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Environ. Int., Volume 206, December 2025 | https://doi.org/10.1016/j.envint.2025.109930
Differential impact of per- and polyfluoroalkyl substances exposure on hypertension risk by kidney function and metabolic status
Yaerim Kim a, Inae Lee b, Jeonghwan Lee c, Gowoon Lee d, Jin Hyuk Paek a, Seungyeup Han a, Younglim Kho e, Chun Soo Lim c f, Kyungho Choi g *, Jung Pyo Lee c f *
aDepartment of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
bDepartment of Public Health, Keimyung University, Daegu, South Korea
cDepartment of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
dDepartment of Safety Engineering, Korean National University of Transportation, Chungju, South Korea
eDepartment of Health, Environment and Safety, Eulji University, Seongnam, South Korea
fDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
gGraduate School of Public Health, Seoul National University, Seoul, South Korea
bDepartment of Public Health, Keimyung University, Daegu, South Korea
cDepartment of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
dDepartment of Safety Engineering, Korean National University of Transportation, Chungju, South Korea
eDepartment of Health, Environment and Safety, Eulji University, Seongnam, South Korea
fDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
gGraduate School of Public Health, Seoul National University, Seoul, South Korea
*Corresponding authors: correspondence to Kyungho Choi or Jung Pyo Lee
Abstract
Background
Per- and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants increasingly linked to hypertension. However, the modifying effects of kidney function and metabolic health remain unclear. This study examined the associations between serum PFAS concentrations and hypertension, with a particular focus on kidney function and metabolic status as potential effect modifiers.
Methods
Data were obtained from the Korean National Environmental Health Survey (KoNEHS, 2018–2020), which included adults aged 19 years or older with available serum PFAS, blood pressure, and kidney function data. Adjusted odds ratios for hypertension were estimated using multivariable logistic regression across PFAS quartiles, with stratified analyses by kidney function and metabolic status.
Results
Among 2,993 participants, elevated levels of perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDeA), and total PFAS were associated with higher hypertension risk. Associations were more evident in individuals in the higher eGFR group, whereas effect estimates were attenuated in those with lower eGFR. In quartile-based analyses, positive exposure–response trends were observed for most PFAS, supporting the consistency of associations across exposure levels. Associations were stronger in participants with favorable metabolic profiles (e.g., without central obesity, normal triglycerides, high high-density lipoprotein cholesterol, normoglycemia) but attenuated in those with metabolic abnormalities.
Conclusions
PFAS exposure is associated with an increased risk of hypertension, particularly among those in the higher eGFR range and favorable metabolic profiles. These findings highlight the need to consider related disease phenotypes when assessing PFAS-associated cardiovascular toxicity and emphasize the importance of exposure mitigation in the healthy general population.
Per- and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants increasingly linked to hypertension. However, the modifying effects of kidney function and metabolic health remain unclear. This study examined the associations between serum PFAS concentrations and hypertension, with a particular focus on kidney function and metabolic status as potential effect modifiers.
Methods
Data were obtained from the Korean National Environmental Health Survey (KoNEHS, 2018–2020), which included adults aged 19 years or older with available serum PFAS, blood pressure, and kidney function data. Adjusted odds ratios for hypertension were estimated using multivariable logistic regression across PFAS quartiles, with stratified analyses by kidney function and metabolic status.
Results
Among 2,993 participants, elevated levels of perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDeA), and total PFAS were associated with higher hypertension risk. Associations were more evident in individuals in the higher eGFR group, whereas effect estimates were attenuated in those with lower eGFR. In quartile-based analyses, positive exposure–response trends were observed for most PFAS, supporting the consistency of associations across exposure levels. Associations were stronger in participants with favorable metabolic profiles (e.g., without central obesity, normal triglycerides, high high-density lipoprotein cholesterol, normoglycemia) but attenuated in those with metabolic abnormalities.
Conclusions
PFAS exposure is associated with an increased risk of hypertension, particularly among those in the higher eGFR range and favorable metabolic profiles. These findings highlight the need to consider related disease phenotypes when assessing PFAS-associated cardiovascular toxicity and emphasize the importance of exposure mitigation in the healthy general population.
논문정보
- Research article
- 2025년 11월 (BRIC 등록일 2025-12-02)
- 국내 연구진
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