Abstract
Animal experiments have shown that high exposure to ethylene oxide (EO) can cause multiple system damages including the renal system. Recent studies have reported associations between exposure to EO and cancer, dyslipidemia, diabetes, and cardiovascular disease. However, the impact of exposure to EO on the prevalence and prognosis of chronic kidney disease (CKD) in humans is scarcely investigated. The study was designed to investigate the associations between EO exposure and incidence and prognosis of CKD among 2900 US adults. Exposure to EO was measured by detecting the levels of hemoglobin adducts of EO (HbEO). The diagnosis of CKD was made according to an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 and/or a urinary albumin-to-creatinine ratio (UACR) > 30 mg/g. Prognosis of CKD was assessed based on the evaluation system initiated by KDIGO that consists of eGFR and UACR. Survey-weighted generalized linear models and proportional odds models were constructed to assess the associations between HbEO and prevalence and prognosis of CKD, with odds ratios (ORs) and proportional odds ratios (PORs) and their 95% confidence intervals (CIs) reported, respectively. Restricted cubic spline (RCS) function was performed to depict the correlation between HbEO and CKD. The weighted median (interquartile range) of HbEO was 31.3 (23.1–60.3) pmol/g Hb. A total of 491 participants (16.9%) were diagnosed with CKD, and 153 participants (5.31%) were identified to be at high or very high risk. Referred to the first tertile of HbEO, the adjusted ORs (95% CIs) for CKD in the second and third tertile were 1.46 (0.85, 2.50) and 1.69 (1.00, 2.85), and the adjusted PORs (95% CIs) for prognosis of CKD in the second and third tertile were 1.37 (0.94, 1.99) and 1.58 (1.10, 2.26). When HbEO was analyzed as a continuous variable, the adjusted OR (95% CI) for CKD and POR (95% CI for prognosis of CKD were 1.24 (0.97, 1.58) and 1.22 (1.01, 1.47), respectively. RCS analysis revealed a non-linear positive correlation between HbEO and prevalence of CKD (P for nonlinearity < 0.05). Subgroup analysis indicated smoking status had a significant impact on this association, which remained significant among never smokers but lost significance among smokers. Among US adults, increased EO exposure was independently related to increased CKD prevalence and poor CKD outcomes, which was established in never smokers but not among ever smokers.
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Data availability
The NHANES data utilized in this paper is accessible to the public.
Abbreviations
- BMI :
-
Body mass index
- CKD :
-
Chronic kidney disease
- CI :
-
Confidence interval
- eGFR :
-
Estimated glomerular filtration rate
- EO :
-
Ethylene oxide
- HbEO :
-
Hemoglobin adduct N-(2-hydroxyethyl) valine
- HPLC-MS/MS :
-
High-performance liquid chromatography coupled with tandem mass spectrometry
- hs-CRP :
-
High-sensitivity C-reactive protein
- KDIGO :
-
Kidney disease: improving global outcomes
- MET :
-
Metabolic equivalent
- MEC :
-
Mobile examination center
- NCEH :
-
National Center for Environmental Health
- NCHS :
-
National Center for Health Statistics
- OR :
-
Odds ratio
- POR :
-
Proportional odds ratio
- RCS :
-
Restricted cubic spline
- UACR :
-
Urine albumin to creatinine ratio
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Acknowledgements
We sincerely thank all staff for their industrious contributions and all participants in the NHANES program. We would like to express our gratitude to Prof. Zhang Jing from Shanghai Tongren Hospital for his invaluable contribution to our analysis of the NHANES database. The nhanesR package and webpage that he developed have greatly facilitated our work with the database.
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This study received financial support from the Capital’s Funds for Research and Application of Clinical Diagnosis and Treatment Technology with reference number Z191100006619121.
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YMY and JZ designed and supervised the study. SW carried out the statistical analysis and drafted the paper. SW, LLW, WX, SQL, JW, HZ, and XHS were responsible for data extraction and cleaning. YMY and JZ revised the manuscript and approved the final version for publication. All authors reviewed and approved the final version of the manuscript.
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The Ethics Committee of the National Center for Health Statistics gave approval to the NHANES protocols, and participants were informed of the study and signed informed consent form.
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Wu, S., Yang, Ym., Zhu, J. et al. Impact of hemoglobin adducts of ethylene oxide on the prevalence and prognosis of chronic kidney disease in US adults: an analysis from NHANES 2013–2016. Environ Sci Pollut Res 31, 2802–2812 (2024). https://doi.org/10.1007/s11356-023-30712-4
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DOI: https://doi.org/10.1007/s11356-023-30712-4