Association of Perfluoroalkyl Substances with Hyperuricemia and Gout

Previous population cross-sectional studies have reported a positive association of polyfluoroalkyl substances (PFASs), including perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), with hyperuricemia and chronic kidney diseases (CKD) defined as estimate glomerular filtration rate (eGFR) <60 mL/minute/1.73 m2 . We investigated whether there is an association between exposure to PFAS, and serum uric acid and gout in the adult population of the (NHANES) 2009-2012 (n=3248). PFAS includes PFOA, PFOS perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS). Multivariate logistic regression were performed to analyze the association of PFAS with hyperuricemia and gout. Serum PFOA, PFNA, PFOS and PFHxA were analyzed as quartiles. Multivariate linear regression were performed to analyze the association of PFAS with uric acid and eGFR. Analyses were also restricted to individuals with normal eGFR. The weighted prevalence of hyperuricemia was 17.7 % (95% CI: 15.8% – 19.73%), and of self-reported gout was 3.2 % (95% CI: 2.5% – 4.1%). After adjustment for potential confounders, all four PFAS investigated were associate with increased serum uric acid and decreased eGRF. There were statistically significant associations between the highest quartile of PFOA, PFNA and PFHxS, but not PFOS, and hyperuricemia. These association were confirmed for PFOA and PFNA, when the analyses were restricted to participants with normal eGFR.The adjusted odd ratio for gout among participants in the 4th PFOA quartile was 2.80 (95% CI: 1.16, 6.74) compared the 1st PFOA quartile. The positive association was also found when the analyses excludes individuals with CKD. In this population cross-sectional analysis, we found an association between PFOA with self-reported gout. We also confirmed previous reports of an association of PFAS with hyperuricemia and decreased eGFR. Longitudinal studies examining the relationship of PFAS renal function are needed.