Université de Poitiers, CNRS, EBI, F-86000 Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation Clinique CIC1402, Axe santé Environnementale, Poitiers, France; CHU de Poitiers, Biology-Pharmacy-Public Health Department, F-86000 Poitiers, France.
CHU de Poitiers, Digestiv, Urology, Nephrology, Endocrinology Department, F-86000 Poitiers, France.
Ecotoxicol Environ Saf. 2024 Jan 15;270:115880. doi: 10.1016/j.ecoenv.2023.115880. Epub 2023 Dec 29.
Patients with end stage kidney disease treated by dialysis (ESKDD) process dialysis sessions to remove molecules usually excreted by kidneys. However, dialysis therapy could also contribute to endocrine disruptors (ED) burden. Indeed, materials like dialyzer filters, ultrapure dialysate and replacement fluid could exposed ESKDD patients to Bisphenol A (BPA) and chlorinated derivatives of BPA (ClxBPAs). Thus, our aim was to compare BPA and ClxBPAs exposure between ESKDD patients, patients with stage 5 chronic kidney disease (CKD5) not dialyzed and healthy volunteers. Then we describe the impact of a single dialysis session, according to dialysis modalities (hemodialysis therapy (HD) versus online hemodiafiltration therapy (HDF)) and materials used with pre-post BPA and ClxBPAs concentrations. The plasma levels of BPA and four ClxBPAs, were assessed for 64 ESKDD patients in pre and post dialysis samples (32 treated by HD and 32 treated by HDF) in 36 CKD5 patients and in 24 healthy volunteers. BPA plasma concentrations were 22.5 times higher for ESKDD patients in pre-dialysis samples versus healthy volunteers (2.208 ± 5.525 ng/mL versus 0.098 ± 0.169 ng/mL) (p < 0.001). BPA plasma concentrations were 16 times higher for CKD5 patients versus healthy volunteers, but it was not significant (1.606 ± 3.230 ng/mL versus 0.098 ± 0.169 ng/mL) (p > 0.05). BPA plasma concentrations for ESKDD patients in pre-dialysis samples were 1.4 times higher versus CKD5 patients (2.208 ± 5.525 ng/mL versus 1.606 ± 3.230 ng/mL) (p < 0.001). For healthy volunteers, ClxBPAs were never detected, or quantified while for CKD5 and ESKDD patients one ClxBPAs at least has been detected or quantified in 14 patients (38.8%) and 24 patients (37.5%), respectively. Dialysis therapy was inefficient to remove BPA either for HD (1.983 ± 6.042 ng/mL in pre-dialysis versus 3.675 ± 8.445 ng/mL in post-dialysis) or HDF (2.434 ± 5.042 ng/mL in pre-dialysis versus 7.462 ± 15.960 ng/mL in post dialysis) regarding pre-post BPA concentrations (p > 0.05). The same result was observed regarding ClxBPA analysis. Presence of polysulfone in dialyzer fibers overexposed ESKDD patients to BPA in pre-dialysis samples with 3.054 ± 6.770 for ESKDD patients treated with a polysulfone dialyzer versus 0.708 ± 0.638 (p = 0.040) for ESKDD patients treated without a polysulfone dialyzer and to BPA in post-dialysis samples with 6.629 ± 13.932 for ESKDD patients treated with a polysulfone dialyzer versus 3.982 ± 11.004 (p = 0.018) for ESKDD patients treated without a polysulfone dialyzer. This work is to our knowledge the first to investigate, the impact of a dialysis session and materials used on BPA and ClxBPAs plasma concentrations and to compare these concentrations to those found in CKD5 patients and in healthy volunteers.
患者接受透析（ESKDD）治疗终末期肾病（ESKDD）的过程中，通过透析来清除肾脏通常排泄的分子。然而，透析疗法也可能导致内分泌干扰物（ED）负担。事实上，透析器过滤器、超纯透析液和置换液等材料可能会使 ESKDD 患者接触到双酚 A（BPA）和 BPA 的氯化衍生物（ClxBPAs）。因此，我们的目的是比较 ESKDD 患者、未接受透析的 5 期慢性肾脏病（CKD5）患者和健康志愿者之间的 BPA 和 ClxBPAs 暴露情况。然后，我们描述了单次透析治疗对 BPA 和 ClxBPAs 浓度的影响，根据透析方式（血液透析治疗（HD）与在线血液透析滤过治疗（HDF））和使用的材料进行比较。在 64 名 ESKDD 患者（32 名接受 HD 治疗，32 名接受 HDF 治疗）、36 名 CKD5 患者和 24 名健康志愿者的透析前和透析后样本中，评估了 BPA 和四种 ClxBPAs 的血浆水平。与健康志愿者相比，ESKDD 患者透析前样本中的 BPA 血浆浓度高 22.5 倍（2.208 ± 5.525 ng/mL 比 0.098 ± 0.169 ng/mL）（p < 0.001）。与健康志愿者相比，CKD5 患者的 BPA 血浆浓度高 16 倍，但差异无统计学意义（1.606 ± 3.230 ng/mL 比 0.098 ± 0.169 ng/mL）（p > 0.05）。与 CKD5 患者相比，ESKDD 患者透析前样本中的 BPA 血浆浓度高 1.4 倍（2.208 ± 5.525 ng/mL 比 1.606 ± 3.230 ng/mL）（p < 0.001）。对于健康志愿者，从未检测到或定量检测到 ClxBPAs，而对于 CKD5 和 ESKDD 患者，在 14 名患者（38.8%）和 24 名患者（37.5%）中至少检测到或定量检测到一种 ClxBPAs。HD（透析前 3.675 ± 8.445 ng/mL，透析后 3.675 ± 8.445 ng/mL）或 HDF（透析前 7.462 ± 15.960 ng/mL，透析后 7.462 ± 15.960 ng/mL）的透析治疗均不能有效去除 BPA，这两种治疗方法的透析前和透析后 BPA 浓度之间没有显著差异（p > 0.05）。ClxBPA 分析也得到了同样的结果。透析器纤维中的聚砜材料使 ESKDD 患者在透析前样本中接触到更多的 BPA，接受聚砜透析器治疗的 ESKDD 患者为 3.054 ± 6.770 ng/mL，而不使用聚砜透析器治疗的 ESKDD 患者为 0.708 ± 0.638 ng/mL（p = 0.040）。在透析后样本中，接受聚砜透析器治疗的 ESKDD 患者为 6.629 ± 13.932 ng/mL，而不使用聚砜透析器治疗的 ESKDD 患者为 3.982 ± 11.004 ng/mL（p = 0.018）。这项工作是我们所知的首次调查透析治疗和使用的材料对 BPA 和 ClxBPAs 血浆浓度的影响，并将这些浓度与 CKD5 患者和健康志愿者的浓度进行比较。
