Pesticide Use May Increase Risk of End-stage Renal Disease

by | Aug 14, 2018 | 2016, Environmental Health, Kidney Health, Pesticides and Solvents

Written by Joyce Smith, BS. Researchers, linking data from the Agricultural Health Study to the US Renal Data System, reveal an association between end-stage renal diseases and chronic exposure to pesticides among male pesticide applicators in Iowa and North Carolina.

In 2011, over 600,000 US residents received treatment for end-stage renal disease (ESRD), a life threatening condition requiring dialysis or kidney transplant for survival 1. Although much research has been conducted on clinical risk factors for ESRD, such as diabetes and hypertension, research on the impact of environmental and occupational factors such as pesticide use and application is limited. Very little literature exists on the nephrotoxic effects of pesticides in humans and while experimental studies suggest a relationship between pesticide exposure and renal impairment, more epidemiological evidence is needed. 2,3

In this clinical trial, Lebov et al 4 seeking to evaluate the relationship between pesticide use and ESRD, linked data from the Agricultural Health Study (AHS) 5, (the largest prospective cohort study of licensed pesticide applicators in Iowa and North Carolina) to the US Renal Data System (USRDS). Using this linkage enabled them to evaluate a potential relationship between 39 pesticides and ESRD risk. Between 1993 and 1997 the AHS recruited 52,394 private pesticide applicators and 4,916 commercial pesticide applicators of which 82% private and 47% commercial applicators were enrolled in this present clinical trial. Extensive medical histories and self-reported questionnaires regarding life-time pesticide use (including duration and frequency) and application practices were obtained from the enrolled applicators 6. Linkage to the USRDS allowed researchers to identify all ESRD cases occurring between enrollment and the end of follow up (December 31, 2011). Excluded from the analysis were the 2.7% female applicators and the 127 applicators under 18 years of age as well as the 11.5% of ESRD cases diagnosed prior to enrolment, which left 55, 580 participants for analyses of enrolment questionnaires, and 24,565 participants for analyses of take-home questionnaires.

Of these 55,580 eligible participants, 320 applicators (308 private and 12 commercial) were diagnosed with ESRD over an average 15.7-year follow-up period (incidence rate: 36.6 ESRD cases per 100,000 person-years). Among the subset of 24, 565 participants who returned their take-home questionnaire, 136 cases of ESRD occurred (incidence rate: 35.1 ESRD cases per 100, 000 person-years). ESRD incidence was significantly higher in North Carolina compared with Iowa, regardless of age, which follows the pattern of ESRD incidence in the general population.

Exposure assessment and statistical analysis using Cox proportional hazards models revealed that in this study of male pesticide applicators, risk of end-stage renal disease increased with increasing cumulative exposure to several pesticides, including the herbicides alachlor, metolachlor, paraquat and pendimethalin, and the insecticide permethrin (p for trend <0.05).

Risk of end-stage renal disease was also significantly greater for pesticide applicators who reported multiple doctor visits due to pesticide use (HR=2.13; 95% CI 1.17 to 3.89) and hospitalization due to pesticide use (HR=3.05; 95% CI 1.67 to 5.58), compared with those who reported no medical visits due to pesticide use, revealing a significant trend for increasing number of pesticide-related doctor visits (p for trend=0.038). Among non-herbal pesticides, a significant positive exposure-response trend was present only for permethrin (for crops) (p for trend=0.0311).

This study provides evidence for an association between ESRD risk and chronic exposure to specific chemicals among pesticide applicators in Iowa and North Carolina. Researchers believe that the pathway between pesticide exposure and kidney disease should be better characterized to include assessments of earlier disease stages, the rate of progression from chronic kidney disease to end stage renal disease, and other potential routes of pesticide exposure, such as spray drift and carry-home exposures. They recommend additional epidemiological studies to validate these results and expand on the renal toxicity of specific chemicals.

Source: Lebov, Jill F., Lawrence S. Engel, David Richardson, Susan L. Hogan, Jane A. Hoppin, and Dale P. Sandler. “Pesticide use and risk of end-stage renal disease among licensed pesticide applicators in the Agricultural Health Study.” Occup Environ Med 73, no. 1 (2016): 3-12.

Occupational and Environmental Medicine is an open access journal.

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Posted August 14, 2018.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from  the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

References:

  1. Kidney Disease Statistics for the United States. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease. Accessed August 8, 2018, 2018.
  2. Soloukides A, Moutzouris D-A, Kassimatis T, Metaxatos G, Hadjiconstantinou V. A fatal case of paraquat poisoning following minimal dermal exposure. Renal failure. 2007;29(3):375-377.
  3. Memiş D, Tokatlıoglu D, Koyuncu O, Hekimoglu S. Fatal aluminium phosphide poisoning. European journal of anaesthesiology. 2007;24(3):292-293.
  4. Lebov JF, Engel LS, Richardson D, Hogan SL, Hoppin JA, Sandler DP. Pesticide use and risk of end-stage renal disease among licensed pesticide applicators in the Agricultural Health Study. Occup Environ Med. 2016;73(1):3-12.
  5. Alavanja M, Sandler D, McMaster S, Zahm S, McDonnell C, Lynch C. The Agricultural Health Study Environ Health Perspect 104: 362–369. Find this article online. 1996.
  6. Tarone RE, Alavanja MC, Zahm SH, et al. The Agricultural Health Study: factors affecting completion and return of self‐administered questionnaires in a large prospective cohort study of pesticide applicators. American journal of industrial medicine. 1997;31(2):233-242.