Environmental exposure to perchlorate, nitrate, and thiocyanate in relation to chronic kidney disease in the general US population, NHANES 2005–2016

Chinese Medical Journal · 4 authors, 2 centres

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TL;DR

This cross-sectional study of 13,373 US adults analyzed urinary levels of perchlorate, nitrate, and thiocyanate in relation to kidney function markers. The central result was that higher urinary levels of nitrate and thiocyanate were associated with better kidney function markers (higher eGFR, lower ACR) and a lower prevalence of chronic kidney disease.

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Multivariable regression and restricted cubic splines were used. After adjustment, nitrate and thiocyanate were positively associated with estimated glomerular filtration rate (eGFR) and negatively associated with urinary albumin-to-creatinine ratio (ACR); higher levels were linked to lower chronic kidney disease (CKD) risk. Perchlorate showed significant associations primarily with ACR. Dose-response associations were observed in quartile analyses, and non-linear L-shaped relationships were found for some exposures. Limitations include the cross-sectional design, which prevents causal inference and may involve reverse causality, as well as potential unmeasured confounders and reliance on single exposure measurements. The findings suggest possible associations between environmental PNT exposure and better kidney function in the general population, but prospective studies are needed to confirm causality.

STUDY TYPE

cross-sectional

SPECIALTY

nephrology

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ORIGINAL PAPER

PMC10325772

Environmental exposure to perchlorate, nitrate, and thiocyanate in relation to chronic kidney disease in the general US population, NHANES 2005–2016

Chinese Medical Journal

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ABSTRACT

Abstract Background: Few studies have explored the impact of perchlorate, nitrate, and thiocyanate (PNT) on kidney function. This study aimed to evaluate the association of urinary levels of PNT with renal function as well as the prevalence of chronic kidney disease (CKD) among the general population in the United States. Methods: This analysis included data from 13,373 adults (≥20 years) from the National Health and Nutrition Examination Survey 2005 to 2016. We used multivariable linear and logistic regression, to explore the associations of urinary PNT with kidney function. Restricted cubic splines were used to assess the potentially non-linear relationships between PNT exposure and outcomes. Results: After traditional creatinine adjustment, perchlorate (P-traditional) was positively associated with estimated glomerular filtration rate (eGFR) (adjusted β: 2.75; 95% confidence interval [CI]: 2.25 to 3.26; P < 0.001), and negatively associated with urinary albumin-to-creatinine ratio (ACR) (adjusted β: −0.05; 95% CI: −0.07 to −0.02; P = 0.001) in adjusted models. After both traditional and covariate-adjusted creatinine adjustment, urinary nitrate and thiocyanate were positively associated with eGFR (all P values <0.05), and negatively associated with ACR (all P values <0.05); higher nitrate or thiocyanate was associated with a lower risk of CKD (all P values <0.001). Moreover, there were L-shaped non-linear associations between nitrate, thiocyanate, and outcomes. In the adjusted models, for quartiles of PNT, statistically significant dose–response associations were observed in most relationships. Most results were consistent in the stratified and sensitivity analyses. Conclusions: Exposures to PNT might be associated with kidney function, indicating a potential beneficial effect of environmental PNT exposure (especially nitrate and thiocyanate) on the human kidney.

CITATION EXPORT

Wei Li, Hong Wu, Xuewen Xu et al.. Environmental exposure to perchlorate, nitrate, and thiocyanate in relation to chronic kidney disease in the general US population, NHANES 2005–2016. Chinese Medical Journal. (2023). https://doi.org/10.1097/CM9.0000000000002586

AUTHORS

4 · 2 CENTRES

Wei Li, Hong Wu, Xuewen Xu, Yange Zhang

1Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
2Department of Liver Surgery and Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, Sichuan 610041, China.

EDITOR / REVIEWER

Jinjiao Li, Yuanyuan Ji