| Lead, Diabetes, Hypertension, and Renal Function: The Normative Aging Study Shirng-Wern Tsaih,1,2 Susan Korrick,1,2 Joel Schwartz,2,3 Chitra Amarasiriwardena,1,2 Antonio Aro,1,2 David Sparrow,4 and Howard Hu1,2 1Occupational Health Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; 2Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA; 3Environmental Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; 4The Normative Aging Study, Department of Veterans Affairs Medical Center, Boston, Massachusetts, USA Abstract
In this prospective study, we examined changes in renal function during 6 years of follow-up in relation to baseline lead levels, diabetes, and hypertension among 448 middle-age and elderly men, a subsample of the Normative Aging Study. Lead levels were generally low at baseline, with mean blood lead, patella lead, and tibia lead values of 6.5 µg/dL, 32.4 µg/g, and 21.5 µg/g, respectively. Six percent and 26% of subjects had diabetes and hypertension at baseline, respectively. In multivariate-adjusted regression analyses, longitudinal increases in serum creatinine (SCr) were associated with higher baseline lead levels but these associations were not statistically significant. However, we observed significant interactions of blood lead and tibia lead with diabetes in predicting annual change in SCr. For example, increasing the tibia lead level from the midpoints of the lowest to the highest quartiles (9-34 µg/g) was associated with an increase in the rate of rise in SCr that was 17.6-fold greater in diabetics than in nondiabetics (1.08 mg/dL/10 years vs. 0.062 mg/dL/10 years ; p < 0.01) . We also observed significant interactions of blood lead and tibia lead with diabetes in relation to baseline SCr levels (tibia lead only) and follow-up SCr levels. A significant interaction of tibia lead with hypertensive status in predicting annual change in SCr was also observed. We conclude that longitudinal decline of renal function among middle-age and elderly individuals appears to depend on both long-term lead stores and circulating lead, with an effect that is most pronounced among diabetics and hypertensives, subjects who likely represent particularly susceptible groups. Key words: blood lead, bone lead, diabetes, hypertension, kidney function, serum creatinine. Environ Health Perspect 112:1178-1182 (2004) . doi:10.1289/ehp.7024 available via http://dx.doi.org/ [Online 3 June 2004]
Address correspondence to S.-W. Tsaih, Jackson Laboratory, Box 303, 600 Main St., Bar Harbor, ME 04609 USA. Telephone: (207) 288-6000 ext. 1281. Fax: (207) 288-6077. E-mail: stsaih@jax.org We gratefully acknowledge the research management of S. Datta and G. Fleischaker and the research assistance of S.Y. Park, S. Oliveira, and N. Lupoli. This research was supported by five National Institutes of Health (NIH) grants (R01-ES05257, R01-ES08074, P42-ES05947, General Clinical Research Center RR02635, and Center Grant ES00002) . The Normative Aging Study is supported by the Cooperative Studies Program/Epidemiology Research and Information Center, Department of Veterans Affairs, and is a research component of the Massachusetts Veterans Epidemiology Research and Information Center. The KXRF instrument used in this work was developed by ABIOMED, Inc. (Danvers, MA) with support from NIH (ES03918) . The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Environmental Health Sciences, NIH, or the U.S. Environmental Protection Agency. The authors declare they have no competing financial interests. Received 11 February 2004 ; accepted 3 June 2004.
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