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PLoS One. 2018 Jul 17;13(7):e0200271. doi: 10.1371/journal.pone.0200271. eCollection 2018.

Associations between perfluorinated chemicals and serum biochemical markers and performance status in uremic patients under hemodialysis.

Liu WS1,2,3,4, Lai YT5,6, Chan HL7, Li SY2,8, Lin CC2,8, Liu CK9, Tsou HH4, Liu TY4,10.

Author information

Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
College of Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan.
Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
Department of Nursing, Yuanpei University, Hsinchu, Taiwan.
Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
College of Medicine & Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan.
Institute of Food Safety and Health Risk Assessment, National Yang-Ming University, Taipei, Taiwan.


Perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA) are commonly used perfluorinated chemicals (PFCs). PFCs are mainly excreted by urine. Uremic patients tend to accumulate toxins in their body and have poor functional status. We investigated the associations between PFCs and the clinical profile of uremic patients under hemodialysis (HD). Liquid chromatography tandem mass spectrometry coupled with isotope dilution was used to quantify PFOA and PFOS. We enrolled 126 patients under regular HD. Compared with previous research, the concentration of PFOA was lower, but that of PFOS was higher in uremic patients than in the general population. The levels of PFOA and PFOS in uremic patients before dialysis were 0.52 (ng/ml) and 21.84 (ng/ml) respectively. The PFOA level remained unchanged but that of PFOS decreased to1.85 ng/mL after dialysis. PFOS can be removed by HD. Patients using hypertensive medication had a lower PFOS then those who did not. The PFOS level was negatively correlated with the duration of the HD session and patient performance status, but positively correlated with levels of cholesterol, chloride (an indicator of acidemia), ferritin, and total protein. (p<0.05). The association with serum protein may explain the long half-life of PFCs in humans. This is the first study which investigated PFCs in uremic patients and showed PFCs are associated with adverse effects in this population.

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