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Blood lead levels, malnutrition, inflammation, and mortality in patients with diabetes treated by long-term hemodialysis.
Am J Kidney Dis. 2008 Jan; 51(1):107-15.AJ

Abstract

BACKGROUND

Blood lead levels (BLLs) are associated with mortality in the general population. The clinical significance of BLLs in long-term hemodialysis (HD) patients with diabetes is unknown.

STUDY DESIGN

A cross-sectional and 1-year prospective study.

SETTINGS & PARTICIPANTS

211 patients with diabetes on long-term HD therapy at 3 centers.

PREDICTOR

BLLs measured before HD at baseline, categorized as abnormal (>20 microg/dL), high normal (10 to 20 microg/dL), and low normal (<10 microg/dL).

OUTCOMES & MEASUREMENTS

Malnutrition, defined as serum albumin level less than 3.6 g/dL, and inflammation, defined as high-sensitivity C-reactive protein level greater than 3 mg/dL, for cross-sectional analyses. Mortality and cause of death for longitudinal analyses.

RESULTS

34, 112, and 65 patients had abnormal, high-normal, and low-normal BLLs at baseline. At baseline, patients with abnormal BLLs had a greater proportion of malnutrition (14.7% versus 1.5% and 11.6%; P = 0.01) and inflammation (76.5% versus 52.3% and 50.9%; P = 0.01) than those with low- and high-normal BLLs. Backward stepwise regression analysis found that high-sensitivity C-reactive protein level correlated positively and albumin level correlated negatively with BLLs after other confounders were adjusted. At the end of follow-up, 16 patients had died. Kaplan-Meier analysis showed that patients with an abnormal BLL had greater mortality than those with low and low-normal BLLs (P = 0.004).

LIMITATIONS

Small sample size, sparse outcomes, and limited follow-up.

CONCLUSIONS

BLL may contribute to inflammation and nutritional status in long-term HD patients with diabetes on long-term HD therapy and may relate to 1-year mortality in these patients.

Authors+Show Affiliations

Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC. jllin99@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18155539

Citation

Lin, Ja-Liang, et al. "Blood Lead Levels, Malnutrition, Inflammation, and Mortality in Patients With Diabetes Treated By Long-term Hemodialysis." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 51, no. 1, 2008, pp. 107-15.
Lin JL, Lin-Tan DT, Yen TH, et al. Blood lead levels, malnutrition, inflammation, and mortality in patients with diabetes treated by long-term hemodialysis. Am J Kidney Dis. 2008;51(1):107-15.
Lin, J. L., Lin-Tan, D. T., Yen, T. H., Hsu, C. W., Jenq, C. C., Chen, K. H., Hsu, K. H., & Huang, Y. L. (2008). Blood lead levels, malnutrition, inflammation, and mortality in patients with diabetes treated by long-term hemodialysis. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 51(1), 107-15.
Lin JL, et al. Blood Lead Levels, Malnutrition, Inflammation, and Mortality in Patients With Diabetes Treated By Long-term Hemodialysis. Am J Kidney Dis. 2008;51(1):107-15. PubMed PMID: 18155539.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood lead levels, malnutrition, inflammation, and mortality in patients with diabetes treated by long-term hemodialysis. AU - Lin,Ja-Liang, AU - Lin-Tan,Dan-Tzu, AU - Yen,Tzung-Hai, AU - Hsu,Ching-Wei, AU - Jenq,Chang-Chyi, AU - Chen,Kuan-Hsing, AU - Hsu,Kuang-Hung, AU - Huang,Yen-Lin, PY - 2007/04/03/received PY - 2007/10/09/accepted PY - 2007/12/25/pubmed PY - 2008/1/18/medline PY - 2007/12/25/entrez SP - 107 EP - 15 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 51 IS - 1 N2 - BACKGROUND: Blood lead levels (BLLs) are associated with mortality in the general population. The clinical significance of BLLs in long-term hemodialysis (HD) patients with diabetes is unknown. STUDY DESIGN: A cross-sectional and 1-year prospective study. SETTINGS & PARTICIPANTS: 211 patients with diabetes on long-term HD therapy at 3 centers. PREDICTOR: BLLs measured before HD at baseline, categorized as abnormal (>20 microg/dL), high normal (10 to 20 microg/dL), and low normal (<10 microg/dL). OUTCOMES & MEASUREMENTS: Malnutrition, defined as serum albumin level less than 3.6 g/dL, and inflammation, defined as high-sensitivity C-reactive protein level greater than 3 mg/dL, for cross-sectional analyses. Mortality and cause of death for longitudinal analyses. RESULTS: 34, 112, and 65 patients had abnormal, high-normal, and low-normal BLLs at baseline. At baseline, patients with abnormal BLLs had a greater proportion of malnutrition (14.7% versus 1.5% and 11.6%; P = 0.01) and inflammation (76.5% versus 52.3% and 50.9%; P = 0.01) than those with low- and high-normal BLLs. Backward stepwise regression analysis found that high-sensitivity C-reactive protein level correlated positively and albumin level correlated negatively with BLLs after other confounders were adjusted. At the end of follow-up, 16 patients had died. Kaplan-Meier analysis showed that patients with an abnormal BLL had greater mortality than those with low and low-normal BLLs (P = 0.004). LIMITATIONS: Small sample size, sparse outcomes, and limited follow-up. CONCLUSIONS: BLL may contribute to inflammation and nutritional status in long-term HD patients with diabetes on long-term HD therapy and may relate to 1-year mortality in these patients. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18155539/Blood_lead_levels_malnutrition_inflammation_and_mortality_in_patients_with_diabetes_treated_by_long_term_hemodialysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(07)01352-2 DB - PRIME DP - Unbound Medicine ER -