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Multicenter Study
. 2020 Mar 6;15(3):311-319.
doi: 10.2215/CJN.08350719. Epub 2020 Feb 27.

Particulate Matter and Albuminuria, Glomerular Filtration Rate, and Incident CKD

Matthew F Blum  1 , Aditya Surapaneni  2 , James D Stewart  3 , Duanping Liao  4 , Jeff D Yanosky  4 , Eric A Whitsel  3   5 , Melinda C Power  6 , Morgan E Grams  7   2
Affiliations
Multicenter Study

Particulate Matter and Albuminuria, Glomerular Filtration Rate, and Incident CKD

Matthew F Blum et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Exposure to particulate matter (PM) <2.5 μm in aerodynamic diameter (PM2.5) has been linked to detrimental health effects. This study aimed to describe the relationship between long-term PM2.5 exposure and kidney disease, including eGFR, level of albuminuria, and incident CKD.

Design, setting, participants, & measurements: The study included 10,997 participants from the Atherosclerosis Risk in Communities cohort who were followed from 1996-1998 through 2016. Monthly mean PM2.5 concentrations (μg/m3) were estimated at geocoded participant addresses using geographic information system-based, spatiotemporal generalized additive mixed models-including geospatial covariates such as land use-and then averaged over the 12-month period preceding participant examination. Covariate-adjusted, cross-sectional associations of PM2.5, baseline eGFR, and urinary albumin-creatinine ratio (UACR) were estimated using linear regression. PM2.5 and incident CKD (defined as follow-up eGFR <60 ml/min per 1.73 m2 with ≥25% eGFR decline relative to baseline, CKD-related hospitalization or death based on International Classification of Diseases 9/10 codes, or development of ESKD) associations were estimated using Cox proportional hazards regression. Modeling was stratified by study site, and stratum-specific estimates were combined using random-effects meta-analyses.

Results: Baseline mean participant age was 63 (±6) years and eGFR was 86 (±16) ml/min per 1.73 m2. There was no significant PM2.5-eGFR association at baseline. Each 1-μg/m3 higher annual average PM2.5 was associated with higher UACR after adjusting for demographics, socioeconomic status, and clinical covariates (percentage difference, 6.6%; 95% confidence interval [95% CI], 2.6% to 10.7%). Each 1-μg/m3 higher annual average PM2.5 was associated with a significantly higher risk of incident CKD (hazard ratio, 1.05; 95% CI, 1.01 to 1.10).

Conclusions: Exposure to higher annual average PM2.5 concentrations was associated with a higher level of albuminuria and higher risk for incident CKD in a community-based cohort.

Keywords: ARIC; International Classification of Diseases; air pollution; albumin; albuminuria; atherosclerosis; chronic kidney disease; chronic kidney failure; chronic renal insufficiency; cohort studies; confidence intervals; creatinine; cross-sectional studies; demography; epidemiology and outcomes; follow-up studies; geographic information systems; glomerular filtration rate; hospitalization; humans; kidney function tests; linear models; particulate matter; social class.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Annual average PM2.5 concentration varies across sites. Co, county; PM2.5, particulate matter <2.5 μm in aerodynamic diameter.
Figure 2.
Figure 2.
Higher annual average PM2.5 concentration associates with higher risk of incident CKD. Exposure response function created using model 2. The fifth percentile PM2.5 value of 8.7 μg/m3 was selected as the reference. CI, confidence interval; LCI, lower CI; PM2.5, particulate matter <2.5 μm in aerodynamic diameter; UCI, upper CI.
See this image and copyright information in PMC

Comment in

  • Air Pollution and Kidney Disease.
    Al-Aly Z, Bowe B. Al-Aly Z, et al. Clin J Am Soc Nephrol. 2020 Mar 6;15(3):301-303. doi: 10.2215/CJN.16031219. Epub 2020 Feb 27. Clin J Am Soc Nephrol. 2020. PMID: 32125277 Free PMC article. No abstract available.

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