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ARTICLE

Chelation Therapy for Patients with Elevated Body Lead Burden and Progressive Renal Insufficiency

A Randomized, Controlled Trial

Ja-Liang Lin, MD; Huei-Huang Ho, MD; and Chun-Chen Yu, MD

5 January 1999 | Volume 130 Issue 1 | Pages 7-13

Background: Nephropathy is known to occur in persons exposed to high levels of lead, but the question of whether long-term exposure to low levels of environmental lead is associated with impaired renal function remains controversial.

Objective: To examine whether chelation therapy slows the progression of renal insufficiency in patients with mildly elevated body lead burden.

Design: Randomized, controlled trial.

Setting: Academic medical center in Taiwan.

Patients: 32 patients with chronic renal insufficiency (serum creatinine level > 132.6 µmol/L [1.5 mg/dL] and < 353.8 µmol/L [4.0 mg/dL]), mildly elevated body lead burden (>0.72 µmol [150 µg] of lead per 72-hour urine collection and < 2.90 µmol [600 µg] of lead per 72-hour urine collection [EDTA mobilization tests]), and no history of heavy lead exposure.

Intervention: The treatment group received 2 months of chelation therapy; the control group received no therapy.

Measurements: The reciprocal of serum creatinine (1/Cr) was used as an index of progressive renal insufficiency.

Results: Rates of progression of renal insufficiency were similar in the treatment group and the control group during a 12-month baseline observation period (1/Cr, 0.000054 L/µmol per month compared with 0.000046 L/µmol per month; P > 0.2). After the 2-month treatment period, improvement in renal function was greater in the treatment group than in the control group. In the 12 months after the treatment period, renal insufficiency progressed more slowly in the treatment group than in the control group (1/Cr, 0.000033 ± 0.00038 L/µmol per month compared with 0.000045 ± 0.000038 L/µmol per month; P = 0.0030).

Conclusion: Chelation therapy seems to slow the progression of renal insufficiency in patients with mildly elevated body lead burden. This implies that long-term exposure to low levels of environmental lead may be associated with impaired renal function in patients with chronic renal disease.

Author and Article Information

From Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.

Requests for Reprints: Ja-Liang Lin, MD, Division of Nephrology and Poison Center, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipai, Taiwan, Republic of China.

Current Author Addresses: Drs. Lin and Yu: Division of Nephrology and Poison Center, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipai, Taiwan, Republic of China.

Dr. Ho: Division of Rheumatology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipai, Taiwan, Republic of China.

Grant Support: In part by grant NSC87-2314-B182A-043 from the National Science Council Foundation, Republic of China.

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