Perfluoroalkyl Chemicals and Chronic Kidney Disease in US Adults
Open accessAbstract
Chronic kidney disease (CKD) is a major public health problem. Identifying novel risk factors for CKD, including widely prevalent environmental exposures, is therefore important. Perfluoroalkyl chemicals (PFCs), including perfluorooctanoic acid and perfluorooctane sulfonate, are manmade chemicals that have been detected in the blood of more than 98% of the US population. Results from experimental animal studies have suggested that an association between PFCs and CKD is plausible. However, in humans, the relation between serum PFCs and CKD has not been examined. The authors examined the relation of serum PFCs and CKD in 4,587 adult participants (51.1% women) from the combined 1999-2000 and 2003-2008 cycles of the National Health and Nutritional Examination Survey for whom PFC measurements were available. The main outcome was CKD, defined as a glomerular filtration rate of less than 60 mL/minute/1.73 m(2). The authors found that serum levels of PFCs, including perfluorooctanoic acid and perfluorooctane sulfonate, were positively associated with CKD. This association was independent of confounders such as age, sex, race/ethnicity, body mass index, diabetes, hypertension, and serum cholesterol level. Compared with subjects in quartile 1 (referent), the multivariable odds ratio for CKD among subjects in quartile 4 was 1.73 (95% confidence interval: 1.04, 2.88; P for trend = 0.015) for perfluorooctanoic acid and 1.82 (95% confidence interval: 1.01, 3.27; P for trend = 0.019) for perfluorooctane sulfonate. The present results suggest that elevated PFC levels are associated with CKD.
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Multiple human studies have reported significant associations between PFAS exposure and lower eGFR and increased odds of CKD.
“Multiple studies have reported significant associations between PFAS exposure with lower eGFR and increased odds of CKD”
From A Critical Review and Meta-Analysis of Impacts of Per- and Polyfluorinated Substances on the Brain and Behavior (2022) · cites this paper as Shankar et al., 2011
The Results report that higher PFOA and PFOS levels were associated with lower eGFR and higher odds of CKD in this study. But the Discussion explicitly says there were no previous studies for comparison, contrary to the claim that multiple studies had reported those associations. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredToxicology studies have identified histological and cellular outcomes indicative of PFAS-induced nephrotoxicity, including oxidative stress, apoptosis, and enhanced microvascular endothelial permeability.
“Toxicology studies, including in vivo and in vitro experiments, have identified histological and cellular outcomes indicative of PFAS-induced nephrotoxicity (Shankar et al., 2011; Stanifer et al., 2018). Such findings include oxidative stress, apoptosis, and enhanced microvascular endothelial permeability.”
From A Critical Review and Meta-Analysis of Impacts of Per- and Polyfluorinated Substances on the Brain and Behavior (2022) · cites this paper as Shankar et al., 2011
The Discussion reports histopathologic kidney changes in PFC-exposed rats and increased endothelial-cell permeability. A title in the References (p. 899) mentions PFOS-induced reactive oxygen species, consistent with oxidative stress. Our copy does not report apoptosis, so it does not support the full list of outcomes. (LLM, conf=0.86)
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- Authors
- Shankar, A., Xiao, J., & Ducatman, A.
- Affiliations
- West Virginia University (US)
- Corresponding author
- Shankar, A.
- ORCID
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-08-26
- Volume
- 174
- Issue
- 8
- Pages
- 893-900
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- PMC
- PMC3218627
- OpenAlex
- W2126648541
- Cited by
- 166
- References
- 41
- Citations by year
- 2026: 8 · 2025: 22 · 2024: 9 · 2023: 16 · 2022: 19 · 2021: 15 · 2020: 10 · 2019: 12 · 2018: 17 · 2017: 3 · 2016: 2 · 2015: 12 · 2014: 8 · 2013: 8 · 2012: 5
- FWCI
- 5.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association (1R03ES018888-01)
- West Virginia University
- National Institutes of Health
- National Institute of Environmental Health Sciences (R03ES018888, 5-R03ES0018888-02)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Fluorine in Organic Chemistry
- Keywords
- chronic kidney disease, perfluorooctanoic acid, PFOS, environmental exposure, glomerular filtration rate, risk factors, NHANES
- MeSH terms
- Adult, Caprylates, Environmental Exposure, Female, Fluorocarbons, Glomerular Filtration Rate, Humans, Kidney Failure, Chronic, Male, Middle Aged, Nutrition Surveys, Alkanesulfonic Acids
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