Endocrine disruptors in dialysis therapies: A literature review.

Guillaume Cambien, Antoine Dupuis, Jérémy Guihenneuc, Marc Bauwens, Mohamed Belmouaz, Sarah Ayraud-Thevenot

Journal: Environment international 2023;178():108100

PMID: 37481953

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Abstract

Endocrine disrupting chemicals (EDCs) were defined as "an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects". These compounds are mainly eliminated by the renal route. However, patients with end-stage kidney disease treated by dialysis (ESKDD) can no longer eliminate these EDCs efficiently. Furthermore, EDCs exposure could occur via leaching from medical devices used in dialysis therapy. As a result, ESKDD patients are overexposed to EDCs. The aims of this study were to summarize EDCs exposure of ESKDD patients and to evaluate the factors at the origin of this exposure. To handle these objectives, we performed a literature review. An electronic search on PubMed, Embase and Web of science databases was performed. Twenty-six studies were finally included. The EDCs reported in these studies were Bisphenol A (BPA), Bisphenol S (BPS), Bisphenol B (BPB), Nonylphenol, Di(2-ethylhexyl) phthalate (DEHP), Di-n-butyl phthalate (DBP), and Butylbenzyl phthalate (BBP). Regarding the environment of dialysis patients, BPA, BPB, BPS, DEHP, DBP and nonylphenol have been found. Environmental exposure affects EDCs blood levels in ESKDD patients who are overexposed to BPA, BPS, BPB and DEHP. For ESKDD patients, dialyzers with housing in polycarbonate and fibers in polysulfone seem to overexpose them to BPA. Regarding dialysis therapy, peritoneal dialysis seems to decrease patient exposure vs hemodialysis therapy, and hemodiafiltration therapy seems to reduce this exposure vs hemodialysis therapy. Regarding DEHP, levels tend to increase during dialysis and when DEHP plasticizer is used in PVC devices. Finally, in the European Union a regulation on medical devices was adopted on 5 April 2017 and has been applied recently. This regulation will regulate EDCs in medical devices and thereby contribute to reconsideration of their conceptions and, finally, to reduction of ESKDD patients' exposure.

Address: Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France. Electronic address: [email protected].; Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France. Electronic address: [email protected].; Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France. Electronic address: [email protected].; Digestiv, Urology, Nephrology, Endocrinology Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France. Electronic address: [email protected].; Digestiv, Urology, Nephrology, Endocrinology Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France. Electronic address: [email protected].; Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France. Electronic address: [email protected].

DOI: 10.1016/j.envint.2023.108100

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https://linkinghub.elsevier.com/retrieve/pii/S0160...

Miscellaneous:

https://assays.cancer.gov/CPTAC-1595

Research Materials:

https://antibodies.cancer.gov/detail/CPTC-HLA-B-1

MeSH Terms: Humans, Diethylhexyl Phthalate, Endocrine Disruptors, Renal Dialysis, Phenols, Dibutyl Phthalate, Benzhydryl Compounds