Conway Baqiyyah N, Badders Ashley N, Costacou Tina, Arthur John M, Innes Kim E
Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA,
Department of Community Health, School of Rural and Community Health, University of Texas Health Science Center at Tyler, Tyler, TX, USA,
Diabetes Metab Syndr Obes. 2018 Nov 15;11:707-716. doi: 10.2147/DMSO.S173809. eCollection 2018.
Anemia often complicates chronic kidney disease (CKD), leading to insufficient tissue oxygenation and hypoxic injury, the factor thought to underlie progression from CKD to renal failure. Perfluorocarbons are potent oxygen transporters used in organ preservation and synthetic blood development. Data are scarce on their relationship with kidney function, especially in diabetes where anemia and hypoxia are more prevalent. We investigated the relationship of perfluoroalkyl acids (PFAS) with kidney function and variation by diabetes and anemia status.
Data on 53,650 adults (5,210 with diabetes) were obtained from the C8 Health Project. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m. Four PFAS were investigated: perfluorohexane sulfonate (PFHxS), perfluorooctanoic acid, perfluorooctane sulfonate, and perfluorononanoic acid.
Each PFAS was positively associated with eGFR among those with CKD or anemia; this was the strongest among those with both CKD and anemia, followed by those with CKD uncomplicated by anemia. These relationships were more pronounced among those with diabetes (all <0.01). In the absence of both CKD and anemia, PFAS was inversely associated with eGFR. Among persons with both anemia and diabetes, when further stratified by CKD stage, compared to an eGFR <30, ORs (95% CI) for being in the eGFR ≥ 90, 60-89, 45-59, and 30-45 range, respectively, were 3.20 (2.00-5.13), 2.64 (1.83-3.80), 3.18 (2.17-4.67), and 1.99 (1.38-2.86) for each ng/dL increase in PFHxS. Results were similar for each PFAS.
PFAS are inversely associated with kidney function in CKD and diabetes, with a stronger relation observed when anemia is present.
贫血常使慢性肾脏病（CKD）复杂化，导致组织氧合不足和缺氧性损伤，这一因素被认为是CKD进展至肾衰竭的潜在原因。全氟碳化物是用于器官保存和合成血液研发的强效氧转运体。关于它们与肾功能关系的数据很少，尤其是在贫血和缺氧更为普遍的糖尿病患者中。我们研究了全氟烷基酸（PFAS）与肾功能的关系以及在糖尿病和贫血状态下的差异。
从C8健康项目中获取了53650名成年人（5210名患有糖尿病）的数据。CKD被定义为估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²。研究了四种PFAS：全氟己烷磺酸（PFHxS）、全氟辛酸、全氟辛烷磺酸和全氟壬酸。
在患有CKD或贫血的人群中，每种PFAS都与eGFR呈正相关；在同时患有CKD和贫血的人群中这种相关性最强，其次是患有CKD但无贫血的人群。这些关系在糖尿病患者中更为明显（所有P<0.01）。在既无CKD也无贫血的情况下，PFAS与eGFR呈负相关。在同时患有贫血和糖尿病的人群中，按CKD分期进一步分层后，与eGFR<30相比，PFHxS每增加1 ng/dL，eGFR≥90、60 - 89、45 - 59和30 - 45范围的比值比（95%可信区间）分别为3.20（2.00 - 5.13）、2.64（1.83 - 3.80）、3.18（2.17 - 4.67）和1.99（1.38 - 2.86）。每种PFAS的结果相似。
PFAS与CKD和糖尿病患者的肾功能呈负相关，在存在贫血时这种关系更为明显。
