Rationale and objective

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.

Study design

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.

Results

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).

Limitations

Lack of longitudinal data, limited assessment of diet and nutritional status.

Conclusion

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.

中文翻译：

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慢性肾病儿童的肾功能和双酚 A 和邻苯二甲酸盐的暴露。

理由和目标

在美国，成人和儿童普遍接触双酚 A (BPA) 和邻苯二甲酸盐。在儿童和青少年中，患有慢性肾病 (CKD) 的人可能面临更大的因接触 BPA 和邻苯二甲酸盐而产生不良影响的风险。本研究的目的是评估 CKD 儿童的 BPA 和邻苯二甲酸盐暴露情况，并评估与三种肾功能指标的关联。

学习规划

横断面研究。

设置、参与者和测量

儿童慢性肾病 (CKiD) 研究代表了 CKD 人群，这是一项针对美国肾功能受损儿童的多中心前瞻性队列研究。主要结果是评估 CKiD 入组时化学品暴露与临床实验室检查结果之间的关系。对 1 至 17 岁参与者 (N = 538) 收集的基线数据进行了分析。此时评估尿液 BPA 和邻苯二甲酸盐水平。来自全国健康和营养检查调查 (NHANES) 的数据（具有全国代表性的儿科人群）用于与 CKiD 队列进行比较。

结果

CKiD 人群的尿液 BPA 和邻苯二甲酸盐水平始终低于健康儿童中检测到的水平。此外，BPA 与血压、蛋白尿或估计肾小球滤过率 (eGFR) 没有显着相关性。在 CKiD 人群中，对于选定的单独和组合邻苯二甲酸盐，与尿蛋白：肌酐比值呈负相关（LMW 邻苯二甲酸盐，- 9.53% 变化；95% CI：- 14.21，- 4.21；p = 0.001），并且大多数情况下，与 eGFR 呈正相关（低分子量邻苯二甲酸盐，eGFR 增加 3.46 个单位，95% CI：1.85, 5.07；p < 0.001）。

局限性

缺乏纵向数据，饮食和营养状况评估有限。

结论

在研究队列中，患有 CKD 的儿童接触 BPA 和邻苯二甲酸盐的情况并未增加。重复测量的纵向研究可能会提供更多关于长期接触 BPA 和邻苯二甲酸盐对 CKD 儿科患者可能产生的健康影响的信息。