The hidden danger: prolonged exposure to inorganic contaminants and kidney health in adolescents

Research on the impact of prolonged exposure to inorganic contaminants, such as perchlorate, nitrate, and thiocyanate (PNT), on the kidney health of individuals in the 12 ∼ 19 age range is lacking. We analyzed data from the United States National Health and Nutrition Examination Survey (NHANES) over the period 2005–2016 to investigate the linear relationship between chronic kidney disease (CKD)-related parameters and PNT exposure levels, and to explore population heterogeneity from multiple aspects. Weighted multiple regression analysis estimated the independent associations between water or urine exposure indicators and CKD-related parameters. We utilized stratified subgroup analysis and smooth linear fitting as supplements. Lower estimated glomerular filtration rate (eGFR) (non- or new-creatinine (CR)-adjusted), albumin-to-creatinine ratio (ACR), and blood urea nitrogen (BUN) were associated with urine PNT exposure. Water exposure may not be the primary source of PNT exposure. Females had a stronger negative association between nitrate and eGFR after non- or new-CR adjustment. With the most demographic heterogeneity, perchlorate affected eGFR, ACR, and BUN. Our findings associated urinary PNT exposure with altered renal parameters (eGFR, ACR, BUN) in adolescents aged 12-19, suggesting potential environmental health implications that warrant further investigation. This study observed associations between urinary PNT levels and altered renal parameters (eGFR, ACR, BUN) in adolescents aged 12–19. Tap water was identified as a minor exposure source, suggesting that other routes may contribute significantly to PNT intake. These findings provide valuable evidence for future environmental health policies regarding PNT exposure.

目前针对12~19岁人群长期暴露于高氯酸盐（perchlorate）、硝酸盐（nitrate）与硫氰酸盐（thiocyanate）（三者合称PNT）这类无机污染物对肾脏健康造成的影响的研究尚属空白。我们分析了2005-2016年美国国家健康与营养检查调查（National Health and Nutrition Examination Survey, NHANES）的数据，旨在探究慢性肾脏病（chronic kidney disease, CKD）相关指标与PNT暴露水平之间的线性关联，并从多维度探索人群异质性。我们采用加权多元回归分析，评估水体或尿液暴露指标与CKD相关指标之间的独立关联，并辅以分层亚组分析与平滑线性拟合手段。尿液PNT暴露水平越高，受试者的估算肾小球滤过率（estimated glomerular filtration rate, eGFR）（未经肌酐校正或经新型肌酐（creatinine, CR）校正）、白蛋白肌酐比（albumin-to-creatinine ratio, ACR）与血尿素氮（blood urea nitrogen, BUN）水平越低。水体暴露可能并非PNT暴露的主要来源。在未经肌酐校正或经新型肌酐校正后，女性体内硝酸盐水平与eGFR之间的负相关关系更强。高氯酸盐对eGFR、ACR与BUN的影响展现出最为显著的人口学异质性。本研究结果表明，12~19岁青少年的尿液PNT暴露与肾脏相关指标（eGFR、ACR、BUN）的异常存在关联，提示其存在潜在的环境健康风险，有待进一步深入研究。本研究同样证实，12~19岁青少年的尿液PNT水平与肾脏相关指标（eGFR、ACR、BUN）的异常存在关联。研究发现自来水仅为次要的PNT暴露来源，提示其他暴露途径可能是PNT摄入的主要贡献渠道。本研究结果可为未来制定针对PNT暴露的环境健康政策提供重要参考依据。