Urinary Blood Lead Clearance and its Relationship to Glomerular Filtration Rate Based on a Large Population Survey
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Decreasing glomerular filtration rate (GFR) in association with increasing blood lead levels (BLL) or bone lead (Pb) concentrations has been reported in epidemiological studies of Pb workers and general populations. A complicating factor in studies that rely on BLL or bone Pb as exposure metrics for studying GFR is that alterations in GFR may directly affect Pb body burden by changing Pb clearance (CbPb). Estimates of CbPb and serum creatinine clearance (CsCr) were determined for approximately 7,600 subjects with data provided by the NHANES for survey years 2009–2016. Stepwise linear regression models for CbPb were estimated to identify significant explanatory variables. Regression models explained approximately 68% of variance in CbPb in adults, with >98% of explained variance attributed to CsCr. These results provide an improved understanding of the possible effects of reverse causation in the interpretation of studies of associations between blood Pb and GFR.