Evans Marie, Discacciati Andrea, Quershi Abdul Rashid, Åkesson Agneta, Elinder Carl-Gustaf
Division of Renal Medicine, Department of Clinical Sciences and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Occup Environ Med. 2017 Jun;74(6):396-401. doi: 10.1136/oemed-2016-103876. Epub 2016 Dec 14.
Whether low-level exposure to lead may give rise to chronic kidney disease or end-stage renal disease (ESRD) is debated. In this study, we aimed to specifically investigate if low-level occupational exposure to lead was associated with increased incidence of ESRD.
The incidence of starting renal replacement therapy as a result of ESRD was examined in a cohort of10 303 lead-workers who had controlled blood lead concentrations due to a compulsory occupational health surveillance programme in Sweden during the time period 1977-1990. The ESRD incidence (obtained through register-linkage) among the lead-exposed workers was compared with the age, sex and calendar period-adjusted expected incidence based on data from the Swedish renal registry. Dose-response association was evaluated in external (general population) and internal (within the occupational cohort) comparisons by highest achieved blood lead level.
There were 30 (0.29%) individuals in the cohort who developed ESRD during the median follow-up period of 26.3 years. The standardised incidence ratio (SIR) for ESRD incidence was 0.79 (95% CI 0.54 to 1.13). Among those who achieved the highest blood lead (>41.4 µg/dL), the SIR was 1.01 (0.44 to 1.99). There was no evidence of a dose-response relationship between the maximum achieved blood lead or the cumulative blood lead exposure and ESRD in external or internal comparisons.
This study of workers with documented occupational lead exposures followed for 20 years shows no statistically significant association between lead exposure (following the current occupational recommendations for Sweden) and ESRD.
低水平铅暴露是否会引发慢性肾脏病或终末期肾病（ESRD）存在争议。在本研究中，我们旨在具体调查低水平职业性铅暴露是否与ESRD发病率增加相关。
在1977 - 1990年期间，对瑞典一项强制性职业健康监测计划中血铅浓度得到控制的10303名铅作业工人队列进行了研究，以检查因ESRD而开始肾脏替代治疗的发病率。将铅暴露工人中的ESRD发病率（通过登记链接获得）与基于瑞典肾脏登记处数据的年龄、性别和日历期调整后的预期发病率进行比较。通过最高血铅水平在外部（一般人群）和内部（职业队列内）比较中评估剂量反应关联。
在中位随访期26.3年期间，队列中有30人（0.29%）发生了ESRD。ESRD发病率的标准化发病率比（SIR）为0.79（95%CI 0.54至1.13）。在血铅最高（>41.4μg/dL）的人群中，SIR为1.01（0.44至1.99）。在外部或内部比较中，未发现最高血铅水平或累积血铅暴露与ESRD之间存在剂量反应关系的证据。
这项对有记录的职业性铅暴露工人进行20年随访的研究表明，铅暴露（遵循瑞典当前的职业建议）与ESRD之间无统计学显著关联。
