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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Renal Function and exposure to Bisphenol A and phthalates in children with Chronic Kidney Disease
Julia Malits1, Teresa M Attina1, Rajendiran Karthikraj2
1Department of Pediatrics, Divisions of Nephrology and Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA.
Insights
Children with chronic kidney disease (CKD) showed lower exposure to Bisphenol A (BPA) and phthalates than healthy peers. BPA was not linked to kidney function measures, but some phthalates were associated with improved kidney function in pediatric CKD patients.
Area of Science:
- Environmental Health
- Pediatric Nephrology
- Toxicology
Background:
- Ubiquitous exposure to Bisphenol A (BPA) and phthalates affects US children.
- Children with chronic kidney disease (CKD) may face heightened risks from these exposures.
- Understanding chemical exposure in pediatric CKD is crucial for health risk assessment.
Purpose of the Study:
- To assess BPA and phthalate exposure levels in children with CKD.
- To investigate the association between these exposures and kidney function markers in pediatric CKD patients.
Main Methods:
- Cross-sectional study analyzing data from the Chronic Kidney Disease in Children (CKiD) cohort (N=538).
- Compared urinary BPA and phthalate levels in CKiD participants (ages 1-17) with the National Health and Nutrition Examination Survey (NHANES) cohort.
- Evaluated relationships between chemical exposures and blood pressure, proteinuria, and estimated glomerular filtration rate (eGFR).
Main Results:
- Urinary BPA and phthalate levels were lower in the CKiD cohort compared to healthy children.
- BPA exposure showed no significant association with blood pressure, proteinuria, or eGFR.
- Certain phthalates (LMW) were inversely associated with proteinuria and positively associated with eGFR in children with CKD.
Conclusions:
- Children with CKD in this cohort did not exhibit elevated BPA and phthalate exposure.
- Further longitudinal studies are needed to understand the long-term health effects of these exposures in pediatric CKD.
- Observed associations suggest potential protective effects of some phthalates on kidney function in this population.
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.
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