Article Text

Download PDFPDF
Original research
End-stage renal disease and metalworking fluid exposure
  1. Deepika Shrestha1,
  2. Sally Picciotto2,
  3. Michael P LaValley3,
  4. Sa Liu2,4,
  5. S Katharine Hammond2,
  6. Daniel E Weiner5,
  7. Ellen A Eisen2,
  8. Katie M Applebaum1
  1. 1Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
  2. 2Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
  3. 3Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
  4. 4School of Health Sciences, Purdue University, West Lafayette, Indiana, USA
  5. 5Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Katie M Applebaum, George Washington University, Milken Institute School of Public Health, Department of Environmental and Occupational Health, Washington, District of Columbia DC 20052, USA; kapplebaum{at}gwu.edu

Abstract

Objective Despite increasing prevalence of end-stage renal disease (ESRD), little attention has been directed to how occupational exposures may contribute to risk. Our objective was to investigate the relationship between metalworking fluids (MWF) and ESRD in a cohort of 36 703 male autoworkers.

Methods We accounted for competing risk of death, using the subdistribution hazard approach to estimate subhazard ratios (sHRs) and 95% CIs in models with cubic splines for cumulative exposure to MWF (straight, soluble or synthetic).

Results Based on 501 ESRD cases and 13 434 deaths, we did not observe an association between MWF and ESRD overall. We observed modest associations between MWF and ESRD classification of glomerulonephritis and diabetic nephropathy. For glomerulonephritis, the 60th percentile of straight MWF was associated with an 18% increased subhazard (sHR=1.18, 95% CI: 0.99 to 1.41). For diabetic nephropathy, the subhazard increased 28% at the 60th percentile of soluble MWF (sHR=1.28, 95% CI: 1.00 to 1.64). Differences by race suggest that black males may have higher disease rates following MWF exposure.

Conclusions Exposure to straight and soluble MWF may be related to ESRD classification, though this relationship should be further examined.

  • cutting fluids
  • kidney diseases

Data availability statement

Data are available upon reasonable request. The data that can be made available upon reasonable request are deidentified participant data accompanied by a data dictionary. Data can be requested from Liza Lutzker, Data Manager, UC Berkeley, ORCID: 0000-0003-0611-0158. Conditions of reuse would include submission of researcher’s IRB approval to the UC Berkeley IRB and pending permission from the National Death Index and US Renal Data System.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request. The data that can be made available upon reasonable request are deidentified participant data accompanied by a data dictionary. Data can be requested from Liza Lutzker, Data Manager, UC Berkeley, ORCID: 0000-0003-0611-0158. Conditions of reuse would include submission of researcher’s IRB approval to the UC Berkeley IRB and pending permission from the National Death Index and US Renal Data System.

View Full Text

Footnotes

  • Contributors DS conducted the data analysis using standard regression and competing risk regression. MPL provided statistical guidance and support of these regression models and assisted in interpretation of results. SP conducted analysis of the data using G-estimation with a structural nested accelerated failure time model. SL and SKH provided expertise in the area of industrial hygiene and potential occupational exposures that may act as confounders of the relationships of interest as well as describing potential components of MWF that may affect kidney disease. DEW contributed in the analysis of ESRD and its classification groups and in the consideration of biological mechanisms. EAE and KMA contributed on all aspects of the study design, data collection and data analysis. DS authored the original manuscript and all other coauthors contributed to the revisions.

  • Funding This publication was supported by grants R01 OH010180, R01 OH010028 funded by the Centres for Disease Control and Prevention, National Institute for Occupational Safety and Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centres of Disease Control and Prevention or the Department of Health and Human Services.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.