Body lead burden, II: environmental lead and end-stage renal disease

Approximately 200,000 Americans are currently afflicted with end-stage renal disease (ESRD) at a cost exceeding 2 billion dollars, however, fewer than 10% of ESRD cases are characterized etiologically. Among these, lead nephropathy is unique in that it is not only preventable but also reversible by EDTA Pb chelation therapy. Since over 95% of body Pb is stored in bone the application of rapid, non-invasive measurement of bone Pb by in vivo X-ray fluorescence (XRF) offers the opportunity to perform epidemiological studies of the association of the body Pb burden with an increased risk of ESRD. Five preliminary studies performed over the past two years in a collaboration of the VA with the University of Antwerp and Brookhaven National Laboratory support the conclusion that tibial XRF of chronic hemodialysis patients and case matched controls can establish the impact of body Pb burden on ESRD