2011/10/05 Council Agenda Packet

National Kidney Foundation Fluoride Intake in Chronic Kidney Disease April 15,2008 Background: The National Kidney Foundation(NKF) 1981 position paper on fluoridation' has recently been challenged by a lawyer, an individual with public health training, and an academic dentist,who all oppose water fluoridation. The statement from that position paper regarding insufficient evidence to recommend fluoride-free drinking water for the susceptible kidney disease population has drawn the most criticism. The availability of new information published after 1981,particularly the National Research Council's (NRC)report2 on fluoridation of March 2006 is an additional critique. A recently published review by Kidney Health Australia3 also suggested the NKF position statement is outdated. Lastly, the American Dental Association's listing of the National Kidney Foundation as an organization that recognizes the public health benefits of water fluoridation to prevent tooth decay has been questioned. All four conclusions of the NKF position paper follow, italics added for emphasis and explanation in brackets inserted. 1. For patients undergoing long term dialysis, water used for preparation of dialysate be treated and appropriately monitored according to the AAMI proposed standards for hemodialysis systems. [Association for the Advancement of Medical Instrumentation (AAMI) sets the hemodialysis water quality standard for fluoride at less than 0.2 mg/L, a level that has remained constant since it was established in 1981.]4 2. Water treatment officials should develop and maintain emergency plans so that susceptible individuals and health officials are promptly notified of the occurrence of any situations involving water used for dialysis which may pose a major health risk. . 3. Fluoride concentration monitoring at treatment plants should be capable of detecting the actual fluoride levels directly. 4. It would also seem prudent to monitor the fluoride intake of patients with chronic renal impairment, particularly those living in areas of high naturally occurring fluoride, children, those with excessive fluoride intake, and those with prolonged disease. There is insufficient evidence at this time to recommend the use offluoride-free drinking water for all patients with renal disease. Issues Involved: Fluoride Regulatory Activities, 1981 to 2006: Drinking water in the U.S. is regulated by the Environmental Protection Agency(EPA), according to the Safe Drinking Water Act. The EPA does not regulate or promote the fluoridation of water. In 1986, EPA established the maximum contaminant level goal (MCLG) for fluoride and maximum