Format

Send to

Choose Destination
J Am Soc Nephrol. 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.

Bowe B1, Xie Y1, Li T1,2, Yan Y1,3, Xian H1,4, Al-Aly Z5,2,6,7.

Author information

1
Clinical Epidemiology Center, Research and Education Service and.
2
Department of Medicine.
3
Division of Public Health Sciences, Department of Surgery, and.
4
Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri.
5
Clinical Epidemiology Center, Research and Education Service and zalaly@gmail.com.
6
Nephrology Section, Medicine Service, Veterans Affairs Saint Louis Health Care System, Saint Louis, Missouri.
7
Institute for Public Health, Washington University School of Medicine, Saint Louis, Missouri; and.

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

PMID:
28935655
PMCID:
PMC5748906
[Available on 2019-01-01]
DOI:
10.1681/ASN.2017030253

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center