Haruna Issah, Obeng-Gyasi Emmanuel
Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA.
Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA.
Pollutants. 2025 Jun;5(2). doi: 10.3390/pollutants5020012. Epub 2025 May 13.
Chronic kidney disease (CKD) is a noteworthy global health issue affecting 10% of the world's populace. It is increasingly linked to environmental exposures; however, the interplay of toxic metals, per- and polyfluoroalkyl substances (PFAS), and essential elements has not been fully elucidated. This cross-sectional study analyzed 5800 out of the 9245 participants from the 2017-2018 NHANES dataset to evaluate the combined effect of PFAS, essential elements, and toxic metals on CKD using logistic regression and advanced environmental mixture models, namely, Bayesian Kernel Machine Regression (BKMR), quantile g-computation (qgcomp), and Weighted Quantile Sum (WQS) regression. Our results showed cadmium (Cd) emerging as a significant contributor to CKD (OR = 2.16, = 0.023) from the logistic regression analysis. Mercury (Hg) demonstrated the highest contribution in mixtures (posterior inclusion probability = 0.908) from our BKMR analysis, with a non-linear U-shaped dose-response relationship. Essential elements like selenium (Se) and manganese (Mn) exhibited protective correlations but complex non-linear interactions, moderating toxic metal effects from our qgcomp and WQS regression. Notably, antagonistic interactions between essential elements and some pollutants reduced the overall mixture impact on CKD, showing an overall decreasing joint effect of the combined PFAS, toxic metals, and essential elements on CKD, from the 25th to the 75th quantile. This study highlights the role of environmental co-exposures in CKD risk and highlights the need for advanced statistical and machine learning approaches in studying complex environmental mixture interactions on human health.
慢性肾脏病（CKD）是一个值得关注的全球健康问题，影响着全球10%的人口。它与环境暴露的关联日益紧密；然而，有毒金属、全氟和多氟烷基物质（PFAS）以及必需元素之间的相互作用尚未完全阐明。这项横断面研究分析了2017 - 2018年美国国家健康与营养检查调查（NHANES）数据集中9245名参与者中的5800名，使用逻辑回归和先进的环境混合模型，即贝叶斯核机器回归（BKMR）、分位数g计算（qgcomp）和加权分位数和（WQS）回归，来评估PFAS、必需元素和有毒金属对CKD的综合影响。我们的结果显示，逻辑回归分析表明镉（Cd）是CKD的一个重要促成因素（比值比 = 2.16，P = 0.023）。我们的BKMR分析表明汞（Hg）在混合物中的贡献最大（后验包含概率 = 0.908），呈现非线性U形剂量反应关系。硒（Se）和锰（Mn）等必需元素表现出保护相关性，但存在复杂的非线性相互作用，从我们的qgcomp和WQS回归来看，它们减轻了有毒金属的影响。值得注意的是，必需元素与一些污染物之间的拮抗相互作用降低了混合物对CKD的总体影响，从第25到第75分位数显示，PFAS、有毒金属和必需元素组合对CKD的联合效应总体呈下降趋势。这项研究突出了环境共同暴露在CKD风险中的作用，并强调了在研究复杂环境混合物对人类健康的相互作用时采用先进统计和机器学习方法的必要性。
