Bisphenol A in chronic kidney disease

Area of Science:

• Environmental Health
• Nephrology
• Toxicology

Background:

• Bisphenol A (BPA) is an endocrine-disrupting substance found in consumer plastics, including medical devices like dialyzers.
• Impaired renal function can affect the body's ability to clear toxins, potentially leading to higher BPA levels.

Purpose of the Study:

• To investigate plasma BPA levels in patients with varying stages of chronic kidney disease (CKD).
• To determine if different dialyzer types, varying in elutable BPA, influence plasma BPA levels in maintenance hemodialysis patients.

Main Methods:

• In vitro elution of BPA from three dialyzer types (PUR-H, HF-PSu, LF-PSu).
• Cross-sectional study of plasma BPA in 152 CKD patients.
• Prospective, randomized crossover study in 18 hemodialysis patients using different dialyzers.
• Determination of protein-bound and free BPA fractions.

Main Results:

• BPA elution in vitro was lowest for PUR-H, intermediate for HF-PSu, and highest for LF-PSu.
• Plasma BPA levels rose after CKD stage 3 and were significantly higher in hemodialysis patients compared to CKD stage 5 patients not on dialysis.
• Plasma BPA concentrations inversely correlated with renal function and were substantially higher than in healthy controls.
• No significant changes in plasma BPA levels were observed during hemodialysis with any dialyzer type over 4 weeks.
• Approximately 74% of plasma BPA in dialysis patients was protein-bound.

Conclusions:

• Renal function and ingested BPA quantity are key determinants of plasma BPA levels.
• While dialyzers contribute BPA, differences in elutable BPA do not significantly affect plasma levels in Western European maintenance dialysis patients.
• High protein binding limits the removal of BPA by hemodialysis.