Table 2.

Adjusted difference (95% CI) in hemoglobin concentrations and prevalence of ESA use according to the 90^th percentile community water lead concentration in a patient’s city of primary residence

Outcome	Categories of Increasing Lead Concentrations (mg/L)						Per 0.01 mg/L
	<0.001	0.001 to <0.00375	0.00375 to <0.0075		0.0075 to <0.015	≥0.015
Adjusted difference in pre-ESKD hemoglobin concentration
Hemoglobin (597,968)	Ref.	−0.02 g/dl	−0.007 g/dl		−0.05 g/dl	−0.04 g/dl	−0.02 g/dl
		(−0.03 to 0.00)	(−0.02 to 0.01)		(−0.07 to −0.03)	(−0.07 to −0.01)	(−0.02 to −0.01)
Hemoglobin corrected for  pre-ESKD ESA use (449,205)	Ref.	−0.002 g/dl	−0.01 g/dl		−0.05 g/dl	−0.09 g/dl	−0.03 g/dl
		(−0.02 to 0.02)	(−0.03 to 0.01)		(−0.08 to −0.03)	(−0.13 to −0.05)	(−0.04 to −0.02)
Adjusted difference in hemoglobin concentrations during the first month of dialysis
Hemoglobin (208,912)	Ref.	−0.04	−0.06 g/dl		−0.12 g/dl	−0.14 g/dl	−0.05 g/dl
		(−0.06 to −0.02)	(−0.08 to −0.04)		(−0.15 to −0.09)	(−0.19 to −0.09)	(−0.06 to −0.04)
Hemoglobin corrected for ESA   use during first month  of dialysis (203,006)	Ref.	−0.05	−0.04 g/dl		−0.13 g/dl	−0.14 g/dl	−0.05 g/dl
		(−0.08 to −0.03)	(−0.07 to −0.02)		(−0.17 to −0.10)	(−0.21 to −0.08)	(−0.06 to −0.03)
Adjusted difference in ESA use
Pre-ESKD ESA use  (449,205)	Ref.	−0.3%	0.2%		0.04%	1.9%	0.4%
		(−0.7 to 0.4)	(−0.2 to 0.6)		(−0.43 to 0.50)	(1.0 to 2.8)	(0.2 to 0.6)
ESA use during first month  of dialysis (203,006)	Ref.	0.3%	−0.5%		1.2%	0.8%	0.3%
		(−0.3 to 0.9)	(−1.2 to 0.3)		(0.3 to 2.1)	(−0.9 to 2.5)	(−0.1 to 0.6)

To account for the effect of ESA therapy, corrected hemoglobins were derived by subtracting 2 g/dl from hemoglobin concentrations among pre-ESKD ESA users and among those receiving ESA during the first month of dialysis. Adjusted for age, sex, race, history of diabetes, congestive heart failure, hypertension, cancer, tobacco use, body mass index, estimated glomerular function, insurance status, employment, year of dialysis initiation, and county air pollution.