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Agricultural pesticide exposure and chronic kidney disease: new findings and more questions.

Calvert GM

Occup Environ Med 2016 Jan; 73(1):1-2

https://doi.org/10.1136/oemed-2015-103132

20046778

The vital importance of agriculture is well-recognised, as is the usefulness of pesticides in increasing agricultural yields and reducing spoilage rates. The usefulness of pesticides in mitigating disease carrying pests (eg, mosquitos) is also well known. However, there are also risks associated with pesticide use. In addition to causing acute poisoning, they are also associated with increased cancer risks, among other diseases. A paper by Lebov and colleagues3 provides evidence for another potential risk associated with pesticides, that is, end-stage renal disease (ESRD). To our knowledge, this is the first report using the United States Renal Data System (USRDS) to assess the association between pesticide exposure and ESRD. Currently, there is little literature available on the nephrotoxic effects of pesticides. The little research that does exist comes from animal studies and case reports of pesticide-poisoned individuals. Fortunately, our understanding of the role of occupational exposures, including pesticides, on ESRD development in humans is growing. An important tool supporting the growth of this understanding is the USRDS. Since the US government provides healthcare coverage, under Medicare, for all patients with ESRD and because these ESRD claims data are comprehensively captured by USRDS, USRDS represents a nearly complete national disease registry in the USA. Furthermore, because there is no other medical condition so covered by the US government, there is no other disease or injury in the USA that has such a nearly complete national registry. From the first use of USRDS to identify occupational exposures associated with ESRD, which in that initial case involved an exploration of silica exposure,5 it has been used to identify ESRD associations with several other occupational exposures, including perchloroethylene,6 lead7 and 1,1,1-trichloroethane.8 With the paper in this issue of OEM, USRDS has now been used to assess the association between pesticide exposure and ESRD. Lebov et al matched data from the Agricultural Health Study (AHS), a very large prospective study of licensed pesticide applicators, with data from USRDS to identify cohort members with ESRD and to determine if the observed cases exceeded population rates. Although these authors provided reassuring findings of no increased ESRD risk in the overall cohort, they did find significantly increased ESRD risks and positive exposure-response trends, among pesticide applicators who mixed or applied one or more of six specific pesticides. These pesticides included five herbicides (alachlor, atrazine, metolachor, paraquat and pendimethalin) and the insecticide permethrin.

Agriculture; Agricultural-workers; Agricultural-chemicals; Pesticides; Exposure-levels; Risk-factors; Diseases; Disease-transmission; Insects; Insecticides; Nephrotoxins; Nephrotoxicity; Animals; Laboratory-animals; Poisons; Surveillance

Dr Geoffrey M Calvert, Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, R-17, Cincinnati, OH 45226

OEMEEM

20160101

Journal Article

jac6@cdc.gov

2016

1

1351-0711

DSHEFS

Agriculture, Forestry and Fishing; Services

Occupational and Environmental Medicine

OH