For people with kidney disease, there is no safe amount of lead in drinking water

Washington, DC (July 15, 2021) – The levels of lead in drinking water authorized by the Environmental Protection Agency are having adverse effects on the health of people with kidney disease, according to a new study. The results will be published in a future issue of JASN.

Despite progress in reducing the amount of lead in drinking water, low levels of contamination remain widespread in the United States. This can be particularly dangerous for the 30 to 40 million Americans living with chronic kidney disease, who have an increased susceptibility to the toxic effects of lead.

To examine the effects of low levels of lead contamination on people with advanced kidney disease, investigators analyzed health information from 597,968 patients starting dialysis in the United States between 2005 and 2017. The team also assessed lead concentrations in community water supply systems during the 5-year period prior to the start of dialysis, drawing on city-level data from the information system on drinking water from the Environmental Protection Agency.

Researchers focused on the potential effects of lead on levels of hemoglobin, the oxygen-carrying protein in red blood cells known to be affected by lead poisoning.

People living in cities with detectable levels of lead in their community water had significantly lower hemoglobin concentrations before starting dialysis and during the first month of dialysis therapy. They were also prescribed higher doses of medicines to treat anemia, which occurs when the number of red blood cells or hemoglobin levels are lower than normal. These associations have been observed at lead levels below the Environmental Protection Agency threshold (0.015 mg / L) which requires regulatory action.

The results suggest that for patients with poor kidney function, there is no safe amount of lead in drinking water. “Although drinking water may appear uniformly healthy, the low levels of lead contamination found in the majority of drinking water systems in the United States can have toxic effects for people with chronic kidney disease,” a said lead author John Danziger, MD, MPhil, of Beth Israel Deaconess Medical Center. “More rigorous efforts to improve the infrastructure of the water supply system may be needed to protect individuals from unrecognized dangers.”

Importantly, the study also found worrying inequalities, with higher lead levels in the water seen for black patients compared to white patients. “Combined with the increased susceptibility to kidney disease among blacks, this represents a significant environmental injustice,” said Dr. Danziger.


Study co-authors include Eric Weinhandl PhD, MS and Kenneth J. Mukamal, MD, MPH.

Disclosures: The authors have not reported any financial disclosures.

The article, entitled “Associations of Lead Concentrations in Drinking Water with Hemoglobin Concentrations and Erythropoietin Stimulating Agent Use Patients with Advanced Chronic Kidney Disease”, will appear online at http: // / on July 15, 2021, doi: 10.1681 / ASN.2020091281.

The contents of this article do not reflect the views or opinions of the American Society of Nephrology (ASN). Responsibility for the information and opinions expressed therein rests entirely with their author (s). ASN does not offer medical advice. All the content of ASN publications is provided for informational purposes only and is not intended to cover all the uses, directions, precautions, drug interactions or possible adverse effects. This content should not be used in a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified healthcare provider if you have any questions about any medical condition or before taking any medication, changing your diet, or starting or stopping any treatment. Do not ignore or delay obtaining professional medical advice because of the information accessible via ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has led the fight to prevent, treat and cure kidney disease throughout the world by training healthcare professionals and scientists, advancing research and innovation, communicating new knowledge and advocating for the highest quality patient care. ASN has more than 21,000 members representing 131 countries. For more information visit http: // www.asn-online.organization.

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