Investigators have identified a number of chemicals as potential risk factors for chronic kidney disease (CKD).

In an environmental-wide association study, Jeonghwan Lee, MD, PhD, of Seoul National University Boramae Medical Center in South Korea, and colleagues examined urine and blood test results for 262 chemicals and compared them with CKD diagnoses in 46,748 participants in the US National Health and Nutrition Examination Survey (1999 to 2016).

Seven chemicals significantly associated with a higher risk for albuminuria and/or an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73m2, Dr Lee’s team reported in the Clinical Journal of the American Society of Nephrology. Serum and urine cotinines (markers of exposure to tobacco smoke), blood 2,5-dimethylfuran (a volatile organic compound that may be a marker of exposure to tobacco smoke), and blood cadmium associated with albuminuria. Blood lead and cadmium (both heavy metals) correlated with reduced eGFR. Blood cadmium and lead, blood 2,5-dimethylfuran, blood furan (used to produce other chemicals and occurring naturally in certain foods when heated), and urinary phenylglyoxylic acid (used to synthesize pharmaceutical intermediates and food additives and a marker of occupational exposure to toluene or styrene) associated with a composite of albuminuria and reduced eGFR.

“Our findings suggest that increased exposure to heavy metal lead, cadmium, or volatile organic compounds can be associated with increased prevalence of CKD,” Dr Lee and colleagues wrote.


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The investigators also identified 23 chemicals associated with lower risks of CKD: serum perfluorooctanoic acid, 7 urinary metals, 3 urinary arsenics, urinary nitrate and thiocyanate, 3 urinary polycyclic aromatic hydrocarbons, and 7 volatile organic compounds.

In an accompanying editorial, James S. Kaufman, MD, of New York University, noted that other observational studies have linked metolachlor, paraquat, glyphosate, and diazinon to increased CKD risk. Reverse causation also cannot be ruled out.

People are being exposed to thousands of chemicals in the environment, on the job, through cleaning agents, and natural means. Very few chemicals have been studied, so much more research is needed, he commented.

According to Dr Kaufman, “we need to make sure that workers have appropriate protective equipment when exposed to toxic chemicals and that we all have access to clean, safe water.”

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References

Lee J, Oh S, Kang H, et al. Environment-wide association study of CKD. Clin J Am Soc Nephrol. 2020. doi: 10.2215/CJN.06780619

Kaufman JS. Environmental risks to kidney health. Clin J Am Soc Nephrol. 2020. doi: 10.2215/CJN.05290420