LAUSR

Introduction Although U.S. Environmental Protection Agency (U.S. EPA) regulations mandate action when the 90th percentile of tested community water samples exceeds 15 lg=L lead, the great majority of water systems in the United States fail to reach the U.S. EPA’s maximum contaminant goal of zero (https://www.epa. gov/laws-regulations/summary-safe-drinking-water-act). Patients with chronic kidney disease (CKD) have heightened susceptibility to heavy-metal exposure due to a combination of increased proportions absorbed across the gastrointestinal tract and reduced urinary excretion.1,2 We have recently demonstrated that lead levels found widely in United States water systems associate with lower hemoglobin concentrations among individuals with advanced CKD.3 Herein, focusing on the End-Stage Kidney Disease (ESKD) population, we describe whether exposure to drinking water lead is associated with higher use of medications used to treat anemia during the first 12 months of maintenance dialysis therapy.