Association between serum organophosphorus pesticides and the risk of incident chronic kidney disease: findings from Dongfeng-Tongji cohort

• This is the first study to link serum OPPs parent compounds to CKD risk. • Serum methidathion, ethion, phorate, and diazinon are associated with incident CKD. • Diazinon and frequent fish/seafood consumption may jointly increase CKD risk. • Findings support OPP biomonitoring in CKD screening and public health guidance. Although chronic kidney disease (CKD) represents a significant worldwide public health concern, evidence linking organophosphorus pesticides (OPPs) to incident CKD remains scarce. This study, conducted within the Dongfeng-Tongji cohort, included 1,902 participants free of CKD at baseline, with a mean age of 64.13 years. Serum concentrations of OPPs were measured. Incident CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m 2 or positive urine protein. Multivariate logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). During a median follow-up of 5.16 years, 287 incident CKD cases were identified. Multivariate logistic regression models revealed that higher serum levels of methidathion (Q4 vs. Q1: OR = 1.61, 95% CI: 1.11–––2.33) and ethion (Q4 vs. Q1: OR = 1.58, 95% CI: 1.09–––2.30) were significantly associated with higher risk of CKD. Phorate and diazinon, analyzed as binary variables due to low detection rates (<50%), were also positively associated with CKD risk (OR = 1.41, 95% CI: 1.09–––1.83; and OR = 1.37, 95% CI: 1.02–––1.84, respectively). Moreover, significant multiplicative and additive interactions were observed between diazinon and fish/seafood consumption (≥5 times/week), with an attributable proportion due to interaction of 0.59 (95% CI: 0.25–––0.94). These findings demonstrate that OPPs are significantly associated with incident CKD risk and identify a novel interaction between diazinon and dietary factors. This study supports the inclusion of serum OPPs compounds in the early biological monitoring system for CKD-susceptible populations and underscores the importance of environmental monitoring in disease prevention.