A retrospective cohort study of chronic kidney disease in workers exposed to trichloroethylene and other solvents.

摘要

Objective. Several case-control studies have reported an increased likelihood of exposure to hydrocarbons for subjects with end stage renal disease (ESRD) and chronic renal failure (CRF), but no large cohort studies have been conducted. We studied the association between trichloroethylene (TCE), as well as other solvents, and ESRD and CRF using a retrospective cohort design.;Methods. A database of former civilian employees of the Hill Air Force Base in Utah was matched to the National Death Index to assess vital status and to the United States Renal Data System to assess ESRD status. Multivariable Cox and Logistic Regression Models were used for data analysis, and covariates for age, gender and race were included in the models. Subjects with no chemical exposure served as the referent group.;Results. ESRD: For the period 1973 through 2000, there were 86 cases of ESRD of which 80% were exposed to solvents. In multivariable Cox models for this period, there was a statistically significant increased relative risk of ESRD for subjects exposed to TCE (hazard ratio [HR] = 1.86; 95% confidence interval [CI] = 1.02--3.39), 1,1,1-trichloroethane (HR = 2.31; 95% CI = 1.04--5.10) and JP4 gasoline (HR = 2.26; 95% CI = 1.16--4.41). Risks were elevated, although not statistically significant, for several other solvents. For the period 2001 through 2002, 17 additional ESRD cases occurred of which only 41% were exposed to solvents; this resulted in none of the associations being statistically significant for the full period, 1973 through 2002. This attenuation of the associations when 2001 and 2002 were included in the analyses was likely due to chance.;CRF: In multivariable Cox models, there was a statistically significant increased relative risk of CRF death for HAFB subjects exposed to xylene (HR = 4.75; 95% CI = 1.07--20.96) and styrene (HR = 3.64; 95% CI = 1.06--12.54). Risks for CRF death were elevated, but not statistically significant, for several other solvents.;Conclusions. The results of this cohort study support findings from earlier case-control studies that exposure to hydrocarbons increases the risk of ESRD and CRF. Further research is required.