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High prevalence of elevated lead levels in pediatric dialysis patients

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Abstract

Background

After parents raised concerns about potential lead (Pb) contamination of calcium carbonate for treatment of hyperphosphatemia in chronic kidney disease (CKD), we measured blood Pb using high-resolution sector field inductively coupled mass spectrometry in a quality-assurance investigation of ten pediatric dialysis patients (nine on hemodialysis) and six patients before dialysis.

Methods

We assessed the kidney function as cystatin C estimated glomerular filtration rate (eGFR), blood Pb levels, calcium carbonate dose, and standard laboratory parameters, as well as Pb levels in the dialysis feed water.

Results

Mean blood Pb concentration in the 16 pediatric CKD patients was 21.1 ± 15.8 µg/l with a maximum of 58 µg/l, which was significantly higher than that of 467 apparently healthy controls (median 6.35 µg/l, interquartile range 4.47, 8.71) and comparable to that of ten adult peritoneal dialysis (PD) patients. Lead levels correlated with red blood cell distribution width, eGFR, and calcium carbonate dose. Pb in dialysate feed water was always <0.00018 mg/l, which is below the accepted limit for water for dialysis of 0.005 mg/l.

Conclusions

We found a high prevalence of elevated Pb levels in pediatric CKD patients that correlated with the calcium carbonate dose and GFR. Lead levels should be monitored in these patients.

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Acknowledgments

We thank Ms. Ethel Harris, nurse coordinator in our dialysis unit, for the valuable assistance with the data collection. The authors also acknowledge the critical review and valuable discussion with Dr. David Z. Levine from Toronto.

Competing financial interests

There was no funding for this study, and no author had any competing financial interests.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Schulich School of Medicine & Dentistry, London, ON, Canada, N6A 5W9

    Guido Filler, Elizabeth Roach, Abeer Yasin & Ajay P. Sharma

  2. Department of Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada, N6A 5W9

    Guido Filler & Peter G. Blake

  3. Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada, N5A 5A5

    Guido Filler & Liju Yang

  4. Department of Pediatrics, Children’s Hospital, London Health Science Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, Canada, N6A 5W9

    Guido Filler

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  1. Guido Filler
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  2. Elizabeth Roach
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  3. Abeer Yasin
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  4. Ajay P. Sharma
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Correspondence to Guido Filler.

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Filler, G., Roach, E., Yasin, A. et al. High prevalence of elevated lead levels in pediatric dialysis patients. Pediatr Nephrol 27, 1551–1556 (2012). https://doi.org/10.1007/s00467-012-2150-8

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  • DOI: https://doi.org/10.1007/s00467-012-2150-8

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