Residential Proximity to Hazardous Waste Sites and Risk of End-Stage Renal Disease

Article excerpt

Introduction

End-stage renal disease (ESRD) is characterized by total renal failure making hemodialysis or organ transplantation necessary. Some ESRD can be explained by underlying disease processes such as diabetes mellitus or polycystic kidney disease (1). The etiologic origin of many of the remaining ESRD cases has not been determined and might be of environmental origin. Environmental exposures that have been linked to chronic renal failure include exposures to hydrocarbons and metals.

Occupational lead exposures in battery plant workers, lead production or smelter workers, and workers involved in sandblasting of surfaces painted with lead (2-6) have been associated with ESRD. High-level lead exposures in childhood (7,8) and consumption of "moonshine" (presumably contaminated with lead) have been linked to ESRD as well (9). Lead can have a direct effect on the kidneys or an indirect effect through increased blood pressure. Higher body burdens of lead have been found in patients with chronic renal failure than in control patients (10,11).

Cadmium reaches the highest body concentrations in the renal cortex and has been associated with renal dysfunction (12). Human studies were based on occupational exposures and environmental exposures in Japan (Itai-Itai disease), Belgium, and New Zealand. The primary findings associated with chronic cadmium exposures in animals as well as humans were proteinuria, glucosuria, aminoaciduria, and progressive reduction in the glomerular filtration rate which was identified by the significantly increased serum creatinine and beta 2-microglobulin concentrations. It was found that tubular damage was not reversible, and could progress (12,14).

Table 1

The Specific or Contributing Diagnoses for the End-Stage Renal
Disease Cases, as Reported by HCFA(*) End-Stage Renal Disease
Study,
New York, 1994

Diagnosis                     Number             Percent

Glomerulonephritis              88                  55
Hypertension                    53                  33
Urinary system disease          12                   7
Metabolic disease                3                   2
Connective tissue disease        2                   1
Blood disease                    2                   1
Renal failure, unspecified       1       [less than] 1

* This information was available for 161 of the 216 cases
interviewed
Table 2

Demographic Characteristics of Cases and Controls End-Stage Renal
Disease Study, New York, 1994

Variable                           No. of Cases      No. of
Controls

Education

High school or less                    115                   93
More than high school                   98                  123
Don't know                               3                   -

Income (annual)

[less than or equal to] 15,000          41                   27
[greater than] 15,000                  134                  175
Refused/Unknown                         41                   14

Ever smoked

Yes                                    141                  122
No                                      75                   94

Ever drank alcohol

Yes                                    179                  172
No                                      37                   44

Case reports and analytic studies suggest potential associations between work-related hydrocarbon or solvent exposures and ESRD (9,15-18). Agents in this category include solvents used as cleaning agents or degreasers,gasoline, diesel and jet fuel, paints, mineral turpentine, and glue. Compared to other causes of ESRD, solvent exposures have been specifically linked to an increased incidence of glomerulonephritis (19,20).

Heavy metals and solvents, as well as other toxic agents, are often present at hazardous waste sites. They pose potential exposures for residents near such sites through contaminated food, air, and water, and direct contact with surface water and soil. …