Department of Nephrology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No. 1 People's Hospital, Jiujiang, China.
The Third Unit, The Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Sci Rep. 2024 Oct 5;14(1):23230. doi: 10.1038/s41598-024-73724-x.
Epidemiological evidence on the relationship between lead exposure and mortality in specific chronic kidney disease (CKD) populations is limited. We aimed to examine the relationship between urinary lead and blood lead concentrations and all-cause mortality in US patients with CKD. This cohort study included 2320 participants with CKD from the National Health and Nutrition Examination Survey (2005-2018), with follow-up until December 31, 2019. All-cause mortality was ascertained by matching US National Death Index records. Hazard ratios (HRs) and 95% confidence intervals (CI) for urinary lead and blood lead concentrations in relation to all-cause mortality were estimated using a weighted Cox regression model. During a median follow-up period of 79 months, a total of 625 participants with CKD succumbed to mortality. Compared to the lowest quartile, the highest quartile of urine and blood lead concentrations was associated with an increased risk of all-cause mortality, with HRs and corresponding 95% CIs of 1.77 (1.05-2.99) and 2.65 (1.38-5.10), respectively. Furthermore, each additional unit increase in urinary and blood lead concentrations was associated with HRs for all-cause mortality of 1.21 (95% CI 1.06-1.38) and 1.09 (95% CI 1.01-1.19), respectively. Kaplan-Meier survival curve analysis and restricted cubic regression spline curve analysis demonstrated significant positive associations between elevated blood lead levels, elevated urinary lead levels, and all-cause mortality risk (P < 0.05). A nonlinear concentration-response relationship was observed between blood lead level and all-cause mortality risk (P < 0.05), with an inflection point at a concentration of 1.613 µg/dL. Subgroup analysis as well as sensitivity analysis yielded consistent findings. Our findings demonstrate that elevated levels of lead in urine and blood are associated with a significantly increased mortality risk among patients with CKD, underscoring the importance of reducing lead exposure to mitigate mortality risk in individuals at high risk for CKD.
关于铅暴露与特定慢性肾脏病（CKD）人群死亡率之间关系的流行病学证据有限。我们旨在研究美国 CKD 患者尿液铅和血铅浓度与全因死亡率之间的关系。这项队列研究纳入了 2005 年至 2018 年期间国家健康和营养调查（NHANES）中的 2320 名 CKD 患者，随访至 2019 年 12 月 31 日。通过匹配美国国家死亡索引记录确定全因死亡率。使用加权 Cox 回归模型估计尿液铅和血铅浓度与全因死亡率的比值比（HR）和 95%置信区间（CI）。在中位随访 79 个月期间，共有 625 名 CKD 患者死亡。与最低四分位相比，尿液和血铅浓度最高四分位与全因死亡率风险增加相关，HR 及其相应的 95%CI 分别为 1.77（1.05-2.99）和 2.65（1.38-5.10）。此外，尿液和血铅浓度每增加一个单位，全因死亡率的 HR 分别为 1.21（95%CI 1.06-1.38）和 1.09（95%CI 1.01-1.19）。Kaplan-Meier 生存曲线分析和限制性立方样条回归曲线分析表明，血铅水平升高、尿铅水平升高与全因死亡率风险之间存在显著正相关（P<0.05）。血铅水平与全因死亡率风险之间存在非线性浓度-反应关系（P<0.05），拐点浓度为 1.613µg/dL。亚组分析和敏感性分析得出了一致的结果。我们的研究结果表明，尿铅和血铅水平升高与 CKD 患者的死亡率显著增加相关，这突显了减少铅暴露以降低高危 CKD 个体的死亡率风险的重要性。
