Table 4 An overview of longitudinal and cross-sectional studies investigating the association between PFAS and eGFR.

Li et al. [44]

967 diabetes patients from the Dongfeng-Tongji cohort, China.

PFOA, PFOS

Multivariable logistic regression. Least Absolute Shrinkage and Selection Operator (LASSO). Restricted Cubic Spline Regression (RCS).

Statistically significant inverse association was observed between PFOS and the risk of CKD (eGFR < 60 mL/min/1.73 m²).

Caution must be exerted interpreting the findings given the complexity of the relationship between kidney function and serum PFAS concentrations.

Lin et al. [15]

875 prediabetics from various medical centers, USA.

PFOA, PFOS, PFOSA, PFNA, PFHxS, Me-PFOSA^a, Et-PFOSA^b

Generalized linear mixed models.

Linear regression.

PFOS and PFOA isomers were inversely associated with eGFR. For PFASs as a mixture, every one-quartile increase was associated with 2.26-unit decrease in eGFR.

Baseline plasma PFAS was inversely associated with prospective measures of eGFR. Higher baseline plasma concentrations were associated with lower eGFR over 14 years.

Blake et al. [10]

210 participants, Fernald Community Cohort, USA.

PFOA, PFOS, PFOSA, PFNA, PFHxS, PFDeA, Me-PFOSA^a, Et-PFOSA^b

Linear mixed effects models.

Statistically significant negative association between eGFR and PFNA, PFDeA, PFHxS.

Associations between PFAS and eGFR were generally negative, although differences by PFAS congener was observed.

Dhingra et al. [13]

9192 women (age 30–65) from the C8 health project, West Virginia, USA.

PFOA

Linear regression. Pharmacokinetic and environmental prediction model.

Cross-sectional analysis showed a negative association between PFOA and eGFR. Modeled PFOA or cumulative exposure did not find any association.

The negative association between eGFR and measured PFOA is consistent with an increase in serum PFOA that might be expected to result from decreased kidney clearance of PFOA.

Moon et al. [14]

Adults from the National Health and Nutrition Examination Surveys, USA.

PFOA, PFOS, PFHxS, PFNA

Multivariable linear regression. Generalized additive model. Regression discontinuity model. Directed acyclic graphs.

All of the included PFAS was inversely associated with eGFR.

The possibility of reverse causation that increased serum PFAS concentration is the consequence of reduced eGFR and not the cause was low. Further longitudinal epidemiological and toxicological studies are needed.

Liang et al. [30]

1700 adults from the National Health and Nutrition Examination Surveys, USA.

PFOA, PFOS, PFNA, PFDA, PFDeA^c, PFHxS

Multivariable linear regression. Bayesian kernel machine regression.

Higher levels of PFOS and PFHxS were significantly associated with lower eGFR. Joint effects of multiple PFAS on eGFR.

Prospective studies need to explore the joint effects further, and the biological mechanisms behind the associations needs to be further confirmed.

Kataria et al. [29]

1960 adolescents (12–19 years) from the National Health and Nutrition Examination Surveys, USA.

PFOA, PFOS, PFNA, PFHxS

Linear regression, univariable, bivariable and multivariable.

Adolescents in the highest PFOA and PFOS quartile had a lower eGFR compared to the lowest quartile.

Higher levels of PFAS are associated with a reduction in kidney function in otherwise healthy adolescents. Reverse causation and residual confounding could explain the results.

Shankar et al. [28]

4587 adults from the National Health and Nutritional Examination Survey, USA.

PFOA, PFOS

Multivariable linear regression.

Serum levels of PFOA and PFOS were positively associated with CKD (GFR less than 60 mL/minute/1.73 m2.

Elevated PFAS levels are associated with CKD.

Watkins et al. [45]

9660 children (1–18 years) from the C8 health project, West Virginia, USA.

PFOA, PFOS, PFNA, PFHxS

Linear regression. Pharmacokinetic and environmental prediction model.

An interquartile range increase in measured PFOA was associated with a decreased eGFR.

The findings of the study suggest that the cross-sectional association between eGFR and s-PFOA observed may be a consequence, and not a cause of decreased kidney function.

Conway et al. [31]

53,650 adults from the C8 health project, West Virginia, USA.

PFHxS, PFOS, PFNA, PFOA

Linear regression. Chi2-test. Logistic regression.

Each PFAS was positively associated with eGFR among those with CKD or anemia. These relationships were more pronounced along those with diabetes.

PFAS are inversely associated with kidney function in CKD and diabetes, with a stronger relation observed when anemia is present.