Abstract: FR-PO0932
Per- and Polyfluoroalkyl Substances and Diabetic Kidney Disease Risk in Youth with Type 2 Diabetes
Session Information
- Pediatric Nephrology: Genetic Diseases, Development, Neonatal Nephrology, Glomerular Diseases, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Kahwaji, Mariah M., University of Southern California Keck School of Medicine, Los Angeles, California, United States
- Sharkey, Hannah, University of Southern California Keck School of Medicine, Los Angeles, California, United States
- Wang, Hongxu, University of Southern California Keck School of Medicine, Los Angeles, California, United States
- Kowal, Thomas, University of Southern California Keck School of Medicine, Los Angeles, California, United States
- Choi, Ye Ji, University of Washington School of Medicine, Seattle, Washington, United States
- Ramesh, Shivani, University of Washington School of Medicine, Seattle, Washington, United States
- Schaub, Jennifer A., University of Michigan, Ann Arbor, Michigan, United States
- Conti, David, Colorado School of Public Health, Aurora, Colorado, United States
- Nelson, Jonathan W., University of Southern California Keck School of Medicine, Los Angeles, California, United States
- Pyle, Laura, University of Washington School of Medicine, Seattle, Washington, United States
- Walker, Douglas Ian, Emory University Rollins School of Public Health, Atlanta, Georgia, United States
- Bjornstad, Petter, University of Washington School of Medicine, Seattle, Washington, United States
- Goodrich, Jesse Allen, University of Southern California Keck School of Medicine, Los Angeles, California, United States
Background
Exposure to per- and polyfluoroalkyl substances (PFAS), persistent chemicals that accumulate in the kidney and are detected in >98% of people, is linked to diabetic kidney disease (DKD) risk in adults. However, this has not been studied in youth with type 2 diabetes (T2D), a population with high risk of DKD. Studying the association of blood PFAS and DKD is complicated by potential interactions between kidney function and PFAS clearance. PFAS bind albumin with high affinity, and urinary loss of albumin can lower systemic PFAS levels. We aimed to assess associations of blood PFAS and DKD risk in youth with T2D and examine whether high baseline urinary albumin to creatinine ratio (uACR), a proxy for faster PFAS clearance, attenuated these associations.
Methods
Serum PFAS concentrations in 374 youth with T2D aged 10-17 years from the TODAY cohort were measured at baseline. uACR and estimated glomerular filtration rate (eGFR) were measured annually for up to 15 years. Cox regression adjusted for key covariates estimated the risk of clinical albuminuria, rapid eGFR decline (annual decline > 3 ml/min/1.73m2 or ≥ 3.3% at two consecutive visits), and hyperfiltration (eGFR ≥ 135 ml/min/1.73m2). Interactions between PFAS and baseline uACR were included to examine effect modification.
Results
Higher PFAS levels were associated with increased DKD risk in individuals with low baseline uACR, but higher baseline uACR attenuated associations. For example, in participants with baseline uACR=0 mg/g, each SD increase in PFOS was associated with 2.3 (95% CI: 1.18, 4.50) times the risk of severe albuminuria (Figure). In contrast, at higher levels of baseline uACR, PFOS concentrations and severe albuminuria risk were not associated. Similar results were observed for other PFAS and risk of moderate albuminuria and hyperfiltration. PFAS were not associated with rapid eGFR decline.
Conclusion
PFAS exposure is associated with elevated risk of DKD in youth with T2D; this association is attenuated in those with higher starting uACR.
Funding
- NIDDK Support