Exposure to Phthalates\nand Alternative Plasticizers\nin Patients with Impaired Kidney Function in Korea: Temporal Trend\nduring 2011–2020 and Its Association with Chronic Kidney Disease

Phthalates are chemical risk factors of chronic kidney\ndisease\n(CKD); however, little is known about temporal trends of phthalate\nexposure and associated health risks among CKD patients. Such information\nis even scarce for alternative plasticizers. CKD patients were recruited\nfrom 2011 to 2020 in Korea (<i>n</i> = 200) and assessed\nfor the temporal changes of both traditional and alternative plasticizer\nexposure. Their associations with kidney dysfunction were also investigated.\nIn CKD patients, urinary levels of DEP, BBzP, and DEHP metabolites\ndeclined significantly during this period, while those of the DEHTP\nmetabolite increased. The level of DEHP metabolites showed a negative\nassociation with the estimated glomerular filtration rate (eGFR) in\nmultiple association models, but additional eGFR subgroup analysis\nfailed to show consistent results. Associations between phthalate\nexposure and eGFR were influenced by the severity of kidney dysfunction:\nDEHP and BBzP exposure showed negative associations with eGFR only\namong the patients with moderate kidney dysfunction (eGFR 30–59\nmL/min/1.73 m<sup>2</sup>). Changing associations by CKD severity\nmay be explained by negative correlations between eGFR and both urinary\ncreatinine concentration and specific gravity. Our observations show\nthat DEHTP has rapidly replaced DEHP and exposure to several phthalates\nadversely influences kidney function even among CKD patients.