Annals of Occupational and Environmental Medicine

Original Article

Effect of night shift work on the reduction of glomerular filtration rate using data from Korea Medical Institute (2016-2020): Beom Seok Ko, Sang Yop Shin, Ji Eun Hong, Sungbeom Kim, Jihhyeon Yi, Jeongbae Rhie; Ann Occup Environ Med 2023;35:e22. Published online June 30, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e22

Abstract Abstract in Korean PDF PubReader ePub: Background
Shift work increases the risk of chronic diseases, including metabolic diseases. However, studies on the relationship between shift work and renal function are limited. The aim of this study was to investigate the association between shift work and a decreased glomerular filtration rate (GFR).
Methods
Data were evaluated for 1,324,930 workers who visited the Korean Medical Institute from January 1, 2016 to December 31, 2020 and underwent a health checkup. Daytime workers were randomly extracted at a ratio of 1:4 after matching for age and sex. In total, 18,190 workers aged over 40 years were included in the analyses; these included 3,638 shift workers and 14,552 daytime workers. Participants were categorized into the shift work group when they underwent a specific health checkup for night shift work or indicated that they were shift workers in the questionnaire. The odds ratio was calculated using a conditional logistic regression to investigate the relevance of shift work for changes in GFR.
Results
35 workers in the shift group and 54 in the daytime group exhibited an estimated GFR (eGFR) value of < 60 mL/min/1.73m² (p < 0.01). The difference in eGFR values between two checkups differed significantly depending on the type of work (p < 0.01); the difference in the shift work group (−9.64 mL/min/1.73 m²) was larger than that in the daytime work group (−7.45 mL/min/1.73 m²). The odds ratio for eGFR reduction to < 60 mL/min/1.73 m² in the shift group versus the daytime group was 4.07 (95% confidence interval: 2.54–6.52), which was statistically significant.
Conclusions
The results of this study suggest that eGFR decreases by a significantly larger value in shift workers than in daytime workers; thus, shift work could be a contributing factor for chronic kidney disease (CKD). Further prospective studies are necessary to validate this finding and identify measures to prevent CKD in shift workers.; 교대근무가 신사구체 여과율에 미치는 영향
목적
교대근무는 대사질환을 포함한 만성질환의 위험도를 증가시키는 것으로 알려져 있다. 하지만 교대근무와 신기능과 관련된 연구는 제한적이다. 때문에, 본 연구의 목적은 교대 근무와 사구체 여과율 감소와의 연관성을 보고자 하는 것이다.
방법
본 연구는 2016년 1월 1일부터 2020년 12월 31일까지 한국의학연구소(KMI)에 내원하여 건강검진을 받은 1,324,930명의 직장인을 대상으로 시행하였다. 나이와 성별에 대해 매칭한 후, 낮 근무자를 4:1의 비율로 무작위 추출하였다. 총 18,190 명의 40세 이상 근로자를 분석 대상으로 하였으며, 교대 근무자 3,638 명과 낮 근무자 14,552 명이 포함되었다. 참가자들은 야간 특수 건강검진을 받았거나 설문지에서 교대 근무자임을 표시했을 때 교대 근무 그룹으로 분류하였다. 조건부 로지스틱 회귀분석을 사용하여 교대 근무의 관련성과 신기능 변화 간의 상관 관계를 조사하였다.
결과
교대 근무 그룹의 35 명과 낮 근무 그룹의 54 명이 추정 GFR(eGFR) 값이 60 mL/min/1.73m2 미만임을 보였다(P<0.01). 두 검진 간 eGFR 값 차이는 근무 형태에 따라 유의하게 차이가 나며(P<0.01), 교대 근무 그룹(-9.64 mL/min/1.73m2)의 차이가 낮 근무 그룹(-7.45 mL/min/1.73m2)보다 크게 나타났다. 주간근무군에 비해 교대근무군에서 사구체 여과율이 60ml/min/1.73m2 미만으로 떨어질 교차비는 4.07(95% CI 2.54-6.52) 로 통계적으로 유의하게 증가하였다.
결론
본 연구 결과 교대 근무자들의 eGFR 값이 주간 근무자들보다 유의하게 감소하였으며, 교대 근무는 만성 신질환 발생의 요인이 될 수 있다는 것을 알 수 있었다.

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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

Abstract Abstract in Korean PDF PubReader ePub: 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.

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Original Article

The association of perfluoroalkyl substances (PFAS) exposure and kidney function in Korean adolescents using data from Korean National Environmental Health Survey (KoNEHS) cycle 4 (2018–2020): a cross-sectional study: Jisuk Yun, Eun-Chul Jang, Soon-Chan Kwon, Young-Sun Min, Yong-Jin Lee; Ann Occup Environ Med 2023;35:e5. Published online March 15, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e5

Abstract Abstract in Korean PDF PubReader ePub

Background

Perfluoroalkyl substances (PFAS) are chemicals widely used in various products in everyday life. Due to its unique strong binding force, the half-life of PFAS is very long, so bioaccumulation and toxicity to the human body are long-standing concerns. In particular, effects on kidney function have recently emerged and there are no studies on the effect of PFAS on kidney function through epidemiological investigations in Korea. From 2018 to 2020, the Korean National Environmental Health Survey (KoNEHS) cycle 4, conducted an epidemiological investigation on the blood concentration of PFAS for the first time in Korea. Based on this data, the relationship between PFAS blood concentration and kidney function was analyzed for adolescents.

Methods

We investigated 5 types of PFAS and their total blood concentration in 811 middle and high school students, living in Korea and included in KoNEHS cycle 4, and tried to find changes in kidney function in relation to PFAS concentration. After dividing the concentration of each of the 5 PFAS and the total concentration into quartiles, multivariable linear regression was performed to assess the correlation with kidney function. The bedside Schwartz equation was used as an indicator of kidney function.

Results

As a result of multivariable linear regression, when observing a change in kidney function according to the increase in the concentration of each of the 5 PFAS and their total, a significant decrease in kidney function was confirmed in some or all quartiles.

Conclusions

In this cross-sectional study of Korean adolescents based on KoNEHS data, a negative correlation between serum PFAS concentration and kidney function was found. A well-designed longitudinal study and continuous follow-up are necessary.

제 4기 국민환경보건 기초조사(2018-2020) 자료를 바탕으로 한 대한민국 청소년의 과불화 화합물 노출과 신장기능과의 상관관계 연구
목적
과불화 화합물은 일상생활에서 다양한 제품에 널리 쓰이는 화학물질이다. 특유의 강한 결합력으로 인한 반감기가 매우 길기 때문에 이로 인한 생물농축과 인체에 끼치는 독성작용은 오랫동안 큰 관심사이다. 최근에는 특히 신기능에 미치는 영향이 주목받고 있으나 국내에서는 대규모 역학조사를 통한 PFAS가 신기능에 미치는 영향에 대한 조사가 전무한 실정이다. 2018년부터 2020년까지 실시된 국민환경보건 기초조사는 국내 최초로 과불화 화합물의 혈중농도에 대한 대규모 역학조사를 실시했다. 이 자료를 바탕으로 국내 최초로 청소년을 대상으로 하여 과불화 화합물의 혈중농도와 신장기능의 관계를 분석하였다.
방법
제 4기 국민환경보건 기초조사에 포함된 국내에 거주하는 중, 고등학생 828명을 대상으로 5종의 과불화 화합물의 혈중 농도를 조사하고 농도에 따른 신장기능의 변화를 알아보고자 하였다. 5종의 과불화 화합물 각각의 농도와 총 합의 농도를 사분위수로 나눈 후 다중선형회귀분석을 실시하여 신기능과의 상관관계를 분석하였다.
결과
다중선형회귀분석 결과 5종의 과불화 화합물 각각의 농도와 총 합의 농도 증가에 따라 일부 또는 전체 사분위수에서 통계적으로 유의한 신장기능의 감소가 확인되었다.
결론
제 4기 국민환경보건 기초조사 자료를 바탕으로 한국 청소년을 대상으로 한 이번 단면연구에서는 혈중 과불화 화합물의 농도와 신기능 사이에 음의 상관관계가 있음을 발견하였다. 잘 설계된 종단연구와 지속적인 추적관찰이 필요하다.

Citations

Citations to this article as recorded by

Association of Combined Per- and Polyfluoroalkyl Substances and Metals with Chronic Kidney Disease
Issah Haruna, Emmanuel Obeng-Gyasi
International Journal of Environmental Research and Public Health.2024; 21(4): 468. CrossRef
Leveraging Machine Learning for a Comprehensive Assessment of PFAS Nephrotoxicity
Anirudh Mazumder, Kapil Panda
Advances in Science, Technology and Engineering Systems Journal.2024; 9(3): 62. CrossRef

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Research Article

The association between shift work and chronic kidney disease in manual labor workers using data from the Korea National Health and Nutrition Examination Survey (KNHANES 2011–2014): Jun Young Uhm, Hyoung-Ryoul Kim, Gu Hyeok Kang, Young Gon Choi, Tae Hwi Park, Soo Young Kim, Seong Sil Chang, Won Oh Choo; Ann Occup Environ Med 2018;30:69. Published online December 14, 2018; DOI: https://doi.org/10.1186/s40557-018-0279-z

Abstract PDF PubReader ePub

Objective

Kidneys are organs having a biological clock, and it is well known that the disruption of the circadian rhythm increases the risk of chronic kidney disease (CKD), including the decline of renal and proteinuria. Because shift work causes circadian disruption, it can directly or indirectly affect the incidence of chronic kidney disease. Therefore, the purpose of this study was to investigate the association between shift work and chronic kidney disease using a Korean representative survey dataset.

Methods

This study was comprised of 3504 manual labor workers over 20 years of age from data from the fifth and sixth Korea National Health and Nutrition Examination Survey (2011–2014). The work schedules were classified into two types: day work and shift work. The estimated glomerular filtration rate, which is the ideal marker of renal function, was estimated according to the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and chronic kidney disease was defined as urinary albumin to a creatinine ratio equal to or high than 30 mg/g and/or estimated glomerular filtration rate lower than 60 mL/min/1.73 m². The cross-tabulation analysis and multivariate logistic regression analysis were performed to confirm the association between shift work and chronic kidney disease stratified by gender.

Results

The risk of CKD showed a significant increase (odds ratio = 2.04, 95% confidence interval = 1.22, 3.41) in the female worker group. The same results were obtained after all confounding variables were adjusted (odds ratio = 2.34, 95% confidence interval = 1.35, 4.07). However, the results of the male worker group were not significant.

Conclusions

In this study using nationally representative surveys, we found that the risk of CKD was higher female workers and shift work. Future prospective cohort studies will be needed to clarify the causal relationship between shift work and CKD.

Citations

Citations to this article as recorded by

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Journal of Pineal Research.2024;[Epub] CrossRef
Effect of night shift work on the reduction of glomerular filtration rate using data from Korea Medical Institute (2016-2020)
Beom Seok Ko, Sang Yop Shin, Ji Eun Hong, Sungbeom Kim, Jihhyeon Yi, Jeongbae Rhie
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Review

Environmentally induced, occupational diseases with emphasis on chronic kidney disease of multifactorial origin affecting tropical countries: Shehani A. Wimalawansa, Sunil J. Wimalawansa; Ann Occup Environ Med 2016;28:33. Published online August 5, 2016; DOI: https://doi.org/10.1186/s40557-016-0119-y

Abstract PDF PubReader ePub

Background

Environmentally induced, occupational diseases are increasing worldwide, especially in rural agricultural communities. Poverty-associated malnutrition, environmental hazards and pollution, and lack of access to clean water, safe sanitation, and modern healthcare facilities are often associated with these chronic illnesses.

Method

The authors systematically reviewed occupational public health issues that have been related to the environment. General interpretations of results were included as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Pertinent publications from research databases were reviewed on (A) the risk–benefits, (B) the prevalence of risk factors for various diseases, (C) the benefits of not ignoring the risk factors (i.e., broader evidence), and (D) the risks, effects, and outcomes of different types of interventions. The authors used chronic kidney disease of multifactorial origin (CKDmfo) as an example to explore the theme. Emphasis was given to the regions with emerging economies and developing countries located in the vicinity of the equator.

Findings

Geographical, socio-economic and aetiological similarities exist for many chronic non-communicable diseases that are affecting tropical countries around the equator. The authors identified manufacturing, mining, and agriculture as the biggest polluters of the environment. In addition, deforestation and associated soil erosion, overuse of agrochemicals, and irresponsible factory discharge (e.g., chemicals and paint, from rubber and textile factories, etc.), all contribute to pollution. To decrease the escalating incidences of environmentally induced diseases, governments should work proactively to protect the environment, especially watersheds, and take steps to minimise harmful occupational exposures and strictly enforce environmental regulations.

Conclusion

Creating public awareness of environmental issues and their relationship to public health is essential. This includes regular monitoring and periodic publication of the quality of water, air and soil; preventing deforestation and man-made soil erosion, increasing forest and ground cover, preventing occupational injuries, judicious and safe use of agrochemicals, sustainable agriculture and development programs, and implementing legislation to protect and conserve water heriage and the environment. These actions are essential both for a healthier environment and for the health of the people who live in that environment. Such measures would also decrease public health threats from such, including global-warming-related erratic environmental changes and the occurrence and the spread of non-communicable diseases, such as CKDmfo.

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Review

The Relationship between the Occupational Exposure of Trichloroethylene and Kidney Cancer: Inah Kim, Jaehyeok Ha, June-Hee Lee, Kye-mook Yoo, Jaehoon Rho; Ann Occup Environ Med 2014;26:12-12. Published online June 3, 2014; DOI: https://doi.org/10.1186/2052-4374-26-12

Abstract PDF PubReader ePub

Trichloroethylene (TCE) has been widely used as a degreasing agent in many manufacturing industries. Recently, the International Agency for Research on Cancer presented “sufficient evidence” for the causal relationship between TCE and kidney cancer. The aim of this study was to review the epidemiologic evidences regarding the relationship between TCE exposure and kidney cancer in Korean work environments. The results from the cohort studies were inconsistent, but according to the meta-analysis and case–control studies, an increased risk for kidney cancer was present in the exposure group and the dose–response relationship could be identified using various measures of exposure. In Korea, TCE is a commonly used chemical for cleaning or degreasing processes by various manufacturers; average exposure levels of TCE vary widely. When occupational physicians evaluate work-relatedness kidney cancers, they must consider past exposure levels, which could be very high (>100 ppm in some cases) and associated with jobs, such as plating, cleaning, or degreasing. The exposure levels at a manual job could be higher than an automated job. The peak level of TCE could also be considered an important exposure-related variable due to the possibility of carcinogenesis associated with high TCE doses. This review could be a comprehensive reference for assessing work-related TCE exposure and kidney cancer in Korea.

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Case Report

A Case of Chronic Renal Failure and Renal Cancer in a Worker Exposed to Lead: Somin Park, Jongeun Kim, Jungwon Kim, Daegyun Hong, Sangbum Ye, Dongmug Kang, Euna Kim; Korean Journal of Occupational and Environmental Medicine 2008;20(3):272-281. Published online September 30, 2008; DOI: https://doi.org/10.35371/kjoem.2008.20.3.272

Abstract PDF: INTRODUCTION: Studies evaluating rats and mice have provided convincing evidence that renal adenoma and carcinoma are induced by oral doses of lead acetate and lead subacetate, as well as by parenteral doses of lead phosphate. In addition, at least 2 cases of kidney cancer associated with heavy exposure to lead have been reported. However, there is still not enough information to confirm or rule out an association between kidney cancer and exposure to lead.
CASE
REPORT: In this study, we describe a case of kidney cancer in 54-year-old male worker that was exposed to lead-stearate while employed in the polyvinyl chloride processing industry for 17 years. The patient presented with gout and hypertension. Further examination revealed proteinuria, glucose in the urine and elevated blood urea nitrogen/creatinine levels. Renal ultrasonography, renal computed tomography and renal biopsy revealed chronic renal failure and renal cell cancer.
CONCLUSION
We concluded that the gout and chronic renal failure in this case was caused by chronic lead exposure. However, further study is required to determine if the renal cancer was induced by lead exposure.

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Original Article

Reference Values of Cadmium in Kidney and Liver in Korean: Jung Duck Park, Byung Sun Choi, Il Hoon Kweon, Yeon Pyo Hong, Im Won Chang; Korean Journal of Occupational and Environmental Medicine 2000;12(3):346-355. Published online September 30, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.3.346

Abstract PDF

OBJECTIVES
Cadmium (Cd), a toxic and non-essential metal, is recognized as a human carcinogen, which has a tendency to accumulate in the human body. The levels of Cd in renal cortex and liver are good indicators as an index of Cd exposure in the general population. In this study, we present an estimation of reference Cd levels in tissue (renal cortex and liver) and total body burden in the general population of Korea. MEDTHODS: Cd and zinc (Zn) were analyzed in renal cortex and liver from 254 autopsies (male : 188 cases, female : 66 cases) aged 0 to 87 years.
RESULTS
Geometric mean concentration of Cd was 27.4 and 3.1 ua/g wet weight in renal cortex and liver, respectively. The level of Zn in renal cortex and liver was 35.4 and 42. 6 v/g wet weight, respectively. The result suggests that kidney is the target organ for Cd accumulation. The accumulation of Cd in renal cortex was age-dependent with a biphasic pattern. The level of Cd in renal cortex increased with age up to the fifties, and then leveled off thereafter. Based on the data, the regression model for Cd accumulation in renal cortex by age is predicted by : Log KCd = 0. 2325 + 0. 0553 Age 0. 0005 Age. The highest Cd accumulation in renal cortex of Koreans was estimated at 43. 3 ua/g wet weight at 50. 8 years old. In addition, the total Cd body burden by age was estimated by the following equation: Total Cd Body Burden = -4. 5948 + l. 2278 Age - 0. 0121 Age. The highest body burden of Cd was estimated at 26. 5 mg at age 50. 7 years in the Korean general population. The positive correlation between Zn and Cd was observed in renal cortex and liver.
CONCLUSIONS
The level of Cd exposure in Korean was found to be lower than in Japanese, but same as or higher than in American and Europeans.

Citations

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Effects of Environmental Cadmium Exposure on the Liver in Korean Adults: Cross-Sectional and Longitudinal Studies
Mi-Na Seo, Sang-Yong Eom, Ji-Ae Lim, Jung-Eum Lee, Byung-Sun Choi, Ho-Jang Kwon, Young-Seoub Hong, Heon Kim, Jung-Duck Park
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Original Article

Changes in Cadmium Deposit and Histopathologic Finding of Testis, Liver and Kidney in Cadmium Exposed Rats: Young Goo Lee, Jung Duck Park, Byung Sun Choi, Yeon Pyo Hong, Im Won Chang; Korean Journal of Occupational and Environmental Medicine 1994;6(1):56-68. Published online February 28, 1994; DOI: https://doi.org/10.35371/kjoem.1994.6.1.56

Abstract PDF: To assess the changes of cadmium deposit and histopathologic finding of testis, liver and kidney, different dose of cadmium (Cd) was administered into male Sprague-Dawley rat(purchased from KIST, Korea Institute of Science and Technology) by single intravenous injection. At 12, 24, 48, 168 and 672 hours after Cd injection, tissue cadmium concentration and histopathological change were examined. Cd exposed group showed lesser weight gain than the control. Renal Cd content tended to increase in time-dependent pattern, while hepatic and testicular Cd content tended to decrease. Mean of renal Cd content to hepatic Cd content (Cd K/Cd L) also progressively increased. These results suggest that Cd might be gradually transported to kidney fro other organs. In testis and liver, degenerative changes appeared relatively in acute phase. These changes became more pronounced in testis, while less prominent in liver. In kidney, swelling of proximal tubluar cells and thickening of glomerular basement membrane appeared relatively later and these changes were progressively aggravated.

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