228Relationship of pesticide exposure with kidney function in NHANES: lessons from low level chronic exposure

Abstract

Background Exposure to pesticides has been linked to many health outcomes. More recently, chronic kidney disease not related to diabetes or hypertension (CKDu) has been postulated to be related to rural occupational exposures in agricultural workers in several Low to Middle Income Country (LMIC) regions such as Mesoamerica and the Subcontinent. Our study wished to examine the relationship between pesticide exposure and kidney function. Methods We used the resources of pooled population from NHANES 2001-2004, 2007-2010 (n = 29,053). We examined pesticide exposure (logged, continuous) with kidney function as measured by glomerular filtration rate (derived from urinary creatinine) with and without presence of hypertension and diabetes. Logistic regression was adjusted for a range of cofactors such as age, sex, SES, tobacco, and heavy metals. Cadmium was used as a positive control. Results Pesticides 2,4-D, chlorpyrifos, malathion and 3-phenoxybenzoic acid (the major metabolite of deltamethrin) were associated with the increasing risk of kidney dysfunction (not with hypertension or diabetes) after adjusting for a range of known risk factors (OR 1.80 (1.47-2.21); 2.16 (1.57-2.98); 1.20 (0.94-1.54) and 1.40 (1.19-1.64), respectively). Cd was not associated with kidney dysfunction (OR 0.99 (0.81-1.21)), or acephate (OR 0.43 (0.13-1.48)). Conclusions Chronic or acute pesticide exposure may increase the risk of kidney dysfunction, which is not related to hypertension or diabetes in particular. It may have a different pathological pathway from heavy metal exposures and CKD. This has repercussions for interventions in LMIC agricultural practices. Key messages Pesticides are associated with kidney dysfunction not related to hypertension and diabetes.

Two decades of chronic kidney disease of unknown aetiology (CKDu) research: Existing evidence and persistent gaps from epidemiological studies in Sri Lanka

“…Currently, no available studies have sufficient evidence to establish causality for agrochemical usage as a putative exposure for CKDu. A clear link between agrochemical usage and CKD has been demonstrated in other settings, with a recent review of NHANES data demonstrating an increased risk of kidney disease associated with both acute and chronic pesticide exposure 41 . Many existing studies in Sri Lanka are of limited utility in making conclusions due to possible bias in: timing of sample collection, selection of locations, recall self‐report bias, failure to distinguish between different agrochemical usage, and failure to adequately capture usage of personal protective equipment (PPE).…”

“…A clear link between agrochemical usage and CKD has been demonstrated in other settings, with a recent review of NHANES data demonstrating an increased risk of kidney disease associated with both acute and chronic pesticide exposure. 41 Many existing studies in Sri Lanka are of limited utility in making conclusions due to possible bias in: timing of sample collection, selection of locations, recall self‐report bias, failure to distinguish between different agrochemical usage, and failure to adequately capture usage of personal protective equipment (PPE). Differences in exposure measurement between studies may have contributed to some case–control and prevalence studies showing a strong association, 23 , 31 , 33 while others have shown a weak or no association.…”