Clinical and Biological Profile and Factors Associated With High Blood Lead Levels in Chronic Hemodialysis Patients in a Western French Guiana Hospital Center

Abstract

Abstract Background: Lead is toxic to the body. Its chronic intoxication combines various clinical and biological disorders that can be life-threatening. In French Guiana, lead poisoning is particularly worrying, as the incidence rate is nearly sixty times higher than in metropolitan France. In chronic hemodialysis patients, lead levels are often higher and can lead to several adverse consequences. Hence, the interest of this study, which is to describe the clinical and biological characteristics of chronic hemodialysis patients with high blood lead levels and to identify the associated factors to draw attention to its screening and the prevention of its complications. Methods: Descriptive and analytical cross-sectional study that included 65 patients on chronic conventional hemodialysis: with an annual biological assessment in December 2022, including a serum lead assay. The outcome was the notion of hyper lead level, defined by a lead level > 85 μg/l. We described the clinical, biological, and dialytic parameters of patients with hyper lead levels and in logistic regression, we identified the factors that are correlated according to a significance threshold P<0.05. Results: In all, 54% of patients had hyperplumbemia, 2/3 of them women. They were older, with an average age of 62. None of the patients had been occupationally exposed to lead. 94% were hypertensive and half were diabetic. 26% had anemia, and half had erythropoietin resistance. Their ferritin levels were slightly lower, with a mean of 721 μg/l. Mean albumin was 30 g/l, prealbumin 28 g/l, mean parathyroid hormone 1355 ng/ml, NT-pro BNP 9144 ng/ml. Mean CRP was 10.8 mg/l. They had collapsed residual diuresis and natriuresis with averages of 141 ml and 12 mmol/24 hours, respectively. There was a significant positive correlation between high BLL levels and young age, and a negative correlation with female gender, low serum albumin, prealbumin, protein and ferritin levels, as well as collapsed residual diuresis. Conclusion: High blood lead levels are common in the Guyanese chronic hemodialysis population in which it is correlated with female sex, malnutrition, iron deficiency and residual poor renal function and probably with resistance to erythropoietin treatment. It is necessary to screen in at-risk populations to prevent complications associated with it.