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. 2018 Jan;29(1):218-230.
doi: 10.1681/ASN.2017030253. Epub 2017 Sep 21.

Particulate Matter Air Pollution and the Risk of Incident CKD and Progression to ESRD

Benjamin Bowe  1 , Yan Xie  1 , Tingting Li  1   2 , Yan Yan  1   3 , Hong Xian  1   4 , Ziyad Al-Aly  5   2   6   7
Affiliations

Particulate Matter Air Pollution and the Risk of Incident CKD and Progression to ESRD

Benjamin Bowe et al. J Am Soc Nephrol. 2018 Jan.

Abstract

Elevated levels of fine particulate matter <2.5 µm in aerodynamic diameter (PM2.5) are associated with increased risk of cardiovascular outcomes and death, but their association with risk of CKD and ESRD is unknown. We linked the Environmental Protection Agency and the Department of Veterans Affairs databases to build an observational cohort of 2,482,737 United States veterans, and used survival models to evaluate the association of PM2.5 concentrations and risk of incident eGFR <60 ml/min per 1.73 m2, incident CKD, eGFR decline ≥30%, and ESRD over a median follow-up of 8.52 years. County-level exposure was defined at baseline as the annual average PM2.5 concentrations in 2004, and separately as time-varying where it was updated annually and as cohort participants moved. In analyses of baseline exposure (median, 11.8 [interquartile range, 10.1-13.7] µg/m3), a 10-µg/m3 increase in PM2.5 concentration was associated with increased risk of eGFR<60 ml/min per 1.73 m2 (hazard ratio [HR], 1.21; 95% confidence interval [95% CI], 1.14 to 1.29), CKD (HR, 1.27; 95% CI, 1.17 to 1.38), eGFR decline ≥30% (HR, 1.28; 95% CI, 1.18 to 1.39), and ESRD (HR, 1.26; 95% CI, 1.17 to 1.35). In time-varying analyses, a 10-µg/m3 increase in PM2.5 concentration was associated with similarly increased risk of eGFR<60 ml/min per 1.73 m2, CKD, eGFR decline ≥30%, and ESRD. Spline analyses showed a linear relationship between PM2.5 concentrations and risk of kidney outcomes. Exposure estimates derived from National Aeronautics and Space Administration satellite data yielded consistent results. Our findings demonstrate a significant association between exposure to PM2.5 and risk of incident CKD, eGFR decline, and ESRD.

Keywords: ESRD; chronic kidney disease; glomerular filtration rate.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Adjusted survival curves by PM2.5 quartiles. (A) Incident eGFR <60 ml/min per 1.73 m2, (B) incident CKD, (C) eGFR decline ≥30%, and (D) ESRD. Survival curves are adjusted for age, race, sex, and T0 eGFR.
Figure 2.
Figure 2.
Analyses of risk of renal outcomes by PM2.5 concentrations (PM2.5 of 5.7 μg/m3 served as a reference) with PM2.5 probability distribution in the background. (A) Risk of incident eGFR <60 ml/min/1.73 m2 (P for nonlinearity =0.90). (B) Risk of incident CKD (P for nonlinearity =0.90). (C) Risk of eGFR decline ≥30% (P for nonlinearity =0.84). (D) Risk ESRD (P for nonlinearity =0.47). Models adjusted for age, race, sex, cancer, cardiovascular disease, chronic lung disease, diabetes mellitus, hyperlipidemia, hypertension, T0 eGFR, BMI, smoking status, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, county population density, number of outpatient eGFR measurements, number of hospitalizations, and county percent in poverty.
Figure 3.
Figure 3.
Geographic distribution of the national burden of incident CKD attributable to air pollution in the United States. (A) Risk attributable to exposure levels of PM2.5 above the EPA recommended concentration of 12 μg/m3. (B) Risk attributable to exposure levels of PM2.5 above a uniform distribution between 2.4 and 5.9 µg/m3. Burden is per 100,000 population.
Figure 4.
Figure 4.
Flow diagram of cohort participant inclusion.
See this image and copyright information in PMC

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