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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] [MESH Headings] [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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Hamroun A, Génin M, Glowacki F, Sautenet B, Leffondré K, De Courrèges A, Dauchet L, Gauthier V, Bayer F, Lassalle M, Couchoud C, Amouyel P, Occelli F. Multiple air pollutant exposure is associated with higher risk of all-cause mortality in dialysis patients: a French registry-based nationwide study. Front Public Health 2024; 12:1390999. [PMID: 39139668 PMCID: PMC11319261 DOI: 10.3389/fpubh.2024.1390999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
Background Little is known about the effect of combined exposure to different air pollutants on mortality in dialysis patients. This study aimed to investigate the association of multiple exposures to air pollutants with all-cause and cause-specific death in dialysis patients. Materials and methods This registry-based nationwide cohort study included 90,373 adult kidney failure patients initiating maintenance dialysis between 2012 and 2020 identified from the French REIN registry. Estimated mean annual municipality levels of PM2.5, PM10, and NO2 between 2009 and 2020 were combined in different composite air pollution scores to estimate each participant's exposure at the residential place one to 3 years before dialysis initiation. Adjusted cause-specific Cox proportional hazard models were used to estimate hazard ratios (HRs) per interquartile range (IQR) greater air pollution score. Effect measure modification was assessed for age, sex, dialysis care model, and baseline comorbidities. Results Higher levels of the main air pollution score were associated with a greater rate of all-cause deaths (HR, 1.082 [95% confidence interval (CI), 1.057-1.104] per IQR increase), regardless of the exposure lag. This association was also confirmed in cause-specific analyses, most markedly for infectious mortality (HR, 1.686 [95% CI, 1.470-1.933]). Sensitivity analyses with alternative composite air pollution scores showed consistent findings. Subgroup analyses revealed a significantly stronger association among women and fewer comorbid patients. Discussion Long-term multiple air pollutant exposure is associated with all-cause and cause-specific mortality among patients receiving maintenance dialysis, suggesting that air pollution may be a significant contributor to the increasing trend of CKD-attributable mortality worldwide.
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Affiliation(s)
- Aghiles Hamroun
- Service de Santé Publique, Epidémiologie, Economie de la Santé et Prévention, CHU de Lille, Lille, France
- UMR1167 RID-AGE, Institut Pasteur de Lille, INSERM, Université de Lille, CHU Lille, Lille, France
| | - Michaël Génin
- ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | | | - Bénédicte Sautenet
- Service de Néphrologie-Hypertension Artérielle, Dialyses, Transplantation Rénale, CHRU de Tours, Tours, France
- Department of Nephrology, Université de Tours, Tours, France
- INI-CRCT, Vandœuvre-lès-Nancy, France
- INSERM U1246 SPHERE, Université de Tours-Université de Nantes, Tours, France
| | - Karen Leffondré
- INSERM, Bordeaux Population Health Research Center, Université de Bordeaux, Bordeaux, France
| | - Antoine De Courrèges
- Service de Santé Publique, Epidémiologie, Economie de la Santé et Prévention, CHU de Lille, Lille, France
| | - Luc Dauchet
- Service de Santé Publique, Epidémiologie, Economie de la Santé et Prévention, CHU de Lille, Lille, France
- UMR1167 RID-AGE, Institut Pasteur de Lille, INSERM, Université de Lille, CHU Lille, Lille, France
| | - Victoria Gauthier
- Service de Santé Publique, Epidémiologie, Economie de la Santé et Prévention, CHU de Lille, Lille, France
- UMR1167 RID-AGE, Institut Pasteur de Lille, INSERM, Université de Lille, CHU Lille, Lille, France
| | - Florian Bayer
- Coordination Nationale Registre REIN, Agence de la Biomédecine, Saint-Denis, France
| | - Mathilde Lassalle
- Coordination Nationale Registre REIN, Agence de la Biomédecine, Saint-Denis, France
| | - Cécile Couchoud
- Coordination Nationale Registre REIN, Agence de la Biomédecine, Saint-Denis, France
| | - Philippe Amouyel
- Service de Santé Publique, Epidémiologie, Economie de la Santé et Prévention, CHU de Lille, Lille, France
- UMR1167 RID-AGE, Institut Pasteur de Lille, INSERM, Université de Lille, CHU Lille, Lille, France
| | - Florent Occelli
- IMT Lille Douai, JUNIA, ULR LGCgE, Laboratoire de Génie Civil et Géo-Environnement, Université de Lille, Université de Artois, Lille, France
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Spencer A, Lavenburg LM, Sanders AP, Shah AD. Clearing the air: a review of the effects of air pollution on dialysis outcomes. Curr Opin Nephrol Hypertens 2024; 33:192-202. [PMID: 38205827 PMCID: PMC10805370 DOI: 10.1097/mnh.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
PURPOSE OF REVIEW An evolving body of literature indicates exposure to air pollutants is associated with adverse health outcomes in dialysis patients. As the prevalence of kidney disease increases, understanding the role of environmental agents on the health of dialysis patients is critical to reducing global morbidity and mortality. RECENT FINDINGS We identified 16 publications that investigated associations between pollutants including particulate matter (PM 2.5 and PM 10 ), carbon monoxide (CO), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), and ozone (O 3 ) and health outcomes among dialysis patients. Eight studies examined the effects of particulate matter (PM) and four studies examined the effects CO exposure on dialysis patients. Exposure to PM was consistently associated with outcomes including all-cause mortality and a smaller body of literature suggested relationships with subclinical outcomes. Exposure to CO was associated with all-cause mortality, generalized inflammation, and uremic pruritus. An additional four studies examined multiple pollutant exposures including NO 2 , SO 2 , and O 3 and reported associations with all-cause mortality in dialysis patients. SUMMARY This review emphasized the nascent literature that demonstrates consistent relationships between air pollutant exposure and adverse outcomes among dialysis patients. Further research is needed to assess the impact of air pollutants, including how co-exposures will impact dialysis patient health.
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Affiliation(s)
- Annika Spencer
- Department of Environmental and Occupational Health, School of Public Health
| | - Linda-Marie Lavenburg
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison P Sanders
- Department of Environmental and Occupational Health, School of Public Health
| | - Ankur D Shah
- Division of Kidney Disease and Hypertension, Warren Alpert Medical School of Brown University Providence, Rhode Island, USA
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陈 一, 胡 耀, 詹 宇, 孙 雅, 李 春, 辜 永, 曾 筱. [Effect of Short-Term Exposure to Air Pollutants on Hospital Admissions for End-Stage Renal Disease Patients Undergoing Hemodialysis]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1176-1183. [PMID: 38162061 PMCID: PMC10752782 DOI: 10.12182/20231160504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Indexed: 01/03/2024]
Abstract
Objective To evaluate the association between short-term exposure to air pollutants of end-stage renal disease (ESRD) patients on maintenance hemodialysis and the number of daily hospital admissions. Methods The data on hospitalizations were obtained from the database of the municipal Urban Employees' Basic Medical Insurance and Urban Residents' Basic Medical Insurance of a city in Southwest China. Single and multiple pollutant generalized additive models were utilized to estimate the effect of air pollutants (CO, NO2, O3, PM10, PM2.5, and SO2) on patient admissions after the lag time of different numbers of days. In addition, subgroup analyses stratified by sex, age, PM2.5 and PM10 concentration thresholds, seasonality, and comorbidity status for cardiovascular diseases and hypertension were conducted. Results In the single pollutant models, the pollutants significantly associated with patient admissions and the corresponding lag time of the strongest association were as follows, every time CO increased by 0.1 mg/m3, there was a 2.39% increase (95% confidence interval [CI]: 0.96%-3.83%) in patient admissions after 7 days of lag time; every time NO2, O3, PM2.5, PM10, and SO2 increased by 10 μg/m3, patient admissions increased by 4.02% (95% CI: 1.21%-6.91%) after 7 days of lag time, 3.57% (95% CI: 0.78%-6.44%) after 0-4 days of lag time, 2.00% (95% CI: 1.07%-2.93%) after 6 days of lag time, 1.19% (95% CI: 0.51%-1.88%) after 7 days of lag time, and 8.37% (95% CI: 3.08%-13.93%) after 7 days of lag time, respectively. In the multiple pollutant model, every time O3 and PM2.5 increased by 10 μg/m3, there was an increase of 3.18% (95% CI: 0.34%-6.09%) in daily patient admissions after 0-4 days of lag time and an increase of 1.85% (95% CI: 0.44%-3.28%) after 7 days of lag time. Furthermore, subgroup analyses showed that seasonality, the severity of air pollution, and patients' comorbidities might be the effect modifiers for the association between ambient air pollution and hospital admissions in ESRD patients receiving maintenance hemodialysis. Conclusion Air pollution is closely associated with hospital admissions in ESRD patients undergoing maintenance hemodialysis and the strength of this association varies according to seasonality, the severity of air pollution, and patients' status of comorbidities.
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Affiliation(s)
- 一龙 陈
- 四川大学华西医院 肾脏内科与华西生物医学大数据中心 (成都 610041)Department of Nephrology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 四川大学“医学+信息”中心 (成都 610041)Med-X Center for Informatics, Sichuan University, Chengdu 610041, China
| | - 耀 胡
- 四川大学华西医院 肾脏内科与华西生物医学大数据中心 (成都 610041)Department of Nephrology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 四川大学“医学+信息”中心 (成都 610041)Med-X Center for Informatics, Sichuan University, Chengdu 610041, China
| | - 宇 詹
- 四川大学华西医院 肾脏内科与华西生物医学大数据中心 (成都 610041)Department of Nephrology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 雅婧 孙
- 四川大学华西医院 肾脏内科与华西生物医学大数据中心 (成都 610041)Department of Nephrology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 四川大学“医学+信息”中心 (成都 610041)Med-X Center for Informatics, Sichuan University, Chengdu 610041, China
| | - 春漾 李
- 四川大学华西医院 肾脏内科与华西生物医学大数据中心 (成都 610041)Department of Nephrology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 四川大学“医学+信息”中心 (成都 610041)Med-X Center for Informatics, Sichuan University, Chengdu 610041, China
| | - 永红 辜
- 四川大学华西医院 肾脏内科与华西生物医学大数据中心 (成都 610041)Department of Nephrology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 四川大学“医学+信息”中心 (成都 610041)Med-X Center for Informatics, Sichuan University, Chengdu 610041, China
| | - 筱茜 曾
- 四川大学华西医院 肾脏内科与华西生物医学大数据中心 (成都 610041)Department of Nephrology and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China
- 四川大学“医学+信息”中心 (成都 610041)Med-X Center for Informatics, Sichuan University, Chengdu 610041, China
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Hu S, Ji Y, Pei M, Yang B, Chen H, Gao X, He Q, Yang H, Ye L. The impact of long-term exposure to ambient air pollution in patients undergoing peritoneal dialysis: A cohort study in China. CHEMOSPHERE 2023; 316:137871. [PMID: 36646184 DOI: 10.1016/j.chemosphere.2023.137871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/04/2022] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
There is increasing evidence for an association of air pollutants and the incidence of chronic kidney disease, and the progression to end stage kidney disease (ESKD). Despite the global expansion of peritoneal dialysis (PD), the impact of environmental and climatic factors in PD patients has not been studied in detail. We aimed to assess the association of long-term residential exposure to air pollutants, with patient survival and incidence of hospitalizations. This was a cohort study of all prevalent ESKD patients who were stable on PD therapy for more than 90 days in our PD center from 2013/01/01 to 2018/12/31. The enrolled patients were followed until death, cessation of PD, loss to follow-up, or 2018/12/31. Time-varying pollutant exposures were modeled as the key time-dependent variables. We used time-dependent Cox model to evaluate the risk of mortality and hospitalizations associated with air pollutant exposures adjusted for potential confounders. A total of 886 subjects who meets inclusion criteria with 27,024 patient-months were modeled. Over a mean follow-up of 30.5 ± 21.3 months, we ascertained 246 cases of death and 2611 cases of hospital admission. Significant hazard ratios (HRs) were observed for all four air pollutants including PM2.5 (hazard ratio [HR] 1.27, 95% confidence interval [95%CI] 1.05-1.54), PM10 (HR 1.31, 95%CI 1.04-1.65), NO2 (HR 1.45, 95%CI 1.02-2.06), and SO2 (HR 1.20, 95%CI 1.10-1.32) in fully adjusted model, corresponding to per interquartile range μg/m3 increase of air pollutant concentrations for mortality, and non-significant HRs for incidence of hospitalization. Non-linear associations with respect to different air pollutants were observed in models for all-cause mortality and recurrent hospitalization. The estimates for mortality were significantly higher in certain groups of patients. Our findings suggest long-term exposure to ambient air pollution was associated with higher risk of all-cause mortality in PD patients, but the association with incidence of hospitalizations was less clear.
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Affiliation(s)
- Shouci Hu
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yue Ji
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ming Pei
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bo Yang
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongbo Chen
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Xiangfu Gao
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Qiang He
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Hongtao Yang
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Liqing Ye
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
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Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
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Jung J, Park JY, Kim YC, Lee H, Kim E, Kim YL, Kim YS, Lee JP, Kim H. Long-Term Effects of Air Pollutants on Mortality Risk in Patients with End-Stage Renal Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020546. [PMID: 31952187 PMCID: PMC7014206 DOI: 10.3390/ijerph17020546] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
Long-term exposure to air pollutants significantly increases the morbidity and mortality associated with various diseases. However, little is known about the relationship between air pollutants and end-stage renal disease (ESRD)-related mortality. A total of 5041 patients who started dialysis between 2008 and 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease (CRC-ESRD) cohort study. We assigned a daily mean concentration of air pollutants (PM10, NO2, and SO2) to each participant. Time-varying Cox models were used to investigate the relationship between air pollutants and mortality in ESRD patients. During the follow-up period (mean 4.18 years), 1475 deaths occurred among 5041 participants. We found a significant long-term relationship between mortality risk and PM10 (HR 1.33, CI 1.13-1.58), NO2 (HR 1.46, CI 1.10-1.95), and SO2 (HR 1.07, CI 1.03-1.11). Elderly patients and patients who lived in metropolitan areas had an increased risk associated with PM10. Elderly patients also had increased risks associated NO2 and SO2. Long-term exposure to air pollutants had negative effects on mortality in ESRD patients. These effects were prominent in elderly patients who lived in metropolitan areas, suggesting that ambient air pollution, in addition to traditional risk factors, is important for the survival of these patients.
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Affiliation(s)
- Jiyun Jung
- Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul 08826, Korea; (J.J.)
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do 10326, Korea
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongsangbuk-do 38066, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.K.); (Y.S.K.)
| | - Hyewon Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Korea;
- Institute of Health and Environment, Seoul National University, Seoul 08826, Korea
| | - Ejin Kim
- Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul 08826, Korea; (J.J.)
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu 41566, Korea;
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.K.); (Y.S.K.)
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.K.); (Y.S.K.)
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul 07061, Korea
- Correspondence: (J.P.L.); (H.K.); Tel.: +82-2-870-3206 (J.P.L.); +82-2-880-2701 (H.K.)
| | - Ho Kim
- Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul 08826, Korea; (J.J.)
- Correspondence: (J.P.L.); (H.K.); Tel.: +82-2-870-3206 (J.P.L.); +82-2-880-2701 (H.K.)
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Weng CH, Hu CC, Yen TH, Huang WH. Association Between Environmental Particulate Matter and Carpal Tunnel Syndrome in Patients Undergoing Hemodialysis. Kidney Blood Press Res 2017; 42:827-836. [PMID: 29161700 DOI: 10.1159/000484422] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/15/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The deposition of β2-microglobulin induced by reactive inflammation causing carpal tunnel syndrome (CTS) is one of the complications of dialysis-related amyloidosis in maintenance hemodialysis (MHD) patients. Air pollution levels, especially particulate matter with an aerodynamic diameter of <2.5 mm (PM2.5), have significantly been associated with the elevation of systemic inflammatory markers. There is no previous research on possible associations between CTS and PM2.5. METHODS This study enrolled 866 MHD patients treated at the outpatient HD centers. Senior neurologists diagnosed the presence of CTS. Air pollution levels were recorded by a network of 27 monitoring stations near or in the patients' living areas throughout Taiwan. The 12- and 24-month average concentrations of PM with an aerodynamic diameter of <10 and <2.5 mm (PM10 and PM2.5, respectively), sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone were included. RESULTS Multivariate logistic regression analyses showed that HD duration, the normalized protein catabolic rate (nPCR), hypoalbuminemia (albumin < 4 g/dl), and the mean previous 12-month environmental PM2.5 were positively associated with CTS; HD duration, nPCR, hypoalbuminemia (albumin < 4 g/dl), and the mean previous 24-month environmental PM2.5 were positively associated with CTS; HD duration, hypoalbuminemia (albumin < 4 g/dl), and previous 12-month PM2.5 excess days were positively associated with CTS; and HD duration, nPCR, hypoalbuminemia (albumin < 4 g/dl), and previous 24-month PM2.5 excess days were positively associated with CTS. CONCLUSION PM2.5 levels and PM2.5 excessing days were positively correlated with CTS.
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Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Chih Hu
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
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Chen CY, Liu MH, Hsu CW, Weng CH, Yen TH, Huang WH. Positive correlation between environmental PM 2.5 and blood lead levels in patients undergoing maintenance hemodialysis. Ther Clin Risk Manag 2017; 13:555-564. [PMID: 28479856 PMCID: PMC5411403 DOI: 10.2147/tcrm.s131565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients undergoing hemodialysis (HD) have significantly higher mean blood lead levels (BLLs) than those in healthy individuals. Because elementary lead can be found in particulate matter with a diameter of <2.5 μm (PM2.5), this cross-sectional study was conducted to assess the effect of environmental PM2.5 exposure and other clinical variables on BLLs in patients receiving HD. We recruited 921 patients on maintenance HD (MHD) who had undergone HD for at least 6 months and who had previously participated in a BLL study. Mean PM2.5 concentrations in living environments in the previous 12 and 24 months were analyzed using a blood lead test. From a multivariate analysis, after adjustment for related factors, the mean PM2.5 concentrations in the previous 12 and 24 months were positively associated with log BLLs. In addition, days with PM2.5 levels exceeding the standard level during the previous 12 and 24 months were positively associated with log BLLs. Patients exposed to higher PM2.5 concentrations and more days with PM2.5 levels exceeding the standard level exhibited a higher prevalence of high and high-normal BLLs and a lower prevalence of low-normal BLLs. After adjustment for related variables, the BLLs exhibited a significantly positive association with environmental PM2.5 in patients undergoing MHD.
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Affiliation(s)
- Chao-Yu Chen
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Ming-Hui Liu
- Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.,Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
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10
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Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis. Sci Rep 2016; 6:31168. [PMID: 27507591 PMCID: PMC4979007 DOI: 10.1038/srep31168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/13/2016] [Indexed: 11/08/2022] Open
Abstract
Uremic pruritus (UP), also known as chronic kidney disease-associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution-induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of <2.5 μm (PM2.5). In a multivariate logistic regression, hemodialysis duration, serum ferritin levels, low-density lipoprotein levels, and environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD.
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11
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Chang CC, Su MJ, Lee SJ, Tsai YH, Kuo LY, Lin IH, Huang HL, Yen TH, Chu FY. The Immunotyping Distribution of Serum Monoclonal Paraprotein and Environmental Impact on Multiple Myeloma (MM) and Monoclonal Gammopathy of Uncertain Significance (MGUS) in Taiwan: A Medical Center-Based Experience. Asian Pac J Cancer Prev 2016; 17:395-9. [PMID: 26838245 DOI: 10.7314/apjcp.2016.17.1.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether ambient exposure to environmental pollutants leads to hematopoietic malignancies such as multiple myeloma (MM) remains to be ascertained. Therefore, we aimed to investigate the immunotyping distribution of serum monoclonal paraprotein and the environmental influence on MM and monoclonal gammopathy of uncertain significance (MGUS) in the Taiwanese population. MATERIALS AND METHODS Serum protein electrophoresis with immunosubtraction by the capillary zone electrophoresis method was performed as primary screening for MM and MGUS. Clinical, pathological, and residence data of patients were also obtained. RESULTS From August, 2013 to June, 2015, a total of 327 patients underwent serum protein electrophoresis with immunosubtraction. Among these, 281 demonstrated no remarkable findings or non-malignant oligoclonal gammopathy, 23 were detected to have MGUS, 18 were identified as MM, and a further 5 were found as other malignancies. The most frequent immunotyping distribution of serum monoclonal paraprotein was IgG kappa (54.3%, n=25), followed by IgA lambda (15.2%, n=7) and IgG lambda (10.9%, n=5) in subjects with gammopathy. Additionally, it was shown that the elderly (OR: 4.61, 95% CI: 1.88-11.30, P<0.01) and males (OR: 2.04, 95% CI: 1.04-4.02, P=0.04) had significantly higher risk of developing MM and MGUS. There was no obvious impact of environmental factors on the health risk of MM and MGUS evolution (OR: 0.77, 95% CI: 0.40-1.50, P=0.49). CONCLUSIONS The most frequent immunotyping distribution of serum monoclonal paraprotein included IgG kappa, IgA lambda and IgG lambda in MM and MGUS in the Taiwanese population. The elderly and male subjects are at significantly higher risk of MM and MGUS development, but there was no obvious impact of environmental factors on risk.
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Affiliation(s)
- Chih-Chun Chang
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan E-mail :
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12
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Zúñiga J, Tarajia M, Herrera V, Urriola W, Gómez B, Motta J. Assessment of the Possible Association of Air Pollutants PM10, O3, NO2 With an Increase in Cardiovascular, Respiratory, and Diabetes Mortality in Panama City: A 2003 to 2013 Data Analysis. Medicine (Baltimore) 2016; 95:e2464. [PMID: 26765444 PMCID: PMC4718270 DOI: 10.1097/md.0000000000002464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In recent years, Panama has experienced a marked economic growth, and this, in turn, has been associated with rapid urban development and degradation of air quality. This study is the first evaluation done in Panama on the association between air pollution and mortality. Our objective was to assess the possible association between monthly levels of PM10, O3, and NO2, and cardiovascular, respiratory, and diabetes mortality, as well as the seasonal variation of mortality in Panama City, Panama.The study was conducted in Panama City, using air pollution data from January 2003 to December 2013. We utilized a Poisson regression model based on generalized linear models, to evaluate the association between PM10, NO2, and O3 exposure and mortality from diabetes, cardiovascular, and respiratory diseases. The sample size for PM10, NO2, and O2 was 132, 132, and 108 monthly averages, respectively.We found that levels of PM10, O3, and NO2 were associated with increases in cardiovascular, respiratory, and diabetes mortality. For PM10 levels ≥ 40 μg/m3, we found an increase in cardiovascular mortality of 9.7% (CI 5.8-13.6%), and an increase of 12.6% (CI 0.2-24.2%) in respiratory mortality. For O3 levels ≥ 20 μg/m3 we found an increase of 32.4% (IC 14.6-52.9) in respiratory mortality, after a 2-month lag period following exposure in the 65 to <74 year-old age group. For NO2 levels ≥20 μg/m3 we found an increase in respiratory mortality of 11.2% (IC 1.9-21.3), after a 2-month lag period following exposure among those aged between 65 and <74 years.There could be an association between the air pollution in Panama City and an increase in cardiovascular, respiratory, and diabetes mortality. This study confirms the urgent need to improve the measurement frequency of air pollutants in Panama.
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Affiliation(s)
- Julio Zúñiga
- From the Gorgas Memorial Institute for Health Studies (JZ, VH, BG, JM); Centro de Biología Molecular y Celular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (MT); Región de Panamá Oeste, Caja de Seguro Social, Panama City, Panama (MT); and Institute of Specialized Analysis of the University of Panama, Miraflores, Panama City, Panama (WU)
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13
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Weng CH, Hu CC, Yen TH, Huang WH. Association between environmental particulate matter and arterial stiffness in patients undergoing hemodialysis. BMC Cardiovasc Disord 2015; 15:115. [PMID: 26445316 PMCID: PMC4596289 DOI: 10.1186/s12872-015-0107-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022] Open
Abstract
Background Aortic pulse wave velocity (PWV) has been shown to be an independent predictor of cardiovascular mortality in patients with end-stage renal disease and the general population. Atmospheric particulate- matter (PM) concentrations and their effects on cardiovascular system by affecting arterial stiffness and central hemodynamic parameters had been noted. The purpose of this study was to access the correlation of air pollution variables and PWV in patients undergoing hemodialysis (HD). Methods This study analyzed 127 HD patients treated at the outpatient HD center. Brachial-ankle pulse wave velocity (baPWV) was measured by using a Vascular Profiler 1000 (VP-1000). Air pollution levels were recorded by a network of 27 monitoring stations near or in the patients’ living areas throughout Taiwan. The 12-month average concentrations of PM with an aerodynamic diameter of <10 and <2.5 mm (PM10 and PM2.5, respectively), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide(CO), and ozone (O3) were included. Results and Discussion Multivariate linear regression analyses indicated that systolic blood pressure (SBP) (β = 0.589, P < 0.025), age (β = 0.316, P < 0.001), serum aluminum level (Al) (β = 0.149, P = 0.020), and PM10 (β = 0.133, P = 0.036) were positively correlated with baPWV. Conclusion This cross-sectional study shows that in HD patients, the environmental PM10 level is associated with the baPWV.
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Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, 5 Fu-Shin Street, Kwei-Shan 333, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chih Hu
- Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, 5 Fu-Shin Street, Kwei-Shan 333, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, 5 Fu-Shin Street, Kwei-Shan 333, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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14
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Chang CH, Fan PC, Lin CY, Yang CH, Chen YT, Chang SW, Yang HY, Jenq CC, Hung CC, Yang CW, Chen YC. Elevation of Interleukin-18 Correlates With Cardiovascular, Cerebrovascular, and Peripheral Vascular Events: A Cohort Study of Hemodialysis Patients. Medicine (Baltimore) 2015; 94:e1836. [PMID: 26496326 PMCID: PMC4620819 DOI: 10.1097/md.0000000000001836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiocerebral vascular events are the major cause of mortality among patients with end-stage renal disease (ESRD). Subclinical inflammation and atherosclerosis have been implicated in the pathophysiology of ESRD. Evidence has shown the crucial role of interleukin-18 (IL-18) in inflammation. Interleukin-18 has been markedly upregulated in ESRD patients. Nevertheless, the ability of the IL-18 level to predict cardiocerebral vascular events and the correlation between IL-18 levels and cardiocerebral vascular events have not been established in hemodialysis patients.To determine whether the serum IL-18 level predicts cardiocerebral vascular events, the authors studied 171 ESRD patients. Samples were collected and patients were followed for 24 months. Demographic data, the duration of hemodialysis, nutrition status, inflammatory parameters, dialysis adequacy, and lipid profiles were analyzed to predict the outcome by using multivariate logistic regression. Cutoff points were calculated by acquiring the highest Youden index. The Kaplan-Meier method was used to scrutinize the cumulative proportion of events.The multivariate logistic regression model revealed that serum creatinine, C-reactive protein, and IL-18 levels were independent predictors for cardiocerebral vascular events. The odds ratio of events for each increase in IL-18 (pg/mL) was 1.008 for cardiocerebral vascular events. The area under the receiver operating characteristic curve of IL-18 was 0.779 ± 0.039, the overall correctness was 73%, and the Youden index was highest at a cutoff of 463 pg/mL. In the Kaplan-Meier model, patients with an IL-18 level higher than 463 pg/mL exhibited the highest probability of experiencing an adverse event during the entire follow-up period.Increased serum IL-18 could be considered as a predictor of cardiocerebral vascular events in dialysis patients. It is noteworthy that various comorbidities might interfere the expression of IL-18; therefore, further validation study is required to incorporate IL-18 in clinical use.
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Affiliation(s)
- Chih-Hsiang Chang
- From the Department of Nephrology, Kidney Research Center (C-HC, P-CF, C-YL, H-YY, C-CJ, C-CH, C-WY, Y-CC); Department of Cardiology, Chang Gung Memorial Hospital, Taipei (C-HY); College of Medicine (C-HC, P-CF, C-YL, H-YY, C-CJ, C-CH, C-WY, Y-CC, S-WC); Department of Biomedical Sciences (Y-TC); Clinical Informatics and Medical Statistics Research Center (CIMS), Chang Gung University, Taoyuan, Taiwan (S-WC)
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