/srep34313

Wen-Hung Huang, Dan-Tzu Lin-Tan + Show 3 more

Open Access

https://doi.org/10.1038/srep34313

Copy DOI

Abstract

The adverse effects of increased blood lead levels have been well discussed. Several antioxidant agents have been reported to offer protection from lead toxicity and to reduce blood lead levels (BLL). Given that erythropoietin (EPO) also has antioxidant properties, the aim of this cross-sectional study was to assess the role of EPO and other clinical variables on BLL in hemodialysis (HD) patients. We recruited 931 maintenance hemodialysis (MHD) patients who had undergone HD for at least 6 months and who had ever received blood lead level (BLL) study. Use of erythropoiesis-stimulating agents followed the The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) Clinical Practice Guideline. We estimated demographic, hematological, nutritional, inflammatory, biochemical, and dialysis-related data based on this study. In the group with EPO, 7% had high BLL. In the group without EPO, 22% had high BLL. From the stepwise liner regression, urban areas, hemodialysis duration, and clearance of urea (KT/Vurea) were positively associated with log BLL. In contrast, diabetes (DM), and monthly EPO dose were negatively associated with log BLL. This study showed that EPO dose might be negatively associated with blood lead levels in patients on maintenance hemodialysis.

Highlights

In a cross-sectional study in London, Davenport et al.[18] found that blood lead levels (BLL) was positively correlated with hemodialysis vintage, use of reverse osmosis water purification device unit, and that BLL was negatively correlated with residual urine output, with approximately 25.5% of patients having BLL >20 ug/dL
Colleoni et al.[7] uncovered a positive correlation between BLL and PTH levels, but no correlation between BLL and HD duration; the authors reported that the environmental risk factors were associated with BLL
We reported that residual renal function was not associated with BLLs, and that the dose of EPO was negatively associated with BLL

Summary

Introduction

Characteristics Age (y) Male sex Body mass index (kg/m2) Smoking (Yes) Diabetes mellitus (Yes) Hypertension (Yes) Previous CVD (Yes) HBV (Yes) HCV (Yes) Haemodialysis duration (year) Fistula as blood access (Yes) Hemodiafiltration (Yes) Kt/V Daugirdes nPCR (g/kg/day) Non-Anuria (>100 cc/day) Haemoglobin (g/dl) Albumin (g/dl) Creatinine (mg/dl) Ferritin (μg/l)* Corrected-calcium (mg/dl) Phosphate (mg/dl) Intact parathyroid hormone (pg/ml)* hsCRP (mg/l)* Cholesterol (mg/dl) Triglyceride (mg/dl) Blood lead (Pb) (ug/dL)* Blood aluminum (ug/dl)* Urban areas

Results

Conclusion