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End-stage renal disease after occupational lead exposure: 20 years of follow-up
  1. Marie Evans1,
  2. Andrea Discacciati2,
  3. Abdul Rashid Quershi1,
  4. Agneta Åkesson2,
  5. Carl-Gustaf Elinder1
  1. 1Division of Renal Medicine, Department of Clinical Sciences and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
  2. 2Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Marie Evans, M99, Renal department, Karolinska University Hospital, Huddinge, Stockholm, S-14186, Sweden; marie.evans{at}


Objectives Whether low-level exposure to lead may give rise to chronic kidney disease or end-stage renal disease (ESRD) is debated. In this study, we aimed to specifically investigate if low-level occupational exposure to lead was associated with increased incidence of ESRD.

Methods The incidence of starting renal replacement therapy as a result of ESRD was examined in a cohort of10 303 lead-workers who had controlled blood lead concentrations due to a compulsory occupational health surveillance programme in Sweden during the time period 1977–1990. The ESRD incidence (obtained through register-linkage) among the lead-exposed workers was compared with the age, sex and calendar period-adjusted expected incidence based on data from the Swedish renal registry. Dose–response association was evaluated in external (general population) and internal (within the occupational cohort) comparisons by highest achieved blood lead level.

Results There were 30 (0.29%) individuals in the cohort who developed ESRD during the median follow-up period of 26.3 years. The standardised incidence ratio (SIR) for ESRD incidence was 0.79 (95% CI 0.54 to 1.13). Among those who achieved the highest blood lead (>41.4 µg/dL), the SIR was 1.01 (0.44 to 1.99). There was no evidence of a dose–response relationship between the maximum achieved blood lead or the cumulative blood lead exposure and ESRD in external or internal comparisons.

Conclusions This study of workers with documented occupational lead exposures followed for 20 years shows no statistically significant association between lead exposure (following the current occupational recommendations for Sweden) and ESRD.

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  • Contributors All authors conceptualised and designed the study. C-GE and ME acquired data. AD performed the statistical analysis. ME, C-GE and AD drafted the manuscript. All authors contributed to the interpretation of analysis and revised the manuscript critically for important intellectual content.

  • Funding ME acknowledges support from the Stockholm City Council for postdoctoral research. This study was also supported by grants provided by the Stockholm City Council (ALF).

  • Disclaimer The funder was not involved in the design and conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript, or decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Ethics approval This study was approved by the regional ethics committee in Stockholm.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data used for this study is available on reasonable request from the first author.