Department of Pediatrics, Divisions of Nephrology and Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA.
Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, NY, USA.
Environ Res. 2018 Nov;167:575-582. doi: 10.1016/j.envres.2018.08.006. Epub 2018 Aug 9.
Exposure to Bisphenol A (BPA) and phthalates is ubiquitous among adults and children in the United States. Among children and adolescents, those with chronic kidney disease (CKD) are potentially at greater risk of adverse effects from BPA and phthalate exposure. The objective of this study was to evaluate BPA and phthalate exposure among children with CKD and evaluate associations with three measures of kidney function.
Cross sectional study.
SETTING, PARTICIPANTS, AND MEASUREMENTS: The CKD population was represented by the Chronic Kidney Disease in Children (CKiD) Study, a multicenter, prospective cohort study of children with impaired kidney function in the US. The main outcome was assessment of the relationship between chemical exposures and clinical laboratory findings at enrollment into CKiD. Data collected at baseline from participants 1 to 17 years old (N = 538) were analyzed. Urinary BPA and phthalate levels were evaluated at this time point. Data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative pediatric population, were used for comparison to the CKiD cohort.
Urinary BPA and phthalate levels in the CKiD population were consistently lower than levels detected in healthy children. Additionally, BPA was not significantly associated with blood pressure, proteinuria, or estimated glomerular filtration rate (eGFR). Within the CKiD population, for select individual and combined phthalates, there was an inverse relationship with the urinary protein:creatinine ratio (LMW phthalates, - 9.53% change; 95% CI: - 14.21, - 4.21; p = 0.001), and in most cases, a positive relationship with eGFR (LMW phthalates, a 3.46 unit increase in eGFR, 95% CI: 1.85, 5.07; p < 0.001).
Lack of longitudinal data, limited assessment of diet and nutritional status.
In the study cohort, children with CKD did not have increased exposure to BPA and phthalates. Longitudinal studies with repeated measures are likely to be more informative about the possible health effects of prolonged exposure to BPA and phthalates in pediatric patients with CKD.
双酚 A（BPA）和邻苯二甲酸酯在美国的成年人和儿童中普遍存在。在儿童和青少年中，患有慢性肾脏病（CKD）的儿童可能面临更大的 BPA 和邻苯二甲酸酯暴露的不良影响。本研究的目的是评估 CKD 儿童的 BPA 和邻苯二甲酸酯暴露情况，并评估其与三种肾功能指标的关系。
横断面研究。
地点、参与者和测量：CKiD 研究代表了 CKD 人群，这是一项在美国进行的多中心、前瞻性队列研究，纳入了有肾功能受损的儿童。主要结局是评估化学暴露与 CKiD 入组时临床实验室发现之间的关系。分析了来自年龄在 1 至 17 岁（n=538）的参与者基线时的数据。此时评估了尿液中的 BPA 和邻苯二甲酸酯水平。使用来自全国健康和营养调查（NHANES）的数据与 CKiD 队列进行比较，NHANES 是一个具有全国代表性的儿科人群。
CKiD 人群的尿液 BPA 和邻苯二甲酸酯水平始终低于健康儿童的检测水平。此外，BPA 与血压、蛋白尿或估计肾小球滤过率（eGFR）均无显著相关性。在 CKiD 人群中，对于特定的个体和组合邻苯二甲酸酯，与尿蛋白/肌酐比值呈负相关（LMW 邻苯二甲酸酯，-9.53%变化；95%CI：-14.21，-4.21；p=0.001），在大多数情况下，与 eGFR 呈正相关（LMW 邻苯二甲酸酯，eGFR 增加 3.46 个单位，95%CI：1.85，5.07；p<0.001）。
缺乏纵向数据，对饮食和营养状况的评估有限。
在研究队列中，CKD 儿童的 BPA 和邻苯二甲酸酯暴露并未增加。具有重复测量的纵向研究可能更能提供有关儿科 CKD 患者长期暴露于 BPA 和邻苯二甲酸酯可能产生的健康影响的信息。
