Blood Lead Level and Renal Impairment among Adults: A Meta-Analysis
Abstract
:1. Background
2. Methods
2.1. Protocol and Registration
2.2. Searches
2.3. Eligibility Criteria
2.4. Study Selection and Data Extraction
2.5. Quality of the Included Studies (Risk of Bias)
2.6. Study Outcomes
2.7. Statistical Analysis
3. Results
3.1. Search Results
3.2. Characteristics of the Included Studies
3.3. Quality of the Included Studies
3.4. Pooled Mean Blood Lead Level (BLL) among Exposed Participants
3.5. Pooled Mean Difference in BLL between Exposed and Control Participants
3.6. BLL and Gender
3.7. Renal Function Tests
3.8. Renal Function Tests and BLL
3.9. Publication Bias
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviation
BLL | Blood lead level |
BUN | Blood urea nitrogen |
CI | Confidence Interval |
CRCL | Creatinine clearance |
eGFR | estimated Glomerular Filtration Rate |
GF | Glomerular function |
KNHANES | The Korea Nation Health and Nutrition Examination Survey |
NS | Not specified |
PbB | Blood lead |
PVC | Polyvinyl chloride |
Ref | Reference number |
WMD | Weighted Mean Difference |
mg/dL | milligrams per deciliter |
μg/dL | micrograms per deciliter |
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No. (Ref) | Author, Year | Study Area (Years of the Survey), Exposed Level | Study Design | Participants (Exposure and Control Groups) | Lead Exposure Group | Non-Exposed Group | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean/ Median Age, Male (%) | BLL Levels (μg/dL), Duration of Exposure (Years) | BUN (mg/dL) | Creatinine (mg/dL), Creatinine Clearance (mL/min/1.72 m2) | Uric Acid (mg/dL) | Renal Insufficiency (n, %) | Age, Male (%) | BLL Levels (μg/dL), Duration of Exposure (Years) | BUN (mg/dL) | Creatinine (mg/dL), Creatinine Clearance (mL/min/1.72 m2) | Uric Acid (mg/dL) | Renal Insufficiency (n, %) | |||||
1. [15] | Alasia et al., 2010 | Nigeria | Cross-sectional study | Study group (190); welding and metal (42), paint and pigment (38), radiator repairer (37), battery workers (37), petrol (36) Control group (80); hospital workers (80) | NS, 151/190 (79.5%) | 50.37 ± 24.58, 11.9 ± 9.3 | 8.6 ± 2.3 | 1.0 ± 0.2, 98.9 ± 21.3 | 4.6 ± 1.2 | 58/80 (73) | 41.40 ± 26.9, 8.0 ± 7.3 | 7.6 ± 2.4 | 0.9 ± 0.2, 108.2 ± 25.2 | 3.9 ± 1.1 | ||
2. [29] | Buser et al., 2016 | USA (2007–2008, 2009–2010, and 2011–2012) | Cross-sectional study | NHANES (4875) | NS, 2481/4875 (50.9%) | 1.58 (1.49–1.67) or 1.58 ± 0.21 | 0.85 ± 0.00 (4785), 91.95 ± 0.58 | |||||||||
3. [30] | Chen et al., 2019 | China | Cross-sectional study | Polluted area (174), non-exposed area (157) | Mean 58.7 (26–80), 52/164 (31.7%) | 13.1 (8.36–20.6) or 13.8 ± 3.53 | 0.79 (0.7–0.95) or 0.81 ± 0.22, 94.7 (79.0–107.9) or 94.1 ± 8.34 | 56 (25–80), 59/157 | 7.44 (5.44–11.3) or 7.91 ± 1.71 | 0.77 (0.69–0.88) or 0.78 ± 0.21, 102.2 (91.2–112.7) or 102.1 ± 6.21 | ||||||
4. [31] | Chung et al., 2013 | The Republic of Korea (2007–2009) | Cross-sectional study | The Korea National Health and Nutrition Examination Survey (KNHANES) nationally representative survey (2005) | Mean 46 (20–87), male 49.8% | 2.5 eGFR < 60 (83) 2.92 ± 0.13, eGFR ≥ 60 (1922) 2.53 ± 0.03 | GFR: 90.0 ± 0.7 | |||||||||
5. [16] | de Pinto Almeida et al., 1987 | Brazil | Cross-sectional study | Lead workers (52), reference (44) | 44.9 ±9.54, NS | 64.1 ±16.3 | 1.23 ± 0.34 | 6.6 ± 1.7 | 17/52 | 43.4 ± 8.9 | 25.5 ± 4.4 | 1.10 ± 0.20 | 4.7 ± 1.2 | 1/44 | ||
6. [32] | Dioka et al., 2004 | Nigeria | Cross-sectional study | Exposed subjects (25); auto mechanics (18), battery chargers (5), welders (2) unexposed subjects (25); graduate students | 39 ± 8.47, male 50/50 (100%) | 59.6 ± 15.9 | 58.8 ± 13.6 | 1.12 ± 0.2 | 4.04 ± 1.39 | Age matched | 35 ± 7.9 | 55.4 ± 6.79 | 1.15 ± 0.2 | 2.58 ± 1.19 | ||
7. [13] | Ehrlich et al., 1998 | South Africa | Cross-sectional study | Battery making workforce (n = 382) | Mean 41.2 (8.3), NS | 53.5 ± 12.7, 11.6 ± 6.8 | 5.6 ± 1.5 | 1.13 ± 0.18 | BLL 23–50 µg/dL (160), 51–60 (115), 61–110 (101) | |||||||
8. [33] | Gennart et al., 1992 | Belgium | Cross-sectional study | Exposed workers (98); lead acid battery factory control workers (85); the finishing department of the same factory, the maintenance department, the warehouse of a hospital and a chemical factory | 37.7 ± 8.3, male 183/183 (100%) | 51 ± 8, 10.6 ± 8.1 | 1.07 ± 1.16, 107 ± 1.22 | 38.8 ± 8.7 | 20.9 ± 11.1 | 1.07 ± 1.15, 110 ± 1.23 | ||||||
9. [34] | Gerhardsson et al., 1998 | Sweden | Cross-sectional study | Smelter workers (22); active workers (11), retired workers (11) referents (11); nearby machine-shop | NS, 22/22 (100%) | 25.3 ± 11.4 Active workers 31.1 (7.67–49.7) or 29.8 ± 12.9, Retired workers 19.3 (11.2–33.2) or 20.7 ± 7.67 | 4.14 (2.07–7.05) or 4.35 ± 1.45 | |||||||||
10. [35] | Gerhardsson et al., 1992 | Sweden | Cross-sectional study | Smelter workers (100); active workers (70), retired workers (30) referents (41); active truck assembly workers (31), retired truck assembly workers (10) | Active workers 37.4 ± 12–6), NS Retired workers 67.9 ± 47, NS | 23.7 ± 13.5 Active workers 31.91 (4.97–47.45) or 29.1 ± 12.3, Retired workers 9.95 (3.32–20.93) or 11 ± 5.1 Duration of job: 19.8 ± 12.2 Active workers 14.3 ± 9.7, Retired workers (32.6 ± 6.3) | 1.02 ± 0.26 Active workers 1.02 (0.75–1.32) or 1.03 ± 0.26, Retired workers 1.05 (0.71–1.23) or 1.01 ± 0.25 CRCL 102.4 ± 43.2; Active workers 105 (26–180) or 104 ± 44.5, Retired workers 87 (40–180) or 98.5 ± 40.4 | 5.54 ± 3.03 Active workers 4.14 (1.66 -12.4) or 5.59 ± 3.12, Retired workers 3.52 (2.28–12.2) or 5.38 ± 2.88 | 1.02 ± 0.22 Active workers 1.0 (0.84–1.15) or 1 ± 0.22, Retired workers 1.04 (0.89–1.32) or 1.07 ± 0.24 CRCL: Active workers 105 (26–180) µmol/dL, Retired workers 87 (40–180) | |||||||
11. [36] | Goswami et al., 2001 | India | Cross-sectional study | 372 Battery (63%), pigments (12.8%), rolled/extruded (7.7%), cable sheeting (4.5%), gas add (2.2%), others (9.9%) | 36.2 ± 7.8, 372/372 (100%) | 21.2 ± 13.9 Group A (185): 12.6 ± 3.9, Group B (63): 17.9 ± 2.1, Group C (99): 29.8 ± 9.6, Group D (25): 58.7 ± 11.3 | Group A: 13 ± 8, Group B: 26 ± 7, Group C: 35 ± 13, Group D: 51 ± 12 | 1.1 ± 0.89 Group A: 0.9 ± 0.6, Group B: 1.2 ± 0.9, Group C: 1.3 ± 1.1, Group D: 1.5 ± 1.3 eGFR Group A: 141 ± 16, Group B: 86 ± 22, Group C: 55 ± 24, Group D: 33 ± 28 | 25 with advanced renal diseases | |||||||
12. [3] | Harar et al., 2018 | Sweden (2007–2012) | Cohort study | 4341 individuals enrolled and 2567 individuals subsequently followed up | Based line 57 ± 5.9, 1729/ 4341 (39.8%) | 2.5 (0.15–25.8) or 7.74 ± 7.41 | eGFR: based line (4272); 76 ± 14, followed up (2735); 70 ± 15 | 185 chronic kidney diseases | ||||||||
13. [37] | Hernandez-Serrato et al., 2006 | Mexico | Cross-sectional study | Exposed group (413): glazed pottery used, exposure occupation | 37.27 ± 16.3, 156/413 (37.8%) | 43.57 ± 14.5 | 33.17 ± 11.7 | 0.97 ± 0.23 | 6.47 ± 1.90 | BLL ≥ 40 mg/dL (8/244) <40 mg/dL (4/169) | ||||||
14. [38] | Jain RB, 2019 | USA (2003–2014) | Retrospective study | The data from National Health and Nutritional Examination Survey (NHANES): 9822 GF-1: 5710 GF-2: 3263 GF-3A: 563 GF-3B/4: 286 | ≥ 20, 5044/ 9822 (51.4%) | 1.24 ± 0.32 Glomerular function (GF) GF-1: 1.05 (1.02–1.09) or 1.05 ± 0.21, GF-2: 1.42 (1.37–1.47) or 1.42 ± 0.2, GF-3A: 1.74 (1.63–1.87) or 1.75 ± 0.22, GF-3B/4: 1.87 (1.70–2.05) or 1.87 ± 0.23 | ||||||||||
15. [39] | Jung et al., 1998 | Republic of Korea | Cross-sectional study | Lead exposed workers (75): secondary lead smelter industry (27), plastic stabilizer industry (18), radiator manufacturing industry (30) control group (64): male office workers | 41.5 ± 7.67, 75/75 (100%) Highly exposed (21): 43.6 ± 8.3, Moderately exposed (20): 42.3 ± 8.6, Slightly exposed (34): 39.7 ± 6.4 | 44.3 ± 21.8 Highly exposed: 74.6 ± 7.8, moderately exposed: 46.5 ± 5.9, slightly exposed: 24.3 ± 2.7 Duration of employed: 8.27 ± 4.29 Highly exposed: 8.5 ± 3.8, moderately exposed: 8.3 ± 6.2, slightly exposed: 8.1 ± 3.2 | 15.8 ± 4.54 Highly exposed: 18 ± 5.5, moderately exposed: 15.6 ± 3.9, slightly exposed: 14.6 ± 3.8 | 0.86 ± 0.19 Highly exposed: 0.9 ± 0.2, moderately exposed: 0.8 ± 0.1, slightly exposed: 0.8 ± 0.2 | 5.41 ± 1.43 Highly exposed: 6 ± 1.5, moderately exposed: 5.1 ± 1.1, slightly exposed: 5.2 ± 1.5 | Highly exposed (2) | 44.2 ± 8.6 (64) | 7.9 ± 1.4, duration of employed: 8.1 ± 2.4 | 13 ± 4 | 0.9 ± 0.2 | 5.6 ± 1.5 | 1 |
16. [40] | Kim et al., 1996 | USA (1979–1992) | Retrospective study | 459 men randomly selected from the Normative Aging Study | 56.9 ± 8.3, 459/459 (100%) | 9.9 ± 6.1 | 1.22 (0.9–1.8) or 1.29 ± 0.33 | |||||||||
17. [7] | Kshirsagar et al., 2020 | India | Cross-sectional study | Spray painters (42), normal healthy subjects (50) | Range 20–50, NS | 30.5 ± 12.2 | 20.5 ± 4.78 | 1.21 ± 0.26 | 6.6 ± 2 | 20–50 | 5.46 ± 2.58 | 20.5 ± 4.78 | 0.98 ± 0.17 | 5.41 ± 1.03 | ||
18. [41] | Kshirsagar et al., 2019 | India (2018) | Cross-sectional study | Silver jewelry workers (42) control group (50) | Range 20–60, NS | 23.23 ± 5.91 | 22.9 ± 5.93 | 1.12 ± 0.17 | 6.39 ± 1.18 | 20–60 | 5.46 ± 2.58 | 20.5 ± 4.78 | 0.98 ± 0.17 | 5.41 ± 1.03 | ||
19. [11] | Lai et al., 2008 | Taiwan | Cross-sectional study | 2565 residents: aboriginals (1318), nonaboriginals (1247) | > 40, NS | 5.3 ± 1.2 Male (1008): 5.3 ± 1.2, 5.6 ± 1.4), female (1557): 5.3 ± 1.1, 5.4 ± 1.2 | Male (15.4 ± 4.3, 15.5 ± 4.6), female (14.9 ± 4.5, 15.7 ± 5.6) | 1.1 ± 0.28 Male (1.2 ± 0.3, 1.1 ± 0.4), female (1.0 ± 0.2, 1.0 ± 0.5) | Male (6.9 ± 1.8, 8.6 ± 2.1), female (5.8 ± 1.8, 7.0 ± 1.9) | Aboriginals (153), Nonaboriginals (87) | ||||||
20. [25] | Lim et al., 2001 | Singapore | Cross-sectional study | Workers from a factory producing polyvinyl chloride (PVC) stabilizers using lead ingots as raw materials (55) | 35.73 ± 9.59, 55/55 (100%) | 24.1 ± 9.6 <20 μg/dL (18), 20–30 μg/dL (23), > 30 μg/dL (14) | CRCL: (120.9 ± 14.9) | 2 participants with CRCL < 90 | ||||||||
21. [42] | Lin et al., 2007 | China | Cross-sectional study | Exposed group (135): one storage battery plant control group (143): mechanics | 28.7 ± 6.6, NS | 42.2 ± 1.86, 5.8 ± 4.4 | 27.0 ± 8.5 | 11.9 ± 1.96 | ||||||||
22. [43] | Lu et al., 2015 | China (2013) | Cross-sectional study | Participants who live in a region of China with heavy metal pollution (1447) | 46.68 ± 15.1, NS | 15.2 ± 15.1 | 4.47 ± 3.49 | CRCL: 76.78 ± 70.44 | BLL 0–100 µg/L (669), ≥ 100 µg/L (778) | |||||||
23. [44] | Mujaj et al., 2019 | USA (2015–2017) | Cross-sectional study | Newly hired workers at s at battery manufacturing and lead recycling plants in the USA (447) | BLL <3.0 (147): 28.8 ± 9.5), BLL 3.1–6.3 (152): 30.4 ± 11.4), BLL ≥ 6.3 (148): 27.3 ± 5.3 Male %: NS | 5.6 ± 3.62 BLL < 3.0: 1.66 (1.3–2.5) or 1.78 ± 0.4, 3.1–6.3: 4.63 (3.9–5.7) or 4.72 ± 0.56, ≥ 6.3: 10.48 (7.9–12.25) or 10.3 ± 1.27 | BLL < 3.0 µg/dL (0.97 ± 0.12), 3.1–6.3 µg/dL (0.99 ± 0.14), ≥6.3 µg/dL (0.96 ± 0.13) eGFR: BLL <3.0 µg/dL (105.4 ± 14.5), 3.1–6.3 µg/dL (102.6 ± 16.0), ≥ 6.3 µg/dL (107.7 ± 14.8) | BLL <3.0 µg/dL (147), 3.1–6.3 µg/dL (152), ≥ 6.3 µg/dL (148) | ||||||||
24. [45] | Muntner et al., 2003 | USA (1988–1994) | Retrospective study | Normotension by the National Center for Health statistics (10,398) | ≥20, 4991/ 10,398 (48%) | 3.30 ± 0.10 | 1.05 ± 0.004 eGFR: 115 ± 0.7 | 0.7–1.6 µg/dL (114), 1.7–2.8 (166), 2.9–4.6 µg/dL (229), 4.7–52.9 µg/dL (270) CKD (114) | ||||||||
25. [4] | Nakhaee et al., 2018 | Iran (2017) | Case-cohort study | Exposed group: healthy adults with chronic lead exposure (BLL > 10 μg/dL) (100), healthy individuals with BLL < 10 μg/dL (100) | 45.8 ± 11.8, 184/200 (92%) | All group: 27.77 ± 39.45 BLL > 10 μg/dL (51.36 ± 44.72), BLL < 10 μg/dL (4.17 ± 1.97) | BLL > 10 μg/dL (34.0, 27.0–221.0), BLL < 10 μg/dL (30.0, 27.0–36.0) | BLL > 10 μg/dL (0.9, 0.8–1.0), BLL < 10 μg/dL (0.8, 0.7–0.9) | ||||||||
26. [46] | Navas-Acien et al., 2009 | USA (1999–2006) | Retrospective study | National Health and Nutrition Examination Survey (14,778): reduced eGFR (1668), normal GFR (13,110) | Reduced eGFR: 67.6 ± 0.5, 640/ 1668 (38.4%) Normal GFR: 44.7 ± 0.3, 6660/ 13,110 (50.8%) | 1.6 ± 0.27 Reduced eGFR (<60): 2.06 (1.98–2.15) or 2.06 ± 0.21, normal GFR: 1.54 (1.50–1.57) or 1.54 ± 0.21 BLL: < 1.1 (147), 1.1–1.6 (274), 0.6–2.4 (468), > 2.4 (779) | ||||||||||
27. [47] | Oktem et al., 2004 | Turkey | Cross-sectional study | Auto repairers (79), healthy control (71) | 17.3 ± 1.0, NS | 7.79 ± 3.81 BLL; 3.4–4.9 µg/dL (14): 4.11 ± 0.43, 5–9.9 µg/dL (51): 7.08 ± 1.38, 10–25 µg/dL (14): 14.04 ± 4.59 | 12.8 ± 2.3 BLL; 3.4–4.9 µg/dL (14): 12.5 ± 2.5, 5–9.9 µg/dL (51): 12.9 ± 2.2, 10–25 µg/dL (14): 13.1 ± 2.6 | 0.82 ± 0.08 BLL; 3.4–4.9 µg/dL (14): 0.83 ± 0.09, 5–9.9 µg/dL (51): 0.81 ± 0.08, 10–25 µg/dL (14): 0.84 ± 0.10 GFR: 147 ± 16.1 BLL; 3.4–4.9 µg/dL (14): 147 ± 17.9, 5–9.9 µg/dL (51): 149 ± 15.6, 10–25 µg/dL (14): 139 ± 14.5 | 5.6 ± 1.1 BLL; 3.4–4.9 µg/dL (14): 5.7 ± 0.9, 5–9.9 µg/dL (51): 5.5 ± 1.1, 10–25 µg/dL (14): 6.0 ± 1.1 GFR: 147 ± 16.1 | 17.0 ± 1.1 | 1.60 ± 0.80 | 12.1 ± 2.3 | 0.83 ± 0.12 GFR: 146 ± 18.5 | 5.9 ± 1.4 | ||
28. [48] | Omae et al., 1990 | Japan (1985) | Cross-sectional study | Lead exposed workers (165): duration of exposed > 10 years (20), duration of exposed < 10 (134) | 18.4–57.3, NS | 36.5 (6–73) or 36.5 ± 19.3 0–19 (21), 20–29 (39), 30–39 (34), 40–49 (36), 50–59 (25), ≥ 60 (10) Duration of exposed: > 10 years: 43.7 (23–73), Duration of exposed < 10: 36.2 (6–73) | 0–19 (1 ± 1.13), 20–29 (0.96 ± 1.11), 30–39 (0.96 ± 1.14), 40–49 (0.95 ± 1.13), 50–59 (0.93 ± 1.10), ≥ 60 (0.97 ± 1.12) CRCL: 0–19 (99.3 ± 1.12), 20–29 (105.4 ± 1.13), 30–39 (104.5 ± 1.11), 40–49 (105.3 ± 1.14), 50–59 (110.1 ± 1.12), ≥ 60 (102.2 ± 1.18) | |||||||||
29. [17] | Onuegbu et al., 2011 | Nigeria | Cross-sectional study | Exposed workers (53): automobile mechanics (23), battery repair workers (11), petrol station attendants (19) Control (42) | 30.8 ± 7.8, 53/53 (100%) | 69.7 ± 13.2 automobile mechanics (68.8 ± 14.8), battery repair workers (75.5 ± 10.0), petrol station attendants (67.4 ± 12.4) | 65 ± 14.8 automobile mechanics (69 ± 14.7), battery repair workers (55.4 ± 13.6), petrol station attendants (65.6 ± 13.6) | 1.1 ± 0.32 automobile mechanics (1.09 ± 0.04), battery repair workers (1 ± 0.17), petrol station attendants (1.18 ± 0.32) | 30.1 ± 1.2, 42/42 | 18.5 ± 3.6 | 53.2 ± 13.6 | 1.01 ± 0.15 | ||||
30. [49] | Patil et al., 2007 | India | Cross-sectional study | All exposed group (90) Battery manufacturing industries (30), silver jewelry (30) workers, spray painters (30) control group (35) | 20–40 years, 90/90 (100%) | 41.5 ± 18.1 Battery manufacturing industries (53.6 ± 17, silver jewelry (48.6 ± 7.39) workers, spray painters (22.3 ± 8.87) | 25.7 ± 9.59 Battery manufacturing industries (30.4 ± 11), silver jewelry (20 ± 5.84) workers, spray painters (26.7 ± 8.34) | 0.85 ± 0.19 Battery manufacturing industries (0.83 ± 0.15), silver jewelry (0.83±0.20) workers, spray painters (0.88±0.22) | 4.96 ± 1.26 Battery manufacturing industries (5.92 ± 0.95), silver jewelry (4.07 ± 1.01) workers, spray painters (4.90±1.10) | 20–40 years, 35/35 | 12.52 ±4.08 | 25.12 ±5.73 | 0.81 ± 0.11 | 5.57 ± 0.97 | ||
31. [50] | Payton et al., 1994 | USA (1988–1991) | Cross-sectional study | Men participating in the Normative Aging Study (744) | 64 ± 7.4, NS | 8.9 ± 3.9 | 1.3 ± 0.2 CRCL: 88.2 ± 22, eGFR: 71 ± 18.4 | |||||||||
32. [51] | Reilly et al., 2018 | USA | Cross-sectional study | Smelter-working resident (52) control residents (290) | 55.8 ± 10.5, NS | 4.5 ± 5 Duration of residence (14.1 ± 12.2) | 1.3 ± 0.67 eGFR: 85.2 ± 26.5 | 43 ± 14.1 | 2.7 ± 2.5 Duration of residence (11.5 ± 11.9) | 1.2 ± 0.66 eGFR: 96 ± 24.2 | ||||||
33. [20] | Roels et al., 1994 | Belgium | Cross-sectional study | Workforce of a large lead smelter (47) control group (55): the same workplace but never directly occupationally exposed to lead | 42.3 ± 8.1, NS | 46.6 (34.2–67.9) or 48.8 ± 9.74, 15.9 ± 6.8 | 29.7 (15.9–50.3) or 31.4 ± 9.93 | 0.91 (0.69–1.07) or 0.9 ± 0.23, 123.5 (97–177) or 130.3 ± 23.1 | 5.1 (3.3–8.2) or 5.43 ± 1.44 | 43.0 ± 9.1 | 13.9 (6.3–26.1) or 15.1 ± 5.73 | 32.4 (23.3–48.6) or 34.2 ± 7.31 | 0.97 (0.78–1.28) or 1 ± 0.25, 114.2 (81–156) or 116.4 ± 21.66 | 5.4 (3.8–8.1) or 5.68 ± 1.27 | ||
34. [52] | Satarug et al., 2004 | Thailand | Cross-sectional study | Students, factory workers, teachers, and laborers (118) | 37.5 ± 8.8, 53/118 (44.9%) | 3.54 ± 3.99 Male (53): 4.2 ± 5.4, female (65): 3.0 ± 2.2 | Male 12.6 ± 3.4, female 11.0 ± 2.5 | Male 0.94 ± 0.12, female 0.66 ± 0.10 | ||||||||
35. [53] | Staessen et al., 1990 | United Kingdom (1982) | Cross-sectional study | Civil servants (531) | 47.7 ± 5.77, 398/531 (75%) | 5.72 ± 2.1 Male (398): 6.0 ± 2.1, female (133): 4.9 ± 1.9 | Male 9.7 ± 2.6, female 7.8 ± 1.1 | |||||||||
36. [54] | Staessen et al., 1992 | Belgium (1985–1989) | Prospective population-based Study | Exposed group (2327): the Malmo Diet and Cancer Study (MDCS-CC), prospective population-based study (MDCS) | 48 ± 16, 965/ 2327 (41.5%) | 21.4 ± 18.1 Male 11.4 (2.3–72.5) or 24.4 ± 20.3, female 7.5 (1.7–60.3) or 19.3 ± 16.9 | Male 1.24 (0.7–4.64, female 1.05 (0.58–2.71) CRCL: Male 93 ± 30, female 480 ± 25 | |||||||||
37. [55] | Tsaih et al., 2004 | USA | Cohort study | The Normative Aging Study (NAS) | Baseline (448): 66 ± 6.6, NS | Baseline (427): 6.5 ± 4.2, follow-up 4.5 ± 2.5 | Baseline (448): 1.1 ± 0.4, follow-up 1.25 ± 0.2 | |||||||||
38. [56] | Verschoor et al., 1987 | Netherlands | Cross-sectional study | 155 lead workers (155): lead battery plants 1 (36), lead battery plants 2 (52), lead battery plants 3 (9), plastic stabilizer production plant (58) control workers (126): nonlead plants, insulation materials (60), production of drainpipes (56), plant producing concrete (10) | 30–51, NS | Exposed group (148): 47.5 (33.8–66.5) or 48.8 ± 9.45 B plant 1: 50.15 (37.5–66.7), B plant 2: 45.4 (24.7–66.9), B plant 3: 65.9 (46.2–94.3), stab plant: 45.6 (34.2–60.7) BLL < 20.7 µmol/L (125), BLL 20.7–62.2 (113), BLL > 62.2 (27) | 56.6 ± 14.1 BLL < 20.7 (56.6 ± 14.7), BLL 20.7–62.2 (56.6 ± 13.6), BLL > 62.2 (56.6 ± 13.6) | 0.96 ± 0.16 BLL < 20.7 (125): 0.96 ± 0.16, BLL 20.7–62.2 (113): 0.96 ± 0.15, BLL > 62.2 (27): 0.92 ± 0.16 Relative CRCL: 0.17 ± 0.09 | 6.34 ± 1.4 BLL < 20.7 (6.29 ± 1.34), BLL 20.7–62.2 (6.42 ± 1.38), BLL > 62.2 (6.27 ± 1.78) Relative CRCL: 0.17 ± 0.09 | 30–51 years | 0.40 (0.27–0.58) or 0.4 ± 0.22 | Relative CRCL: 0.17 ± 0.08 | ||||
39. [19] | Wang et al., 2002 | Taiwan | Cross-sectional study | Lead battery workers (229) | 40 ± 14.7, 120/229 (52.4%) | 58.6 ± 25.4 Male: 67.7 ± 28.2, female: 48.6 ± 17.0 BLL < 60 µg/dL (134), BLL > 60 µg/dL (95) Work duration: 8.24 ± 8.25 Male: 4.6 (0.2–35) or 11.1 ± 10.1, female: 2.7 (0.2–17) or 5.65 ± 4.87 | BLL < 60 (14.37 ± 0.35), BLL > 60 (16.65 ± 0.43) | BLL < 60 (1.04 ± 0.01)), BLL > 60 (1.05 ± 0.02) Abnormal creatinine BLL < 60 (18), BLL > 60 (23) | BLL < 60 (5.66 ± 0.12), BLL > 60 (6.09 ± 0.15) | |||||||
40. [57] | Wang et al., 2018 | China (2012) | Cross-sectional study | Lead exposure paint workers | 31.7 ± 7.74, 706/747 (94.5%) | 9.0 ± 6.0 (70) BLL positive (70) | Renal dysfunction (93), BLL positive and renal dysfunction (19/70), BLL negative and renal dysfunction (74/751) | |||||||||
41. [58] | Weaver et al., 2011 | Republic of Korea (2004–2005) | Cohort study | Current and former workers employed at 26 lead-using facilities (712) | 47.6 ± 7.9, 563/712 (79%) | 23.1 ± 14.1 Duration of exposed: 13.1 ± 7.3 | 0.87 ± 0.15 eGFR: 97.4 ± 19.2 CRCL: 111.1 ± 30.7 | |||||||||
42. [59] | Weaver et al., 2003 | Republic of Korea (1997–1999) | Cohort study | Current and former lead workers (803): lead battery, lead oxide, lead crystal, radiator manufacture, and secondary lead smelting controls (135) | 40.4 ± 10.1, 639/803 (79.6%) | 32.0 ± 15.0 Duration of job: 8.2 ± 6.5 | 14.4 ± 3.7 | 0.90 ± 0.16 CRCL: 94.7 ± 20.7 | 34.5 ± 9.1, 124/135 | 5.3 ± 1.8 | 13.1 ± 2.9 | 0.91 ± 0.10 CRCL: 108.4 ± 19.4 | ||||
43. [60] | Weaver et al., 2005 | Republic of Korea (1999–2001) | Cohort study | Workers from 26 plants that produced lead batteries, lead oxide, lead crystal, or radiators or secondary lead smelters (652) | 43.3 ± 9.8, 503/652 (77.2%) | 30.9 ± 16.7 | 14.4 ± 3.9 | 0.87 ± 0.15 | 109.2 ± 34.8 |
High mean BLL (>30 µg/dL) | Sources of contamination: welding and metal, paint and pigment, radiator repair, petrol, auto mechanic, battery makers and chargers, glazed pottery, plastic stabilizer industry, radiator manufacturing industry, storage battery plant, automobile mechanic, petrol station, silver jewelry, lead battery plants, production plant, lead oxide, and lead crystal |
Moderate mean BLL (20–30 µg/dL) | Sources of contamination: smelting, batteries, pigment, extruded materials, cable sheeting, gas add, silver jewelry, PVC-producing factory, stabilizers using lead ingots, lead-using facilities |
Low mean BLL (<20 µg/dL) | Sources of contamination: polluted areas, heavy metal pollution, battery manufacturing and lead recycling plants, auto repair, smelting factory |
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Kuraeiad, S.; Kotepui, M. Blood Lead Level and Renal Impairment among Adults: A Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 4174. https://doi.org/10.3390/ijerph18084174
Kuraeiad S, Kotepui M. Blood Lead Level and Renal Impairment among Adults: A Meta-Analysis. International Journal of Environmental Research and Public Health. 2021; 18(8):4174. https://doi.org/10.3390/ijerph18084174
Chicago/Turabian StyleKuraeiad, Saruda, and Manas Kotepui. 2021. "Blood Lead Level and Renal Impairment among Adults: A Meta-Analysis" International Journal of Environmental Research and Public Health 18, no. 8: 4174. https://doi.org/10.3390/ijerph18084174