Table 1.

Human epidemiologic studies (1990–2018) investigating per- and polyfluoroalkyl substances exposure and kidney health

AuthorsStudy YearsStudy DesignSettingPopulationSample SizeExposureKidney OutcomeMajor FindingsSummary Notes
Direct exposure assessments (n=11)
 Dhingra et al. (7)1952–2012Cross-sectionalCommunity surrounding manufacturerAdults living in eligible area29,499PFOAaeGFRAssociation presentNegative trend in eGFR across measured serum PFOA quintiles (β=−0.64 to −1.03; P=0.01)
 Kataria et al. (8)2003–2010Cross-sectionalNHANESChildren 12–19 yr old1960PFOS, PFOA, PFHxS, PFNAeGFRAssociation presentIncreased 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)1999–2008Cross-sectionalNHANESAdults >20 yr old4587PFOA, PFOSeGFR, prevalent CKDAssociation presenteGFR: 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)2003–2008Cross-sectionalNHANESAdults6305PFOAPrevalent CKD, incident ESKDAssociation presentPrevalent 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)1989–2006Retrospective cohortCommunity surrounding manufacturerChildren (1–18 yr old) living in eligible area9660PFOA, PFOS, PFHxS, PFNAaeGFRAssociation presentNegative trend in eGFR (−0.73 to −1.34 ml/min per 1.73 m2) with increasing exposure to each PFAS
 Conway et al. (12)2017Cross-sectionalCommunity surrounding manufacturerAdults living in eligible area53,650PFOA, PFOS, PFHxS, PFNAeGFRNo observed associationNo association with any PFAS
 Emmett et al. (13)2003–2005Cross-sectionalCommunity surrounding manufacturerAdults and children living in eligible areas371PFOASerum creatinineNo observed association
 Olsen et al. (14)2003Cross-sectionalOccupationalAdult employees518PFOSSerum creatinineNo observed association
 Olsen et al. (15)2012Cross-sectionalOccupationalMale employees506PFOA, PFOAeGFR, prevalent CKDNo observed associationNo association with eGFR or prevalent CKD
 Steenland et al. (16)2005–2006Cross-sectionalCommunity surrounding manufacturerAdults living in the eligible area54,951PFOA, PFOSSerum creatinineNo observed associationNo observed association for PFOA or PFOS
 Zhou et al. (17)2013Cross-sectionalCommunity surrounding manufacturer (China)Manufacturer employees living in eligible area39PFOA, PFOS, PFHxSSerum creatinineNo observed associationNo observed association for PFOA, PFOS, or PFHxS
Indirect exposure assessments (n=10)
 Alexander et al. (18)1961–1997Retrospective cohortOccupationalAdult employees2083PFOSGenitourinary and kidney cancerAssociation presentGenitourinary and kidney cancer: SMR, 12.8 (95% CI, 2.6 to 37.4)
 Barry et al. (19)1952–2011Retrospective cohortCommunity surrounding manufacturerAdults living in eligible area32,254PFOAKidney cancerAssociation presentKidney cancer: HR, 1.1 (95% CI, 1.0 to 1.2) per each unit increase in PFOA
 Consonni et al. (20)1950–2008Retrospective cohortCommunity surrounding manufacturerMale employees5879PFOAMortality from kidney cancerAssociation presentKidney cancer: SMR, 1.7 (95% CI, 0.8 to 3.1)
 Mastrantonio et al. (21)1980–2013Retrospective cohort (ecological)Community surrounding manufacturerHigh-risk districts24 districtsPFOA, PFOSMortality from kidney cancerAssociation presentKidney cancer: SMR, 1.1 (95% CI, 0.9 to 1.2)
 Steenland et al. (22)1979–2004Retrospective cohortOccupationalAdult employees5791PFOAaMortality from kidney cancerAssociation presentKidney cancer: SMR, 1.3 (95% CI, 0.7 to 2.2)
 Vieira et al. (23)1996–2005Retrospective cohort (ecological)Community surrounding manufacturerHigh-risk districts, countiesSix water districts, 13 countiesPFOAIncident kidney cancerAssociation presentKidney cancer: OR, 2.0 (95% CI, 1.0 to 3.9)
 Leonard et al. (24)1948–2002Retrospective cohortOccupationalAdult employees6027PFAS, not specifiedMortality from kidney cancer, nephritis, or nephrosisAssociation 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)1978–2007Prospective cohortOccupationalMale employees53PFOASerum creatinineNo observed association
 Dhingra et al. (26)1952–2011Retrospective cohortCommunity surrounding manufacturerAdults living in eligible area28,240PFOAaPrevalent CKDNo observed association
 Raleigh et al. (27)1947–2002Retrospective cohortOccupationalAdult employees9027Ammonium PFOA, PFOAMortality from kidney cancer, CKDNo observed associationNo 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.