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논문분류	춘계학술대회 초록집
제목	The Impact of Urinary Phthalate Metabolites on Kidney Function: A Longitudinal Analysis among CKD Patients
저자	Yaerim Kim
출판정보	2024; 2024(1):
키워드
초록	Objectives: Urinary phthalate metabolites can only reflect recent episodic exposure due to the rapid metabolizing process. Consequently, evaluating diseases based on a single measurement presents limitations. This study evaluates the association between urinary phthalate metabolites and kidney function through values measured repeatedly. Methods: This study included chronic kidney disease (CKD) patients registered in a SKETCH (Study on Kidney disease and EnvironmenTal Chemicals, Clinical Trial No. NCT04679168) cohort, who were followed up quarterly over one year. Urine collected at each visit was analyzed for phthalate metabolites. We used Cox-proportional hazard model to evaluate the impact on the kidney outcome which was defined by estimated glomerular filtration rate (eGFR) by 30% decreasing, doubling of serum creatinine, or starting kidney replacement therapy. Results: In total, 285 patients were studied, with eGFR categories ≥60 (46 patients), 30-60 (155 patients), and <30 (84 patients). Across CKD stages, concentrations of DnBP and cxMEPA showed significant difference. Among 9 urinary phthalate metabolites, MCPP (aHR 1.02, 95% CI 1.01-1.04) and DiNP (aHR 1.02, 95% CI 1.01-1.03) were associated with a significantly increased risk of kidney dysfunction. For patients with eGFR <45 mL/min/1.73m2, the hazardous effects of MCPP and DiNP persisted. Specifically, the impact of MCPP’ remained significant in diabetic patients and non-smokers. In contrast, the impact of DiNP in patients with eGFR <45 varied according to disease status; it increased the risk in patients with diabetes, BMI ≥25, or smokers, but presented a decreased risk in non-diabetic patients, those with BMI <25, or non-smokers. Conclusions: Urinary phthalate metabolites, particularly MCPP and DiNP, demonstrated a significant correlation with kidney dysfunction, highlighting the critical role of repeated measurements for a deeper understanding the complex interplay between phthalate exposure and renal outcomes in CKD patients.
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