Associations of per- and polyfluoroalkyl substances exposure with kidney function in the Korean general population

Per- and polyfluoroalkyl substances (PFAS) are persistent and harmful environmental pollutants of international concerns. Despite widespread use of PFAS in industrial and consumer products, research exploring their effects on kidney function among Asian populations remains limited. Therefore, this study analyzed the Korean National Environmental Health Survey cycle 4 (2018-2020) data to determine the relationship between renal function and serum concentrations of perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDeA) using the estimated glomerular filtration rate (eGFR). Subjects with eGFR values less than 60 mL/min/1.73 m² were classified as having chronic kidney disease (CKD). Multiple linear and logistic regression models were used to assess the associations between PFAS concentrations and eGFR, and Bayesian kernel machine regression was used to evaluate the combined effects of PFAS on renal function. Among the general Korean adult population (n = 2985) significant negative associations were observed between all PFAS and the eGFR (p < 0.001). Natural log transformed level of PFOA, PFOS, PFHxS, PFNA, and PFDeA were associated with odds ratios of 1.801 (95 % confidence interval [CI]: 1.010-3.213), 1.961 (95 % CI: 1.407-2.732), 1.545 (95 % CI: 1.178-2.026), 2.334 (95 % CI: 1.424-3.825), and 1.782 (95 % CI: 0.976-3.254), respectively. Additionally, eGFR was significantly reduced as all PFAS concentrations simultaneously increased, and this association was mainly driven by PFNA and PFDeA. These associations remained consistent after stratification by sex and age. These findings suggest that PFAS exposure is associated with CKD and may have adverse effects on kidney function.