Background

Chronic kidney disease (CKD) is a growing concern worldwide. Exposure to xenoestrogens (XEs), such as phthalates, parabens, and phenols, lead to CKD. However, kidney function and its complex relationship with XEs, lifestyle, and dietary habits are not well understood.

Methods

In the present cross-sectional community-based cohort study, we enrolled 887 subjects for a questionnaire-based interview and laboratory tests. XE exposure concerning lifestyle/dietary habits were evaluated using questionnaires. Urinary levels of 17XE metabolites were measured in 60 subjects with high exposure risk scores and 60 subjects with low exposure risk scores.

Results

Univariate and multivariate linear regression showed that a high exposure score (β ± SE: 4.226 ± 1.830, P = 0.021) was independently negatively associated with eGFR in 887 subjects. Univariate and multivariate linear regression to urinary XEs and urine albumin creatinine excretion ratio (UACR) in 120 subjects indicated that ethylparaben (EP) (β: 1.934, 95% CI: 0.135–3.733, P = 0.035) was significantly associated with increased UACR. Multivariate regression analyses of the CKD subgroup (n = 38), after adjusting for age, showed that higher levels of mono-(2-ethylhexyl) phthalate (MEHP), EP, nonylphenol (NP), and benzophenone-3 (BP-3) were significantly associated with lower estimated glomerular filtration rate (eGFR). Higher urinary levels of MEHP (OR: 3.037, 95% CI: 1.274–7.241) were more likely associated with high exposure scores (>5 points), after adjusting for diabetes, gender, eGFR, age, Na, Ca, albumin, vitamin D, systolic blood pressure (SBP), white blood cell count, total bilirubin, aspartate transaminase, and heart rate. MEHP (β ± SE: 0.033 ± 0.009, P < 0.001) was also significantly positively associated with total exposure scores after applying multivariate linear regression analyses.

Conclusion

XE exposure scores obtained from the questionnaires were negatively associated with kidney function. Urinary metabolites of XEs, including EP, NP, BP-3, and MEHP, are potential risk factors for microalbuminuria and decline in kidney function. MEHP seemed to have the strongest correlation with high exposure scores and decline in kidney function.

中文翻译：

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普通人群中的异种雌激素暴露和肾功能：通过实验室测试和问卷调查得出的基于社区的研究结果

背景

慢性肾脏病 (CKD) 在全球范围内日益受到关注。暴露于异雌激素 (XE)，如邻苯二甲酸盐、对羟基苯甲酸酯和苯酚，会导致 CKD。然而，肾功能及其与 XE、生活方式和饮食习惯的复杂关系尚不清楚。

方法

在目前的基于社区的横断面队列研究中，我们招募了 887 名受试者进行基于问卷的访谈和实验室测试。使用问卷评估与生活方式/饮食习惯有关的 XE 暴露。在 60 名暴露风险评分高的受试者和 60 名暴露风险评分低的受试者中测量了 17XE 代谢物的尿液水平。

结果

单变量和多变量线性回归显示，在 887 名受试者中，高暴露评分（β ± SE：4.226 ± 1.830，P = 0.021）与 eGFR 独立负相关。对 120 名受试者的尿 XE 和尿白蛋白肌酐排泄率 (UACR) 进行单变量和多变量线性回归表明，对羟基苯甲酸乙酯 (EP) (β: 1.934, 95% CI: 0.135–3.733, P = 0.035) 与 UACR 增加显着相关。CKD 亚组 (n = 38) 的多变量回归分析在调整年龄后显示，邻苯二甲酸单 (2-乙基己酯) (MEHP)、EP、壬基酚 (NP) 和二苯甲酮-3 (BP-3) 水平较高) 与较低的估计肾小球滤过率 (eGFR) 显着相关。在调整糖尿病、性别、eGFR、年龄、Na、Ca、白蛋白、维生素后，较高的尿 MEHP 水平（OR：3.037，95% CI：1.274-7.241）更可能与高暴露评分（>5 分）相关D、收缩压（SBP）、白细胞计数、总胆红素、天冬氨酸转氨酶和心率。MEHP (β ± SE: 0.033 ± 0.009, P < 0.001）在应用多元线性回归分析后也与总暴露评分显着正相关。

结论

从问卷中获得的 XE 暴露评分与肾功能呈负相关。XEs 的尿液代谢物，包括 EP、NP、BP-3 和 MEHP，是微量白蛋白尿和肾功能下降的潜在危险因素。MEHP 似乎与高暴露评分和肾功能下降具有最强的相关性。