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Liang KH, Colombijn JMT, Verhaar MC, Ghannoum M, Timmermans EJ, Vernooij RWM. The general external exposome and the development or progression of chronic kidney disease: A systematic review and meta-analyses. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 358:124509. [PMID: 38968981 DOI: 10.1016/j.envpol.2024.124509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 06/07/2024] [Accepted: 07/03/2024] [Indexed: 07/07/2024]
Abstract
The impact of environmental risk factors on chronic kidney disease (CKD) remains unclear. This systematic review aims to provide an overview of the literature on the association between the general external exposome and CKD development or progression. We searched MEDLINE and EMBASE for case-control or cohort studies, that investigated the association of the general external exposome with a change in eGFR or albuminuria, diagnosis or progression of CKD, or CKD-related mortality. The risk of bias of included studies was assessed using the Newcastle-Ottawa Scale. Summary effect estimates were calculated using random-effects meta-analyses. Most of the 66 included studies focused on air pollution (n = 33), e.g. particulate matter (PM) and nitric oxides (NOx), and heavy metals (n = 21) e.g. lead and cadmium. Few studies investigated chemicals (n = 7) or built environmental factors (n = 5). No articles on other environment factors such as noise, food supply, or urbanization were found. PM2.5 exposure was associated with an increased CKD and end-stage kidney disease incidence, but not with CKD-related mortality. There was mixed evidence regarding the association of NO2 and PM10 on CKD incidence. Exposure to heavy metals might be associated with an increased risk of adverse kidney outcomes, however, evidence was inconsistent. Studies on effects of chemicals or built environment on kidney outcomes were inconclusive. In conclusion, prolonged exposure to PM2.5 is associated with an increased risk of CKD incidence and progression to kidney failure. Current studies predominantly investigate the exposure to air pollution and heavy metals, whereas chemicals and the built environment remains understudied. Substantial heterogeneity and mixed evidence were found across studies. Therefore, long-term high-quality studies are needed to elucidate the impact of exposure to chemicals or other (built) environmental factors and CKD.
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Affiliation(s)
- Kate H Liang
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Julia M T Colombijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc Ghannoum
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands; National Poison Information Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Erik J Timmermans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Shang Z, Gao YM, Deng ZL, Wang Y. Long-term exposure to ambient air pollutants and increased risk of end-stage renal disease in patients with type 2 diabetes mellitus and chronic kidney disease: a retrospective cohort study in Beijing, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:5429-5443. [PMID: 38123768 PMCID: PMC10799089 DOI: 10.1007/s11356-023-31346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
Limited data have examined the association between air pollution and the risk of end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). We aimed to investigate whether long-term exposure to air pollutants is related to the development of ESRD among patients with T2DM and CKD. A total of 1,738 patients with T2DM and CKD hospitalized in Peking University Third Hospital from January 1, 2013, to December 31, 2021 were enrolled in this study. The outcome was defined as the occurrence of ESRD. Data on six air pollutants (PM2.5, PM10, CO, NO2, SO2, and O3) from 35 monitoring stations were obtained from the Beijing Municipal Ecological and Environmental Monitoring Center. Long-term exposure to air pollutants during the follow-up period was measured using the ordinary Kriging method. During a mean follow-up of 41 months, 98 patients developed ESRD. Multivariate logistic regression analysis showed that an increase of 10 μg/m3 in PM2.5 (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.03-1.36) and PM10 (OR 1.15, 95% CI 1.02-1.30) concentration were positively associated with ESRD. An increase of 1 mg/m3 in CO (2.80, 1.05-7.48) and an increase of 1 μg/m3 in SO2 (1.06, 1.00-1.13) concentration were also positively associated with ESRD. Apart from O3 and NO2, all the above air pollutants have additional predictive value for ESRD in patients with T2DM and CKD. The results of Bayesian kernel machine regression and the weighted quantile sum regression all showed that PM2.5 was the most important air pollutant. Backward stepwise logistic regression showed that PM2.5 was the only pollutant remaining in the prediction model. In patients with T2DM and CKD, long-term exposure to ambient PM2.5, PM10, CO, and SO2 was positively associated with the development of ESRD.
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Affiliation(s)
- Zhi Shang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University, Beijing, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Yue-Ming Gao
- Department of Nephrology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Zhen-Ling Deng
- Department of Nephrology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Yue Wang
- Department of Nephrology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
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López-Bueno JA, Díaz J, Padrón-Monedero A, Martín MAN, Linares C. Short-term impact of extreme temperatures, relative humidity and air pollution on emergency hospital admissions due to kidney disease and kidney-related conditions in the Greater Madrid area (Spain). THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166646. [PMID: 37652385 DOI: 10.1016/j.scitotenv.2023.166646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
While some studies report a possible association between heat waves and kidney disease and kidney-related conditions, there still is no consistent scientific consensus on the matter or on the role played by other variables, such as air pollution and relative humidity. Ecological retrospective time series study 01-01-2013 to 31-12-2018). Dependent variables: daily emergency hospitalisations due to kidney disease (KD), acute kidney injury (AKI), lithiasis (L), dysnatraemia (DY) and hypovolaemia (HPV). Independent variables: maximum and minimum daily temperature (Tmax, Tmin, °C), and daily relative humidity (RH, %). Other variables were also calculated, such as the daily temperature for risk of kidney disease (Theat, °C) and low daily hazardous relative humidity (HRH%). As variables of air pollution, we used the daily mean concentrations of PM10, PM2.5, NO2 and O3 in μg/m3. Based on these, we then calculated their daily excesses over World Health Organisation (WHO) guideline levels (hPM10, hPM2.5, hNO2 and hO3 respectively). Poisson family generalised linear models (GLMs) (link = log) were used to calculate relative risks (RRs), and attributable risks and attributable admissions. In the models, we controlled for the covariates included: seasonalities, trend, autoregressive component, day of the week, month and year. A statistically significant association was found between Theat and all the dependent variables analysed. The greatest AKI disease burden was attributable to Theat (2.2 % (1.7, 2.6) of attributable hospital admissions), followed by hNO2 (1.7 % (0.9, 3.4)) and HRH (0.8 (0.6, 1.1)). In the case of hypovolaemia and dysnatraemia, the greatest disease burden again corresponded to Theat, with 6.9 % (6.2, 7.6) and 5.7 (4.8, 6.6) of attributable hospital admissions respectively. Episodes of extreme heat exacerbate daily emergency hospital admissions due to kidney disease and kidney-related conditions; and attributable risks are likewise seen for low relative humidity and high ozone levels.
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Affiliation(s)
- J A López-Bueno
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - J Díaz
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
| | - A Padrón-Monedero
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - M A Navas Martín
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - C Linares
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
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Su WY, Wu DW, Tu HP, Chen SC, Hung CH, Kuo CH. Association between ambient air pollutant interaction with kidney function in a large Taiwanese population study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-28042-6. [PMID: 37328721 DOI: 10.1007/s11356-023-28042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/29/2023] [Indexed: 06/18/2023]
Abstract
The associations and interactions between kidney function and other air pollutants remain poorly defined. Therefore, the aim of this study was to evaluate associations among air pollutants, including particulate matter (PM) with a diameter ≤ 2.5 μm (PM2.5), PM10 (PM with a diameter ≤ 10 μm), carbon monoxide (CO), nitrogen oxide (NO), nitrogen oxides (NOx), sulfur dioxide (SO2), and ozone (O3) with kidney function, and explore interactions among these air pollutants on kidney function. We used the Taiwan Air Quality Monitoring and Taiwan Biobank databases to derive data on community-dwelling individuals in Taiwan and daily air pollution levels, respectively. We enrolled 26,032 participants. Multivariable analysis showed that high levels of PM2.5, PM10, O3 (all p < 0.001), and SO2 (p = 0.001) and low levels of CO, NO (both p < 0.001), and NOx (p = 0.047) were significantly correlated with low estimated glomerular filtration rate (eGFR). With regard to negative effects, the interactions between PM2.5 and PM10 (p < 0.001), PM2.5 and PM10 (p < 0.001), PM2.5 and SO2, PM10 and O3 (both p = 0.025), PM10 and SO2 (p = 0.001), and O3 and SO2 (p < 0.001) on eGFR were significantly negatively. High PM10, PM2.5, O3, and SO2 were associated with a low eGFR, whereas high CO, NO, and NOx were associated with a high eGFR. Furthermore, negative interactions between PM2.5 and PM10, O3 and SO2, PM10 and O3, PM2.5 and SO2, and PM10 and SO2 on eGFR were observed. The findings of this study have important implications for public health and environmental policy. Specifically, the results of this study may be useful in individuals and organizations to take action to reduce air pollution and promote public health.
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Affiliation(s)
- Wei-Yu Su
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Da-Wei Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 482, Shan-Ming Rd, Hsiao-Kang Dist, 812, Kaohsiung, Taiwan, Republic of China
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 482, Shan-Ming Rd, Hsiao-Kang Dist, 812, Kaohsiung, Taiwan, Republic of China.
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
| | - Chih-Hsing Hung
- Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 812, Taiwan
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 482, Shan-Ming Rd, Hsiao-Kang Dist, 812, Kaohsiung, Taiwan, Republic of China
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
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Chung CY, Wu SY, Chiu HH, Wu TN, Wang YT, Lin MY. Associations of air pollutant concentrations with longitudinal kidney function changes in patients with chronic kidney disease. Sci Rep 2023; 13:9609. [PMID: 37311921 DOI: 10.1038/s41598-023-36682-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
This longitudinal cohort study investigated the associations of air pollutant exposures, including CO, NO, NO2, NOx, O3, PM10, PM2.5, and SO2, with long-term kidney function changes in patients with chronic kidney disease (CKD). We enrolled 447 CKD patients who took part in a universal hospital pre-ESRD care program during 2011-2015. The daily average air pollutant exposures and temperature were estimated for each patient, with different levels of air pollutant concentrations defined by 5-knot and restricted cubic spline function. Predicted annual estimated glomerular filtration (eGFR) slope values by one mixed model were considered as the study outcome. The average age of the study population was 77.1 ± 12.6 years, and the median annual eGFR decreased by 2.1 ml/min/1.73 m2 per year from 30 ml/min/1.73 m2 at baseline during a mean follow-up time of 3.4 years. The univariable and multivariable analyses revealed no significant linear and non-linear associations between 5-knot air pollutant concentrations and annual eGFR slope. In addition, the visualized spline effect plots show insignificant variation patterns in annual eGFR slope values with increased air pollutant concentrations. These results encourage more extensive studies to clarify the causal relationships and mechanisms of long-term specific air pollutant exposures and longitudinal kidney function change, especially in CKD populations.
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Affiliation(s)
- Cheng-Yin Chung
- Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, 900214, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, TzYou 1st Road, Sanmin District, Kaohsiung City, 80708, Taiwan
| | - Shang-Yu Wu
- Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, 900214, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, TzYou 1st Road, Sanmin District, Kaohsiung City, 80708, Taiwan
| | - Huei-Hsuan Chiu
- Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, 900214, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, TzYou 1st Road, Sanmin District, Kaohsiung City, 80708, Taiwan
| | - Tzu-Ning Wu
- Department of Nursing, Ministry of Health and Welfare, Pingtung Hospital, Pingtung, 900214, Taiwan
| | - Your-Tong Wang
- Department of Nursing, Ministry of Health and Welfare, Pingtung Hospital, Pingtung, 900214, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, TzYou 1st Road, Sanmin District, Kaohsiung City, 80708, Taiwan.
- Department of Kidney Care, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.
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Wen F, Xie Y, Li B, Li P, Qi H, Zhang F, Sun Y, Zhang L. Combined effects of ambient air pollution and PM 2.5 components on renal function and the potential mediation effects of metabolic risk factors in China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 259:115039. [PMID: 37235899 DOI: 10.1016/j.ecoenv.2023.115039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
Growing evidence links long-term air pollution exposure with renal function. However, little research has been conducted on the combined effects of air pollutant mixture on renal function and multiple mediation effects of metabolic risk factors. This study enrolled 8996 adults without chronic kidney disease (CKD) at baseline from the CHCN-BTH cohort study. Three-year exposure to air pollutants [particulate matter ≤ 2.5 µm (PM2.5), PM10, PM1, ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO)] and PM2.5 components [black carbon (BC), ammonium (NH4+), nitrate (NO3-), sulfate (SO42-) and organic matter (OM)] were assessed using well-validated machine learning methods. Linear mixed models were applied to investigate the associations between air pollutants and estimated glomerular filtration rate (eGFR). Quantile G-computation was used to assess the combined effects of pollutant mixtures. Causal mediation analysis and Bayesian mediation analysis were employed to estimate the mediation effects of metabolic risk factors. An interquartile range increases in BC (-0.256, 95 %CI: -0.331, -0.180) and OM (-0.603, 95 %CI: -0.810, -0.397) were significantly associated with eGFR decline; while O3 (1.151, 95 %CI: 0.813, 1.489), PM10 (0.721, 95 %CI: 0.309, 1.133), NH4+ (0.990, 95 %CI: 0.638, 1.342), and NO3- (0.610, 95 %CI: 0.405, 0.815) were associated with higher eGFR. The combined effect of the PM2.5 component mixture was found to be associated with lower eGFR (-1.147, 95 % CI: -1.456, -0.839), with OM contributing 72.4 % of the negative effect. Univariate mediation analyses showed that high-density lipoprotein (HDL) mediated 7.1 %, 6.9 %, and 6.1 % effects of O3, BC, and OM, respectively. However, these mediation effects were not significant in Bayesian mediation analysis. These findings suggest the effect of the PM2.5 component mixture on eGFR decline and the strong contribution of OM. Metabolic risk factors may not mediate the effects of air pollutants. Further study is warranted to clarify the potential mechanisms involved.
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Affiliation(s)
- Fuyuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Pandi Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Han Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China; The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fengxu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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