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Lead-Chelation Therapy -- A Treatment for Chronic Renal Disease?

Therapy with EDTA delayed the progression of chronic renal insufficiency in patients with high-normal body lead burdens.

Chronic renal insufficiency is associated with an increased body lead burden. However, it is unclear whether long-term, low-level, environmental lead exposure accelerates declines in renal function and whether lead-chelation therapy improves renal function.

To address these issues, researchers in Taiwan first identified 202 patients with chronic nondiabetic renal disease of diverse causes (serum creatinine, 1.5 to 3.9 mg/dL). During 2 years of observation, body lead burden at baseline (measured by EDTA-mobilization testing) was one of several independent predictors of renal-function decline. The researchers then randomized 64 patients with high-normal body lead burdens to receive either lead-chelation therapy with EDTA or placebo infusions. During approximately 2 more years of follow-up, mean glomerular filtration rate increased from 32 to 34 mL/min/1.73m² in the chelation group, but decreased from 32 to 26 mL/min/1.73m² in the placebo group. The difference was highly significant.

Comment: Results from this trial suggest that lead-chelation therapy with EDTA can delay the progression of chronic renal insufficiency. The same researchers previously published similar findings from a smaller trial that were largely ignored by the nephrology community (Journal Watch Jan 12 1999). Although it is unclear whether outcomes in Taiwan can be duplicated in the U.S. or in other countries, it seems worthwhile to conduct further research on lead-chelation therapy: Any simple intervention that could delay dialysis therapy would be medically and economically attractive.

— Allan S. Brett, MD

Published in Journal Watch General Medicine February 4, 2003

Citation(s):

Lin J-L et al. Environmental lead exposure and progression of chronic renal diseases in patients without diabetes. N Engl J Med 2003 Jan 23; 348:277-86.

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Marsden PA. Increased body lead burden -- Cause or consequence of chronic renal insufficiency? N Engl J Med 2003 Jan 23; 348:345-7.

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• Medline abstract (Free)