| Summary: | 碩士 === 國立臺灣大學 === 職業醫學與工業衛生研究所 === 105 === Background: Previous studies reported exposure to heavy metals was associated with alteration of kidney function among workers by little is known among general population. This study tried to see whether such exposure is associated with alterations in estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) among residents liv-ing near a petrochemical complex.
Methods: Our study subjects were 2,069 long-term residents aged 35 years old in 2009-2012 in ten townships, including Mailiao, Taisi, Dongshih, Lunbei, Baojhong, Sihhu, Erlun, Yuanchang, Cihtong and Huwei, near the No.6 Naphtha Cracking Complex in Yunlin County, Taiwan. Three variables were used to estimate study subject’s exposure to pollution from the petrochemical complex: (1) the distance from their home addresses to the complex; (2) their urinary arsenic, cadmium, mercury, thallium and 1-hydroxypyrene (1-OHP) levels; (3) their homes in either the high exposure (HE) area, i.e Mailiao and Taisi townships within 10km radius away from the complex, or the low exposure (LE) area of the other 8 townships located beyond the 10km radius away from the complex. Three indicators were as potential outcomes of exposure: (1) eGFR calcu-lated by serum creatinine, age, and gender through the equation of Chronic Kidney Dis-ease Epidemiology Collaboration (CKD-EPI-Taiwan); (2) CKD defined as eGFR lower than 60 ml/min/1.73m2; (3) High-intermediate risk of CKD defined as eGFR lower than 60 ml/min/1.73m2 or eGFR higher than 60 ml/min/1.73m2 and dipstick of urine protein larger than 1+. We applied generalized linear models (GLM) and logistic regression mod-els to estimate the associations between petrochemical exposures and health outcomes, adjusting for demographic characteristics, personal risk factors and traffic pollution. Anal-ysis of covariance (ANCOVA) test was used to determine difference of urinary arsenic, cadmium, mercury, thallium, 1-OHP and eGFR between HE and LE area by adjusting demographic characteristics, personal risk factors, food consumption and traffic pollution. Chi-square test were conducted to determine difference in CKD prevalence between HE and LE areas.
Results: Our study subjects included 40% males, an average age of 57.45 years old, and a mean distance of 14.21 km from their homes to the complex. Their urinary arsenic, cadmium, mercury, thallium and 1-OHP levels averaged at 81.12, 0.88, 2.25, 0.20 µg/g creatinine and 0.12 µmol/mol creatinine, respectively. Their overall mean eGFR was 65.88 ml/min/1.73m2 with 33% of them lower than 60 ml/min/1.73m2. For every 1 km closer to the complex from study subjects’ homes, we found their eGFR decreased 0.29 mL/min/1.73m2 (95% CI: -0.36, -0.22), and the odds ratios were 1.05 (1.03, 1.06) for CKD and 1.03 (1.02, 1.05) for high-intermediate risk of CKD. For 1-fold increase in uri-nary arsenic concentration, we found eGFR decreased by 0.68 mL/min/1.73m2 lower (-1.12, -0.23) and the odds ratio of CKD was 1.14 (1.04, 1.26). The eGFR was 0.49 mL/min/1.73m2 lower (-0.78, -0.20) per 1-fold increase in urinary 1-OHP concentration. The mean distance to the complex was 6.10 km for the 669 subjects in HE area and 18.09 km for the 1,400 subjects in LE area, respectively. Age and gender were comparable for both areas. Urinary concentrations of arsenic, cadmium, mercury, thallium and 1-OHP of subjects in the HE area (94.60, 0.89, 2.34, 0.22 µg/g creatinine and 0.13 µmol/mol creati-nine) were significantly higher than those in the LE area (74.68, 0.87, 2.20, 0.19 µg/g creatinine and 0.11 µmol/mol creatinine). The mean eGFR of subjects in the HE area (63.74 ml/min/1.73m2) was significantly lower than those in the LE area (66.90 ml/min/1.73m2). The CKD prevalence in the HE area (38%) was also significantly higher than that in the LE area (30%). Compared to the LE area, subjects living in the HE area were associated with 3.18 ml/min/1.73m2 (-4.28, -2.08) decrease in eGFR, an odds ratio of 1.68 (1.32, 2.01) for CKD and an odds ratio of 1.45 (1.15, 1.82) for high-intermediate risk of CKD.
Conclusion: We concluded that adults above 35 years old who lived closer to the No.6 Naphtha Cracking Complex, were associated with decreased renal function and increased risks of CKD and the high-intermediate risk of CKD. Arsenic was the pollutant contrib-uting to such associations.
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