Air Quality Criteria for Lead Volume II of II - (NEPIS)(EPA) - US ...

AX6-107
Table AX6-4.3 (cont’d). Renal Effects of Lead in the Patient Population
Reference, Study
Location, and
Period Study Description Pb Measurement Findings, Interpretation
Europe (cont’d)
Miranda-Carús et al.
(1997)
Spain
1990-1994
Nuyts et al. (1995)
Belgium
Study date not
provided
27 patients with gout and CRI.
50 patients with gout only.
26 controls with normal renal function and no gout.
Multiple purine metabolism measures including serum
urate, hypoxanthine, and xanthine, as well as their
excretion, clearance and fractional excretion measures.
Case-control study.
272 cases with chronic renal failure (all types) matched to
272 controls by age, sex and residence.
Exposure assessed by 3 industrial hygienists blinded to
case or control status.
Mean blood Pb
17.8 µg/dL (gout and CRI)
14.9 µg/dL (gout only)
12.4 µg/dL (controls)
Mean EDTA chelatable Pb
845 µg/120 hrs (gout and CRI)
342 µg/120 hrs (gout only)
215 µg/120 hrs (controls)
Pb dose measures significantly higher in patients with
gout and CRI compared to the other two groups.
EDTA chelatable Pb inversely correlated with
creatinine clearance. Each of the 2 patient groups
were dichotomized by EDTA-chelatable Pb level of
600 μg/120 hrs, resulting in 3 small groups (n ranging
from 6 to 14) and one group of 44 participants with
gout and EDTA chelatable Pb below the cut-off. No
significant differences in mean purine metabolism
measures were observed. It is not clear whether
correlations between EDTA-chelatable Pb and the
purine measures were assessed and if so whether the
small groups were combined for this analysis. Thus
lack of power may be one reason for the inconsistency
with Lin’s work. Different Pb body burdens may be a
factor as well.
Uric acid parameters were unchanged following
chelation in 6 participants with EDTA-chelatable
above 600 µg/120 hrs. Again higher Pb body burdens
may be a factor but the small number and limited
details on the group make firm conclusions difficult.
Significantly increased odds ratio for chronic renal
failure with Pb exposure (OR = 2.11 [95% CI: 1.23,
4.36]) as well as several other metals. Increased risk
with diabetic nephropathy.