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Table 3 Reviewed studies ranked by their explanatory potential on the etiological role of pesticide for CKD/CKDu

From: Pesticide exposures and chronic kidney disease of unknown etiology: an epidemiologic review

Study CKD marker Potential to explain pesticide role in CKD/CKDu Associations
Low Medium High
Pesticide exposure indicator
Rugama, 2001 [85] CKD diagnosis at hospital admission Pesticide use    Positive
Gracía-Trabanino et al., 2005 [86] Proteinuria >15 mg/L Pesticide use    No
SCr >1.5 mg/dL Pesticide use No
Peiris-John et al., 2006 [87] Chronic renal failure diagnosis at hospital Acetyl cholinesterase levels in four groups (exposed CRF, unexposed CRF, exposed non-CRF and unexposed non-CRF)    Positive
Wanigasuriya et al., 2007 [36] CKDu hospital diagnosis Pesticides    No
Torres-Lacourt et al. 2008 [88] eGFR <60 ml/min1.73/m2 Pesticide use    Positive
Pesticide intoxication No
Kamel & El Minshawy, 2010 [6] ESRDu Pesticide exposure    Positive
Aroonvilairat et al., 2015 [98] BUN and SCr Pesticide mixing and spraying in orchid for at least three months    No
Orantes et al., 2011 [91] Persistent CKD stages 1-5 determined twice with 3-months interval   Contact with agrichemicals   No
Wanigasuriya et al., 2011 [92] Micro-proteinuria   Pesticides   No
Laux et al., 2012 [93] Proteinuria   Work with pesticides   No
Laws et al., 2015 & 2016 [73, 74] Change in eGFR (ml/min/1.73 m2)   Job as pesticide applicator over 6-month period   No
Change in early kidney injury markers No
Wesseling et al., 2016 [99] eGFR <80 ml/min/1.73m2   Any pesticide use   No
Specific pesticides: glyphosate, paraquat, 2,4-D, chlorpyrifos, cypermethrin No
Sanoff et al., 2010 [89] eGFR <60 ml/min/1.73m2   Pesticides   Weak positive
O’Donnell et al., 2011 [90] eGFR <60 ml/min/1.73m2   Any pesticide exposure   Weak positive
Mixing/applying pesticides No
Athuraliya et al., 2011 [19]
Sri Lanka
Proteinuric CKD   Pesticides   Negative in CKDu endemic area
Positive in non-endemic area
Raines et al., 2014 [45] eGFR <60 ml/min/1.73m2   Lifetime days mixing/applying   No
History of accidentally inhaling pesticides Reported positive, but not interpretable
García-Trabanino et al., 2015 [94] eGFR <60 ml/min/1.73m2   Any pesticide use   No
Carbamate insecticides Positive
Glyphosate, paraquat, 2,4-D, triazines, organo-phosphates, pyrethroids No
Jayasumana et al., 2015 [95]     Use of fertilizers, organo-phosphates, paraquat, MCPA, bispyribac, mancozeb Positive only in unadjusted analyses
Use of glyphosate Positive also in multivariate analyses
Drinking water from serving wells and from abandoned wells (hardest water and highest glyphosate levels) Positive with dose response
Siddharth et al., 2012 and Siddharth et al., 2014 [75, 76] CKDu with eGFR <60 ml/min/1.73m2 for >3 months    Urinary organochlorine pesticides and metabolites and interaction with GST polymorphism Positive
Lebov et al., 2016 [97] ESRD among male applicators    Intensity weighted lifetime days for 39 pesticides:
Alachlor, atrazine, metalochlor, paraquat, pendimethalin, permethrin
Positive with dose-response
Petroleum oil, imazethapyr, coumaphos, parathion, phorate, aldicarb, chlordane, and metalaxyl Weak positive without dose responses
Glyphosate and 24 other pesticides No
Pesticide exposure resulting in medical visit or hospitalization Positive
Diagnosed pesticide poisoning No
High level pesticide exposure event No
Lebov et al., 2015 [96] ESRD among wives of licensed applicators    Intensity weighted lifetime days for applying
-Pesticides in general
-Specific pesticides No
Husband’s use of paraquat Positive
Residential exposure No