Association of phthalate exposure with all-cause mortality across renal function status: The U.S. National Health and Nutrition Examination Survey, 2005–2018

Hao-Wei Tao; Wen-Wen Han; Yu-Jie Liu; Hong-Zhen Du; Zeng-Ning Li; Li-Qiang Qin; Guo-Chong Chen; Jing-Si Chen

Ecotoxicology and Environmental Safety (Jan 2024)

Association of phthalate exposure with all-cause mortality across renal function status: The U.S. National Health and Nutrition Examination Survey, 2005–2018

Hao-Wei Tao,
Wen-Wen Han,
Yu-Jie Liu,
Hong-Zhen Du,
Zeng-Ning Li,
Li-Qiang Qin,
Guo-Chong Chen,
Jing-Si Chen

Affiliations

Hao-Wei Tao: Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
Wen-Wen Han: Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
Yu-Jie Liu: Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
Hong-Zhen Du: Department of Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Nutrition and Health, Shijiazhuang, Hebei, China
Zeng-Ning Li: Department of Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Nutrition and Health, Shijiazhuang, Hebei, China; Hospital of Stomatology of Hebei Medical University Shijiazhuang, China
Li-Qiang Qin: Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
Guo-Chong Chen: Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Correspondence to: Department of Nutrition and Food Hygiene, Suzhou Medical College of Soochow University, 199 Ren’ai Road, Suzhou 215123, China.
Jing-Si Chen: Department of Nutrition and Food Hygiene, MOE Key Laboratory of Geriatric Diseases and Immunology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Correspondence to: School of Public Health, Medical College of Soochow University, 5880075, China.

Journal volume & issue: Vol. 270
p. 115881

Abstract

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Background: Wide phthalate exposure has been associated with both declines in renal function and an elevated risk of mortality. Whether phthalate-associated risk of premature mortality differs by renal function status remains unclear. Methods: This study included 9605 adults from the U.S. National Health and Nutrition Examination Survey. Urinary concentrations of 11 phthalate metabolites were assessed using high-performance liquid chromatography-electrospray ionization tandem mass spectrometry. According to estimated glomerular filtration rate (eGFR), participants were grouped as having normal or modestly declined renal functions, or chronic kidney disease (CKD). Multivariable Cox regression models estimated all-cause mortality associated with phthalate exposure, overall and by renal function status. Results: Overall, Mono-n-butyl phthalate (MnBP), Mono-benzyl phthalate (MBzP), Mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and Mono-(2-ethyl-5-carbox-ypentyl) phthalate (MECPP) were associated with an elevated risk of mortality (P-trend across tertile <0.05). Moreover, significant interactions were observed between eGFR and MEHHP, MEOHP, MECPP, DEHP in the whole population (P for interactions <0.05). After stratification by renal function, total Di (2-ethylhexyl) phthalate (DEHP) was additionally found to be associated with mortality risk in the CKD group (HR = 1.12; 95% CI: 1.01, 1.25). Co-exposure to the 11 phthalate metabolites was associated with a higher risk of all-cause mortality in the CKD (HR = 1.47; 95% CI: 1.18, 1.84) and modestly declined renal function group (HR = 1.25; 95% CI: 1.09, 1.44). Conclusions: The associations between phthalate exposure and risk of all-cause mortality were primarily observed in CKD patients, reinforcing the need for monitoring phthalate exposure in this patient population.

Published in Ecotoxicology and Environmental Safety

ISSN: 0147-6513 (Print); 1090-2414 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Technology: Environmental technology. Sanitary engineering: Environmental pollution; Geography. Anthropology. Recreation: Environmental sciences
Website: https://www.journals.elsevier.com/ecotoxicology-and-environmental-safety

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