Table 1.
Human epidemiologic studies (1990–2018) investigating per- and polyfluoroalkyl substances exposure and kidney health
| Authors | Study Years | Study Design | Setting | Population | Sample Size | Exposure | Kidney Outcome | Major Findings | Summary Notes |
|---|---|---|---|---|---|---|---|---|---|
| Direct exposure assessments (n=11) | |||||||||
| Dhingra et al. (7) | 1952–2012 | Cross-sectional | Community surrounding manufacturer | Adults living in eligible area | 29,499 | PFOAa | eGFR | Association present | Negative trend in eGFR across measured serum PFOA quintiles (β=−0.64 to −1.03; P=0.01) |
| Kataria et al. (8) | 2003–2010 | Cross-sectional | NHANES | Children 12–19 yr old | 1960 | PFOS, PFOA, PFHxS, PFNA | eGFR | Association present | Increased odds (OR, 2.0; 95% CI, 1.4 to 2.9) for lower eGFR with increasing exposure levels for PFOS and PFOA |
| Shankar et al. (9) | 1999–2008 | Cross-sectional | NHANES | Adults >20 yr old | 4587 | PFOA, PFOS | eGFR, prevalent CKD | Association present | eGFR: 5.7 and 6.7 ml/min per 1.73 m2 lower with increasing exposure |
| Prevalent CKD: OR, 1.7 (95% CI, 1.0 to 2.9) and 1.8 (95% CI, 1.0 to 3.3) for PFOA and PFOS | |||||||||
| Vearrier et al. (10) | 2003–2008 | Cross-sectional | NHANES | Adults | 6305 | PFOA | Prevalent CKD, incident ESKD | Association present | Prevalent CKD: OR, 1.2 (95% CI, 1.1 to 1.3); incident ESKD: OR, 1.9 (95% CI, 1.2 to 3.0) |
| Watkins et al. (11) | 1989–2006 | Retrospective cohort | Community surrounding manufacturer | Children (1–18 yr old) living in eligible area | 9660 | PFOA, PFOS, PFHxS, PFNAa | eGFR | Association present | Negative trend in eGFR (−0.73 to −1.34 ml/min per 1.73 m2) with increasing exposure to each PFAS |
| Conway et al. (12) | 2017 | Cross-sectional | Community surrounding manufacturer | Adults living in eligible area | 53,650 | PFOA, PFOS, PFHxS, PFNA | eGFR | No observed association | No association with any PFAS |
| Emmett et al. (13) | 2003–2005 | Cross-sectional | Community surrounding manufacturer | Adults and children living in eligible areas | 371 | PFOA | Serum creatinine | No observed association | – |
| Olsen et al. (14) | 2003 | Cross-sectional | Occupational | Adult employees | 518 | PFOS | Serum creatinine | No observed association | – |
| Olsen et al. (15) | 2012 | Cross-sectional | Occupational | Male employees | 506 | PFOA, PFOA | eGFR, prevalent CKD | No observed association | No association with eGFR or prevalent CKD |
| Steenland et al. (16) | 2005–2006 | Cross-sectional | Community surrounding manufacturer | Adults living in the eligible area | 54,951 | PFOA, PFOS | Serum creatinine | No observed association | No observed association for PFOA or PFOS |
| Zhou et al. (17) | 2013 | Cross-sectional | Community surrounding manufacturer (China) | Manufacturer employees living in eligible area | 39 | PFOA, PFOS, PFHxS | Serum creatinine | No observed association | No observed association for PFOA, PFOS, or PFHxS |
| Indirect exposure assessments (n=10) | |||||||||
| Alexander et al. (18) | 1961–1997 | Retrospective cohort | Occupational | Adult employees | 2083 | PFOS | Genitourinary and kidney cancer | Association present | Genitourinary and kidney cancer: SMR, 12.8 (95% CI, 2.6 to 37.4) |
| Barry et al. (19) | 1952–2011 | Retrospective cohort | Community surrounding manufacturer | Adults living in eligible area | 32,254 | PFOA | Kidney cancer | Association present | Kidney cancer: HR, 1.1 (95% CI, 1.0 to 1.2) per each unit increase in PFOA |
| Consonni et al. (20) | 1950–2008 | Retrospective cohort | Community surrounding manufacturer | Male employees | 5879 | PFOA | Mortality from kidney cancer | Association present | Kidney cancer: SMR, 1.7 (95% CI, 0.8 to 3.1) |
| Mastrantonio et al. (21) | 1980–2013 | Retrospective cohort (ecological) | Community surrounding manufacturer | High-risk districts | 24 districts | PFOA, PFOS | Mortality from kidney cancer | Association present | Kidney cancer: SMR, 1.1 (95% CI, 0.9 to 1.2) |
| Steenland et al. (22) | 1979–2004 | Retrospective cohort | Occupational | Adult employees | 5791 | PFOAa | Mortality from kidney cancer | Association present | Kidney cancer: SMR, 1.3 (95% CI, 0.7 to 2.2) |
| Vieira et al. (23) | 1996–2005 | Retrospective cohort (ecological) | Community surrounding manufacturer | High-risk districts, counties | Six water districts, 13 counties | PFOA | Incident kidney cancer | Association present | Kidney cancer: OR, 2.0 (95% CI, 1.0 to 3.9) |
| Leonard et al. (24) | 1948–2002 | Retrospective cohort | Occupational | Adult employees | 6027 | PFAS, not specified | Mortality from kidney cancer, nephritis, or nephrosis | Association present (kidney cancer) | Kidney cancer: SMR, 1.5 (95% CI, 0.8 to 2.7) |
| No observed association (nephritis or nephrosis) | |||||||||
| Costa et al. (25) | 1978–2007 | Prospective cohort | Occupational | Male employees | 53 | PFOA | Serum creatinine | No observed association | – |
| Dhingra et al. (26) | 1952–2011 | Retrospective cohort | Community surrounding manufacturer | Adults living in eligible area | 28,240 | PFOAa | Prevalent CKD | No observed association | – |
| Raleigh et al. (27) | 1947–2002 | Retrospective cohort | Occupational | Adult employees | 9027 | Ammonium PFOA, PFOA | Mortality from kidney cancer, CKD | No observed association | No observed associations for ammonium PFOA or PFOA |
PFOA, perfluorooctanoic acid; NHANES, The National Health and Nutrition Examination Survey; PFOS, perfluorooctane sulfonate; PFHxS, perfluorohexane sulfonate; PFNA, perfluorononanoic acid; OR, odds ratio; 95% CI, 95% confidence interval; PFAS, per- and polyfluoroalkyl substances; SMR, standardized mortality ratio; HR, hazard ratio.
a
Study used model-predicted cumulative serum concentrations as measure of exposure.