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Melamine exposure threshold in early chronic kidney disease patients - A benchmark dose approach

Chu-Chih Chen1, Yi-Chun Tsai2, Yin-Han Wang3

  • 1Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Taiwan.

Environment International
|May 25, 2021
PubMed

Insights

Environmental melamine exposure can harm kidney function in early-stage chronic kidney disease (CKD) patients. Safe melamine intake levels are much lower than current guidelines, suggesting avoidance of melamine products for CKD individuals.

Area of Science:

  • Environmental Health
  • Nephrology
  • Toxicology

Background:

  • Environmental melamine exposure is linked to worsening kidney function in patients with early-stage chronic kidney disease (CKD).
  • Establishing safe exposure thresholds is crucial for protecting kidney health in vulnerable populations.

Purpose of the Study:

  • To determine a benchmark dose (BMD) for melamine exposure in patients with early-stage CKD (eGFR ≥ 30 ml/min per 1.73 m²).
  • To compare derived melamine exposure thresholds with current international tolerable daily intake recommendations.

Main Methods:

  • A benchmark dose (BMD) approach was applied to 293 early-stage CKD patients.
  • Melamine intake was estimated from spot urine samples, and kidney outcomes (serum creatinine, eGFR decline) were monitored over a median of 7.0 years.
  • Bayesian model averaging was used to derive BMD and lower confidence limits (BMDLs) for dichotomous and continuous kidney outcomes.

Main Results:

  • The study established BMDLs for melamine exposure ranging from 0.74 to 2.03 μg/kg body weight/day.
  • These derived BMDLs are one to two orders of magnitude lower than the WHO's tolerable daily intake (200 μg/kg/day) and the US FDA's guideline (63 μg/kg/day).
  • Kidney outcomes analyzed included doubling of serum creatinine, annual eGFR decline, and percentage decline in eGFR.

Conclusions:

  • Current tolerable daily intake levels for melamine may not be sufficiently protective for early-stage CKD patients.
  • Early-stage CKD patients are advised to strictly avoid melamine tableware and other melamine-containing products to prevent kidney function deterioration.
  • This research highlights the need for revised safety guidelines regarding melamine exposure in individuals with compromised kidney function.
Keywords:
Average daily intakeBayesian model averagingCox regression modelMarkov chain Monte Carlo simulationsMixed model

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