| Kidney disease

Forever Chemicals (PFAS) and Kidney Health

November 02, 2023, 8:41am EDT

Person drinking water after exercising

A recent study1 revealed that at least 45% of tap water in the United States is contaminated with PFAS, also known as forever chemicals. What are these chemicals, where are they found, and what dangers do they pose? Here's what you need to know.

Key takeaway

Forever chemicals are linked to increased risk of several health issues, including kidney cancer, decreased fertility, and more. The bad news is these chemicals have been in production for a long time and don't easily break down in the environment, so there is no way to avoid them altogether. The good news is that you can limit your exposure to protect your health by avoiding contaminated water, shopping for fish carefully, looking at ingredient lists, and eating a high-fiber diet. 

Did you know that 1 in 3 Americans are at risk of kidney disease? Take this one-minute quiz to find out if you are one of them. 

What are forever chemicals?

According to the Agency for Toxic Substances and Disease Registry (ATSDR)2, PFAS are chemicals that break down extremely slowly in the environment and build up in the body. There are thousands of forever chemicals, many of which have been used since the 1940s because they are resistant to grease, oil, water, and heat. 

Common forever chemicals include:

  • PFOS: Perfluorooctane sulfonic acid
  • PFOA (or C8): Perfluorooctanoic acid
  • PFNA: Perfluorononanoic acid
  • PFDA: Perfluorodecanoic acid
  • PFOSA (or FOSA): Perfluorooctane sulfonaminde
  • MeFOSAA (Me-PFOSA-AcOH): 2-(N-Methyl-perfluorooctane sulfonamido) acetic acid
  • Et-FOSAA (aka Et-PFOSA-AcOH): 2-(N-Ethyl-perfluorooctane sulfonamido) acetic acid
  • PFHxS: Perfluorohexane sulfonic acid

Exposure to forever chemicals3 is most common through contaminated drinking water, eating foods containing them (mainly fish), and breathing PFAS-contaminated air.

Other exposure routes include: 

  • Swallowing contaminated dust or soil
  • Using products or eating food packaged with materials containing PFAS
  • Working as a firefighter or in a factory using PFAS in manufacturing or processing

What are the dangers of forever chemicals?

The Environmental Protection Agency (EPA)4 has reviewed current peer-reviewed scientific studies and found that forever chemicals may cause:

  • Increased risk of prostate, testicular, and kidney cancer
  • Decreased fertility 
  • Increased high blood pressure in pregnant people
  • Developmental effects or delays in children
  • Reduced ability to fight infection and decreased vaccine response
  • Interference with natural hormones
  • Increased risk of obesity and high cholesterol

Most forever chemicals stay in the body, but some may be excreted (removed) through urine, breast milk, and menstrual blood. The chemicals that don’t leave may accumulate in the kidney and cause a decline in function.5 

Unfortunately, more research must be done to understand the full effects of forever chemicals and how much exposure results in these issues. Blood tests for forever chemicals are available if requested. However, these tests are more valuable if done community-wide for research purposes. Individual testing can not determine or help predict future health problems related to PFAS. 

Learn how to read a comprehensive metabolic panel.

How to limit forever chemicals

It isn't possible to completely avoid forever chemicals, but these steps can help you limit exposure to them. 

1. Avoid contaminated water

Consuming contaminated water is currently the highest source of forever chemicals in the United States. To determine whether your water has unsafe levels of PFAS, contact your state or local government for a water test. If they don't provide this service, choose an EPA-certified laboratory to perform the test. If the test returns positive, ATSDR recommends you use an alternative or treated water source for drinking, food preparation, and any other activity requiring drinking water.

Learn which water treatment technology is right for you.

2. Be picky about the fish you eat

Fish is currently one of the foods that contain the most forever chemicals, but that doesn't mean you should take fish off the menu. Instead, avoid eating fish from areas listed in the EPA's state, territory, and tribal fish advisories. You can also choose saltwater fish over wild-caught freshwater fish, which contain much higher levels of PFAS.6

3. Look at consumer product ingredient labels

Avoid purchasing new consumer products that list PFAS in the ingredients. You can also audit existing products to reduce your daily exposure to forever chemicals.

Forever chemicals are commonly found in found in3:

  • Water and stain-resistant fabrics and coatings
  • Cleaning products
  • Cosmetics like nail polish and eye makeup
  • Some grease-resistant paper, fast food containers or wrappers, pizza boxes, and candy wrappers
  • Household products like non-stick cookware
  • Personal care products like shampoo and dental floss
  • Paints, varnishes, and sealants

Find PFAS-free products recommended by the EPA.

4. Eat a high-fiber diet

A recent study7 funded by the National Institute of Environmental Health Sciences (NIEHS) found that a diet high in fiber, found in plant-based foods, may help protect the body against PFOS (perfluorooctane sulfonic acid), a forever chemical often found in water. While this preliminary research is promising, more studies will need to be done to determine how dietary fiber protects against forever chemicals and to what degree other lifestyle choices affect these results. 

Even if fiber plays only a minor role in protecting people against forever chemicals, there are still many benefits to a plant-based diet. It may also help prevent or slow the progression of chronic kidney disease, Type 2 diabetes, high blood pressure, and heart disease.

Learn more about the benefits of plant-based diets

Have questions?

Contact NKF Cares, our patient helpline, toll-free at 855.NKF.CARES (855.653.2273) or email nkfcares@kidney.org.

1Smalling, Kelly L., et al. “Per- and Polyfluoroalkyl Substances (PFAS) in United States Tapwater: Comparison of Underserved Private-Well and Public-Supply Exposures and Associated Health Implications.” Environment International, vol. 178, 2023, p. 108033, https://doi.org/10.1016/j.envint.2023.108033.
2“Frequently Asked Questions about Pfas Chemicals.” PFAS FAQs, 9 Sept. 2022. https://www.atsdr.cdc.gov/pfas/resources/pfas-faqs.html
3“Pfas Chemical Exposure.” How Can I Be Exposed?, 1 Nov. 2022, www.atsdr.cdc.gov/pfas/health-effects/exposure.html. 
4“Our Current Understanding of the Human Health and Environmental Risks of PFAS.” PFOA, PFOS and Other PFAS, www.epa.gov/pfas/our-current-understanding-human-health-and-environmenta.... Accessed 3 Aug. 2023.
5Liu D, Yan S, Wang P, Chen Q, Liu Y, Cui J, Liang Y, Ren S, Gao Y. Perfluorooctanoic acid (PFOA) exposure in relation to the kidneys: A review of current available literature. Front Physiol. 2023 Jan 26;14:1103141. doi: 10.3389/fphys.2023.1103141. PMID: 36776978; PMCID: PMC9909492.
6Barbo, Nadia, et al. “Locally Caught Freshwater Fish across the United States Are Likely a Significant Source of Exposure to PFOS and Other Perfluorinated Compounds.” Environmental Research, vol. 220, 2023, p. 115165, https://doi.org/10.1016/j.envres.2022.115165. 
7Wiener, Maggie. “High-Fiber Diet May Protect against Exposure to Pfos.” National Institute of Environmental Health Sciences, factor.niehs.nih.gov/2023/4/community-impact/diet-protects-against-pfos. Accessed 1 Aug. 2023.

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