Annals of Occupational and Environmental Medicine

Original Article

Organic solvent exposure for the chronic kidney disease: updated systematic review with meta-analysis: Chaeseong Lim, Hyeoncheol Oh; Ann Occup Environ Med 2023;35:e11. Published online May 17, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e11

Background

Studies on the relationship between organic solvent exposure and chronic kidney disease (CKD) have presented inconsistent results. Definition of CKD has changed in 2012, and other cohort studies have been newly published. Therefore, this study aimed to newly confirm the relationship between organic solvent exposure and CKD through an updated meta-analysis including additional studies.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted on January 2, 2023 using Embase and MEDLINE databases. Case-control and cohort studies on the relationship between organic solvent exposure and CKD were included. Two authors independently reviewed full-text.

Results

Of 5,109 studies identified, a total of 19 studies (control studies: 14 and cohort studies: 5) were finally included in our meta-analysis. The pooled risk of CKD in the organic solvent exposed group was 2.44 (1.72–3.47). The risk of a low-level exposure group was 1.07 (0.77–1.49). The total risk of a high-level exposure group was 2.44 (1.19–5.00). The risk of glomerulonephritis was 2.69 (1.18–6.11). The risk was 1.46 (1.29–1.64) for worsening of renal function. The pooled risk was 2.41 (1.57–3.70) in case-control studies and 2.51 (1.34–4.70) in cohort studies. The risk of subgroup classified as ‘good’ by the Newcastle Ottawa scale score was 1.93 (1.43–2.61).

Conclusions

This study confirmed that the risk of CKD was significantly increased in workers exposed to mixed organic solvents. Further research is needed to determine the exact mechanisms and thresholds. Surveillance for kidney damage in the group exposed to high levels of organic solvents should be conducted.

Trial Registration

PROSPERO Identifier: CRD42022306521

유기용제와 만성 콩팥병 ; 갱신된 메타-분석
목적
유기용제는 많은 산업현장에서 널리 사용되고 있는 물질로, 산업현장 근로자들의 건강에 나쁜 영향을 초래하고 있다. U.Ravnskov et al, 2000 에서는 유기용제 노출과 만성 신부전에 대해 조사했던 환자-대조군 연구들을 모아 메타분석을 시행하였다. 해당 메타 분석이 발표된 이후 만성 신부전의 정의가 변경되었으며 새로운 코호트 연구들도 새로 발표되었다. 따라서 본 연구에서는 기존 메타 분석에서 포함되지 못한 연구들을 추가로 포함하여 업데이트된 메타 분석을 시행하였다.
방법
본 체계적 검토는 Preferred Reporting Items For Systematic Reviews and Meta-Analysis(PRISMA) guideline 에 의거하여 진행되었다. 검색은 Embase 와 MEDLINE 데이터베이스를 활용하여 2021년 11월 9일날 시행되었다. 유기용제 노출에 의한 만성 신부전에 대한 총 위험도와 더불어, 저도 노출, 중등도 노출, 고도 노출로 구분된 논문들을 모아 노출강도에 따른 하위그룹의 위험도 또한 분석하였다.
결과
유기용제 노출군은 비노출군에 비해 만성 신부전에 대한 총 위험도 (pooled risk) 는 2.44(1.72-3.47) 로 나왔다. 저도 노출의 경우 위험도 1.07(0.77-1.49) 로 나타났고 고도 노출군의 경우 총 위험도 2.44(1.19-5.00) 로 나타났다. 사구체 신염 발생의 경우 위험도가 2.69(1.18-6.11), 신기능 악화의 경우 1.46(1.29-1.64) 로 나타났다. 환자-대조군 연구들의 경우 2.41(1.57-3.70), 코호트 연구들의 경우 2.51(1.34-4.70) 으로 나타났다. Newcastle Ottawa scale 점수가 ‘좋음’으로 분류된 연구들의 경우 1.93(1.43-2.61)로 나타났다.
결론
선행 연구와 마찬가지로 혼합 유기용제 노출 근로자에서 만성 신부전의 위험성이 유의하게 증가한 것을 확인하였다. 이는 현재 석유 관련 제품 취급자, 도장공, 금속가공, 실험실 근로자 등 혼합 유기용제 고용량 노출군에 대한 특수건강진단 시 신기능 검사나 단백뇨 검사의 범위를 넓혀야 함을 시사할 수 있다.

Citations

Citations to this article as recorded by

Identifying and Prioritizing Hazardous Chemicals in Construction Metal Structure Coating Systems: A Roadmap for Data‐Driven Disease Prevention
Paridhi Patel, Dhimiter Bello, Anila Bello
American Journal of Industrial Medicine.2025;[Epub] CrossRef
Mixed Solvency Concept to Replace Harmful Organic Solvent: Recent Trends and Future Challenges in Formulation Development
Pranjal Kumar Singh, Nidhi Singh, Atul Pratap Singh, Poonam Bhardwaj, Kapil Sachan, Smita Singh
Combinatorial Chemistry & High Throughput Screening.2025; 28(2): 226. CrossRef
The Exposome and the Kidney: A Silent Dialogue Shaping Chronic Kidney Disease
Livia Alvarenga, Marcia Ribeiro, Ludmila F. M. F. Cardozo, Natália A. Borges, Peter Stenvinkel, Denise Mafra
Journal of Xenobiotics.2025; 15(3): 73. CrossRef

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Review

Technetium-99m hand perfusion scintigraphy (Raynaud’s scan) as a method of verification in hand arm vibration syndrome: a review: Taewoong Ha, Hyeoncheol Oh, Jungwon Kim; Ann Occup Environ Med 2022;34:e26. Published online October 11, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e26

Abstract Abstract in Korean PDF

It is important to assess the blood flow of fingers in the verification of hand-arm vibration syndrome. In the Republic of Korea, most assessments of the blood flow in the fingers are performed using a cold provocation test with finger skin color change. However, this test is a non-objective method with a relatively low sensitivity, leading to possible social and legal problems. Thus, we reviewed the characteristics of several tests that assess the blood flow in the fingers. Among these tests, using the radioactive isotope method, Raynaud’s scan has a relatively higher sensitivity and specificity than other tests, provides objective results, and is approachable in many hospitals. So we suggest using Raynaud's scan as an alternative test when cold provocation test with finger skin color change is negative in vibration exposed worker.

테크네튬-99m 레이노 스캔을 이용한 수완진동 증후군 진단 리뷰
수완진동증후군의 검증에서는 손가락의 혈류를 평가하는 것이 중요하다. 대한민국에서는 레이노증후군의 업무관련성 평가 시 대부분 손가락의 혈류량 평가를 냉각부하 손가락 피부색 변화 검사만으로 시행하고 있다. 그러나 이 검사는 상대적으로 민감도가 낮은 주관적인 검사방법으로 사회적, 법적 문제가 발생할 수 있다. 따라서 우리는 손가락의 혈류를 평가할 수 있는 여러 검사의 특성을 검토하였다. 이 검사 방법들 중, 방사성 동위원소법을 이용한 레이노스캔은 객관적인 결과를 제공하며 다른 검사방법들에 비하여 상대적으로 민감도와 특이도가 높고 많은 병원에서 접근성이 좋다. 따라서 진동노출작업자에서 냉각부하 손가락 피부색 검사 결과가 음성인 경우 대안검사로서 레이노스캔을 사용할 것을 제안한다.

Citations

Citations to this article as recorded by

Raynaud’s Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment
Hirut Yadeta Ture, Nan Young Lee, Na Ri Kim, Eon Jeong Nam
Vascular Specialist International.2024;[Epub] CrossRef

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Review

A work-relatedness assessment in epidemiological case investigation of occupational cancers: II. Practice: an upper urinary tract cancer in a dyer: Kihun Kim, Hyeoncheol Oh, Jungwon Kim; Ann Occup Environ Med 2020;32:e31. Published online September 1, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e31

Abstract PDF: An epidemiological case investigation of occupational cancer is conducted to determine the causation between the cancer and the worker's job. This review describes the overall process of work-relatedness assessment of the epidemiological case investigation through a case of upper urinary tract cancer (UUTC) in benzidine exposed worker in dyeing industry. Medical referrals, occupational history, material safety data sheet, and working environment monitoring submitted by the Korea Workers' Compensation and Welfare Service were reviewed. We further investigated literatures about the cotton dyeing industry, the domestic law and working environment monitoring reports. Benzidine was listed as an International Agency for Research on Cancer risk factor only for bladder cancer among urinary tract cancers, requiring different logical grounds for establishing causation. A literature review was conducted on the metabolic pathways of benzidine to establish biological plausibility. In addition, several papers were investigated that UUTC and bladder cancer share risk factors to extrapolate the epidemiological studies of bladder cancer. Epidemiologic studies of benzidine and bladder cancer were investigated. The worker is a 71-year-old man and performed dyeing and transporting at several dyeing factories for 29 years. The worker was diagnosed with UUTC based on radiologic and histologic results. It was critical to consider that he worked as a dyer for 3 years. The cancer was diagnosed in 2018, with a latent period of approximately 35 years. The worker performed cotton dyeing, and benzidine-based dye was mainly used. The quantitative exposure level of benzidine was reported from non-detection to 397.4 µg/m³. In biological metabolisms, N-acetylhydroxylamine changes DNA structure of urothelium. As a result of reviewing 4 epidemiological studies, the standardized incidence ratio and standardized mortality ratio were significantly high with 3 years of exposure. Work-relatedness was finally assessed as probable based on biological mechanisms and epidemiological evidence. This review will help solutions for work-relatedness assessment processes.

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