Association between pesticide exposure and end-stage renal disease: A case-control study from Morocco based on the STROBE guidelines

Experimental studies have shown that various pesticides can damage kidney function, but epidemiological information on the effects of long-term low-level pesticide exposure is lacking. A study in Fez Meknes, Morocco, examined the link between 31 pesticides and end-stage renal disease (ESRD). This study involved 12 hemodialysis centers in various areas. Duration and frequency of use determined lifetime pesticide use, which was adjusted by an intensity factor to account for differences in pesticide application practices. The STROBE guideline was applied in the present work. Multivariate logistic regression was used to assess the correlations between end-stage renal disease, and the ordinal categories of lifetime pesticide use, weighted by intensity, for 31 pesticides. The study included 82 cases and 161 controls, and exposure to Glyphosate, paraquat, 2-4 D, 2-4 D+2-4 MCPA, azoxystrobin and difenoconazole demonstrated positive exposure-response trends. End-stage renal disease was significantly associated with the intensity-weighted exposure to the herbicides 2,4 D (OR = 1.005, CI: 1.003-1.007, p < 0.0001) and 2,4 D + 2,4 MCPA (OR = 1.009, CI: 1.004-1.013, p < 0.0001), and the fungicide difenoconazole (OR = 1.017, CI: 1.001-1.033, p = 0.033). These findings suggest a potential link between exposure to these pesticides and ESRD, warranting further investigation into the underlying mechanisms and the generalizability of these results to other rural populations.