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Differential impact of per- and polyfluoroalkyl substances exposure on hypertension risk by kidney function and
Yaerim Kim1, Inae Lee2, Jeonghwan Lee3
1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea.
Background:
Per- and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants increasingly linked to hypertension. However, the modifying effects of kidney function and metabolic health remain unclear. This study examined the associations between serum PFAS concentrations and hypertension, with a particular focus on kidney function and metabolic status as potential effect modifiers.
Methods:
Data were obtained from the Korean National Environmental Health Survey (KoNEHS, 2018-2020), which included adults aged 19 years or older with available serum PFAS, blood pressure, and kidney function data. Adjusted odds ratios for hypertension were estimated using multivariable logistic regression across PFAS quartiles, with stratified analyses by kidney function and metabolic status.
Results:
Among 2,993 participants, elevated levels of perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDeA), and total PFAS were associated with higher hypertension risk. Associations were more evident in individuals in the higher eGFR group, whereas effect estimates were attenuated in those with lower eGFR. In quartile-based analyses, positive exposure-response trends were observed for most PFAS, supporting the consistency of associations across exposure levels. Associations were stronger in participants with favorable metabolic profiles (e.g., without central obesity, normal triglycerides, high high-density lipoprotein cholesterol, normoglycemia) but attenuated in those with metabolic abnormalities.
Conclusions:
PFAS exposure is associated with an increased risk of hypertension, particularly among those in the higher eGFR range and favorable metabolic profiles. These findings highlight the need to consider related disease phenotypes when assessing PFAS-associated cardiovascular toxicity and emphasize the importance of exposure mitigation in the healthy general population.
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