2011/10/05 Council Agenda Packet

Everett City Council October 5, 2011 Page Five [This is a serious problem, affecting 41% of adolescents with some level of fluorosis, 8.6% with moderate fluorosis, and 3.6% with severe fluorosis. See: http://www.cdc.gov/nchs/data/databriefs/db53.pdf. See: http://jada.ada.org/content/ 133/2/157.full.] Fluoride may interact with aluminum to worsen osteomalacia. [This is a serious problem. See: http://www.fluoridealert.org/health/bone/fluorosis/dialysis.html.] Patients with an estimated GFR less than approximately 25 ml/min/1.73m2 retain more fluoride than healthy individuals based on older studies that used creatinine clearance to assess kidney function. Fluoride blood levels are approximately 4-fold higher or about 4 umol/L in patients with CKD stages 4 and 5. [Those with kidney disease retain more fluoride and therefore should consume as little fluoride as possible.] Although several position statements recommend monitoring intake in the potentially susceptible CKD population, the absence of fluoride concentrations on food and beverage labels and lack of data about fluoride intake from dental products and other sources makes this difficult to implement. [This is all the more reason why those with kidney disease should consume as little fluoride as possible.] Individuals with CKD should be notified of the potential risk of fluoride exposure by providing information on the National Kidney Foundation website including a link to the report in brief of the NRC and the Kidney Health Australia position paper. [The National Kidney Foundation posted its 2008 withdrawal of its 1981 position statement on fluoridation on its web site, but it posted no link to it. See: http://www.kidney.org/atoz/pdf/Fluoride Intake in CKD.pdf. It is hidden away and difficult to find unless you know the exact wording of it and can do a search for it. There is nothing in the 2008 withdrawal of the 1981 position paper or anywhere else on the www.kidney.org web site where the National Kidney