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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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Ortega-Romero M, Rojas-Lima E, Rubio-Gutiérrez JC, Aztatzi-Aguilar OG, Narváez-Morales J, Esparza-García M, Barrera-Hernández Á, Mejia MÁ, Mendez-Hernández P, Medeiros M, Barbier OC. Associations among environmental exposure to trace elements and biomarkers of early kidney damage in the pediatric population. Biometals 2024; 37:721-737. [PMID: 38642266 DOI: 10.1007/s10534-024-00603-3] [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] [Received: 06/27/2023] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND In kidney damage, molecular changes can be used as early damage kidney biomarkers, such as Kidney Injury Molecule-1 and Neutrophil gelatinase-associated lipocalin. These biomarkers are associated with toxic metal exposure or disturbed homeostasis of trace elements, which might lead to serious health hazards. This study aimed to evaluate the relationship between exposure to trace elements and early damage kidney biomarkers in a pediatric population. METHODS In Tlaxcala, a cross-sectional study was conducted on 914 healthy individuals. The participants underwent a medical review and a socio-environmental questionnaire. Five early damage kidney biomarkers were determined in the urine with Luminex, and molybdenum, copper, selenium, nickel, and iodine were measured with ICP-Mass. RESULTS The eGFR showed a median of 103.75 mL/min/1.73 m2. The median levels for molybdenum, copper, selenium, nickel, and iodine were 24.73 ng/mL, 73.35 ng/mL, 4.78 ng/mL, 83.68 ng/mL, and 361.83 ng/mL, respectively. Except for molybdenum and nickel, the other trace elements had significant associations with the eGFR and the early kidney damage biomarkers. Additionally, we report the association of different exposure scenarios with renal parameters. DISCUSSION and Conclusions. Among the explored metals, exposure to Cu and iodine impairs renal function. In contrast, Se may manifest as a beneficial metal. Interactions of Mo-Se and Mo-Iodine seem to alter the expression of NGAL; Mo-Cu for CLU; Mo-Cu, Mo-Se, and Mo-iodine for Cys-C and a-1MG; and Mo-Cu and Mo-iodine for KIM-1; were noticed. Our study could suggest that trace element interactions were associated with early kidney damage biomarkers.
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Affiliation(s)
- Manolo Ortega-Romero
- Unidad de Investigación en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Elodia Rojas-Lima
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Juan Carlos Rubio-Gutiérrez
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Octavio Gamaliel Aztatzi-Aguilar
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Juana Narváez-Morales
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Mariela Esparza-García
- Unidad de Investigación en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Ángel Barrera-Hernández
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Miguel Ángel Mejia
- Fundación Franco-Mexicana Para La Medicina, I.A.P, Ciudad de México, Mexico
| | - Pablo Mendez-Hernández
- Departamento de Calidad y Educación en Salud, Secretaría de Salud de Tlaxcala, Tlaxcala, Mexico
- Facultad de Ciencias de La Salud, Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico
| | - Mara Medeiros
- Unidad de Investigación en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
- Departamento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Olivier Christophe Barbier
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México, Mexico.
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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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Huang Y, Wan Z, Zhang M, Hu L, Song L, Wang Y, Lv Y, Wang L. The association between urinary metals/metalloids and chronic kidney disease among general adults in Wuhan, China. Sci Rep 2023; 13:15321. [PMID: 37714886 PMCID: PMC10504376 DOI: 10.1038/s41598-023-42282-z] [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] [Received: 06/07/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023] Open
Abstract
The relation between exposure to single metal/metalloid and the risk of chronic kidney disease (CKD) remains unclear. We aimed to determine the single and mixed associations of 21 heavy metals/metalloids exposure and the risk of CKD. We performed a cross-sectional study that recruited 4055 participants. Multivariate logistic regression, linear regression and weighted quantile sum (WQS) regression were conducted to explore the possible effects of single and mixed metals/metalloids exposure on the risk of CKD, the risk of albuminuria and changes in the estimated glomerular filtration rate (eGFR). In single-metal models, Cu, Fe, and Zn were positively associated with increased risks of CKD (P-trend < 0.05). Compared to the lowest level, the highest quartiles of Cu (OR = 2.94; 95% CI: 1.70, 5.11; P-trend < 0.05), Fe (OR = 2.39; 95% CI: 1.42, 4.02; P-trend < 0.05), and Zn (OR = 2.35; 95% CI: 1.31, 4.24; P-trend < 0.05) were associated with an increased risk of CKD. After multi-metal adjustment, the association with the risk of CKD remained robust for Cu (P < 0.05). Weighted quantile sum regression revealed a positive association between mixed metals/metalloids and the risk of CKD, and the association was largely driven by Cu (43.7%). Specifically, the mixture of urinary metals/metalloids was positively associated with the risk of albuminuria and negatively associated with eGFR.
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Affiliation(s)
- Yuchai Huang
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhengce Wan
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingye Zhang
- State Key Laboratory of Environment Health (Incubation), Key Laboratory of Environment and Health, Ministry of Education, Key Laboratory of Environment and Health (Wuhan), Ministry of Environmental Protection, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liu Hu
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yongman Lv
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Le Wang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan, Hubei, China.
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Lee W, Heo S, Stewart R, Wu X, Fong KC, Son JY, Sabath B, Braun D, Park JY, Kim YC, Lee JP, Schwartz J, Kim H, Dominici F, Bell ML. Associations between greenness and kidney disease in Massachusetts: The US Medicare longitudinal cohort study. ENVIRONMENT INTERNATIONAL 2023; 173:107844. [PMID: 36841189 DOI: 10.1016/j.envint.2023.107844] [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: 09/27/2022] [Revised: 01/22/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Recent studies have identified the association of environmental stressors with reduced kidney function and the development of kidney disease. While residential greenness has been linked to many health benefits, the association between residential greenness and the development of kidney disease is not clear. We aimed to investigate the association between residential greenness and the development of kidney disease. METHODS We performed a longitudinal population-based cohort study including all fee-for-service Medicare Part A beneficiaries (aged 65 years or older) in Massachusetts (2000-2016). We assessed greenness with the annual average Enhanced Vegetation Index (EVI) based on residential ZIP codes of beneficiaries. We applied Cox-equivalent Poisson models to estimate the association between EVI and first hospital admission for total kidney disease, chronic kidney disease (CKD), and acute kidney injury (AKI), separately. RESULTS Data for 1,462,949 beneficiaries who resided in a total of 644 ZIP codes were analyzed. The total person-years of follow-up for total kidney disease, CKD, and AKI were 9.8, 10.9, and 10.8 million person-years, respectively. For a 0.1 increase in annual EVI, the hazard ratios (HRs) were 0.95 (95% CI: 0.93 to 0.97) for the first hospital admission for total kidney disease, and the association was more prominent for AKI (HR: 0.94 with 95% CI: 0.92 to 0.97) than CKD (HR: 0.98 with 95% CI: 0.95-1.01]). The estimated effects of EVI on kidney disease were generally more evident in White beneficiaries and those residing in metropolitan areas compared to the overall population. CONCLUSIONS This study found that higher levels of annual residential greenness were associated with a lower risk of the first hospital admission for kidney diseases. Results are consistent with the hypothesis that higher residential greenness benefits kidney patients.
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Affiliation(s)
- Whanhee Lee
- School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, Republic of Korea.
| | - Seulkee Heo
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Rory Stewart
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Xiao Wu
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Kelvin C Fong
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Ji-Young Son
- Yale School of the Environment, Yale University, New Haven, CT, USA
| | - Benjamin Sabath
- Faculty of Arts and Sciences Research Computing Department, Harvard University, Boston, MA, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Republic of Korea; Department of Internal Medicine, Dongguk University College of Medicine, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Republic of Korea
| | - Joel Schwartz
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute for Sustainable Development, Graduate School of Public Health, Seoul National University, Republic of Korea
| | - Francesca Dominici
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Michelle L Bell
- Yale School of the Environment, Yale University, New Haven, CT, USA
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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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Genetically Predicted Circulating Copper and Risk of Chronic Kidney Disease: A Mendelian Randomization Study. Nutrients 2022; 14:nu14030509. [PMID: 35276868 PMCID: PMC8840411 DOI: 10.3390/nu14030509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 12/30/2022] Open
Abstract
Elevated circulating copper levels have been associated with chronic kidney disease (CKD), kidney damage, and decline in kidney function. Using a two sample Mendelian randomization approach where copper-associated genetic variants were used as instrumental variables, genetically predicted higher circulating copper levels were associated with higher CKD prevalence (odds ratio 1.17; 95% confidence interval 1.04, 1.32; p-value = 0.009). There was suggestive evidence that genetically predicted higher copper was associated with a lower estimated glomerular filtration rate and a more rapid kidney damage decline. In conclusion, we observed that elevated circulating copper levels may be a causal risk factor for CKD.
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Qian Y, Li H, Rosenberg A, Li Q, Sarnat J, Papatheodorou S, Schwartz J, Liang D, Liu Y, Liu P, Shi L. Long-Term Exposure to Low-Level NO2 and Mortality among the Elderly Population in the Southeastern United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:127009. [PMID: 34962424 PMCID: PMC8713651 DOI: 10.1289/ehp9044] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/01/2021] [Accepted: 11/29/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Mounting evidence has shown that long-term exposure to fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)] and ozone (O3) can increase mortality. However, the health effects associated with long-term exposure to nitrogen dioxide (NO2) are less clear, in particular the evidence is scarce for NO2 at low levels that are below the current international guidelines. METHODS We constructed a population-based full cohort comprising all Medicare beneficiaries (aged ≥65, N=13,590,387) in the southeastern United States from 2000 to 2016, and we then further defined the below-guideline cohort that included only those who were always exposed to low-level NO2, that is, with annual means below the current World Health Organization guidelines (i.e., ≤21 ppb). We applied previously estimated spatially and temporally resolved NO2 concentrations and assigned annual means to study participants based on their ZIP code of residence. Cox proportional hazards models were used to examine the association between long-term exposure to low-level NO2 and all-cause mortality, adjusting for potential confounders. RESULTS About 71.1% of the Medicare beneficiaries in the southeastern United States were always exposed to low-level NO2 over the study period. We observed an association between long-term exposure to low-level NO2 and all-cause mortality, with a hazard ratio (HR)= 1.042 (95% CI: 1.040, 1.045) in single-pollutant models and a HR= 1.047 (95% CI: 1.045, 1.049) in multipollutant models (adjusting for PM2.5 and O3), per 10-ppb increase in annual NO2 concentrations. The penalized spline indicates a linear exposure-response relationship across the entire NO2 exposure range. Medicare enrollees who were White, female, and residing in urban areas were more vulnerable to long-term NO2 exposure. CONCLUSION Using a large and representative cohort, we provide epidemiological evidence that long-term exposure to NO2, even below the national and global ambient air quality guidelines, was approximately linearly associated with a higher risk of mortality among older adults, independent of PM2.5 and O3 exposure. Improving air quality by reducing NO2 emissions, therefore, may yield significant health benefits. https://doi.org/10.1289/EHP9044.
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Affiliation(s)
- Yaoyao Qian
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Haomin Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrew Rosenberg
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Qiulun Li
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jeremy Sarnat
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Stefania Papatheodorou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joel Schwartz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Donghai Liang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yang Liu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Pengfei Liu
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Liuhua Shi
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Chen Y, Cao F, Xiao JP, Fang XY, Wang XR, Ding LH, Wang DG, Pan HF. Emerging role of air pollution in chronic kidney disease. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:52610-52624. [PMID: 34448134 DOI: 10.1007/s11356-021-16031-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/14/2021] [Indexed: 06/13/2023]
Abstract
Chronic kidney disease (CKD), a global disease burden related to high rates of incidence and mortality, manifests as progressive and irretrievable nephron loss and decreased kidney regeneration capacity. Emerging studies have suggested that exposure to air pollution is closely relevant to increased risk of CKD, CKD progression and end-stage kidney disease (ESKD). Inhaled airborne particles may cause vascular injury, intraglomerular hypertension, or glomerulosclerosis through non-hemodynamic and hemodynamic factors with multiple complex interactions. The mechanisms linking air pollutants exposure to CKD include elevated blood pressure, worsening oxidative stress and inflammatory response, DNA damage and abnormal metabolic changes to aggravate kidney damage. In the present review, we will discuss the epidemiologic observations linking air pollutants exposure to the incidence and progression of CKD. Then, we elaborate the potential roles of several air pollutants including particulate matter and gaseous co-pollutants, environmental tobacco smoke, and gaseous heavy metals in its pathogenesis. Finally, this review outlines the latent effect of air pollution in ESKD patients undergoing dialysis or renal transplant, kidney cancer and other kidney diseases. The information obtained may be beneficial for further elucidating the pathogenesis of CKD and making proper preventive strategies for this disease.
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Affiliation(s)
- Yue Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, China
| | - Fan Cao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Jian-Ping Xiao
- Department of Nephrology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xin-Yu Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, China
| | - Xue-Rong Wang
- Department of Nephrology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Li-Hong Ding
- Department of Nephrology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - De-Guang Wang
- Department of Nephrology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, China.
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Pini F, Piras G, Astiaso Garcia D, Di Girolamo P. Impact of the different vehicle fleets on PM10 pollution: Comparison between the ten most populous Italian metropolitan cities for the year 2018. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 773:145524. [PMID: 33592474 DOI: 10.1016/j.scitotenv.2021.145524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
The main aim of this research effort is to assess the impact of the different circulating vehicle fleets on PM10 pollution, comparing the results from the ten most populated metropolitan cities in Italy. Circulating diesel vehicles have been categorized in different groups depending on the vehicle type (car or Light Commercial Vehicle - LCV) and European emission standard. The annual mileage and the total PM10 emission for each category has been determined based on several data sources. Estimated overall annual emissions of PM10 particles have been compared with PM10 concentration measurements from distributed ground monitoring stations. A new index, named SoP (Strength of Pollution), has been defined in order to quantify the contribution of each fleet category to the overall PM10 pollution. The index has been computed for the ten most populated Italian metropolitan cities, i.e. all cities with more than 300.000 inhabits: Rome, Milan, Naples, Turin, Palermo, Genoa, Bologna, Florence, Bari and Catania. Results in terms of SoP estimates for year 2018 reveal the presence in these Italian cities of emission clusters with heterogeneous characteristics, which impose the adoption of different PM10 pollution mitigation approaches in the different cities. For example, in Naples, Catania and Palermo, Euro 0 car fleets emit a total PM10 mass which is respectively 19, 10 and 5 times the mass emitted by Euro 6 vehicles, and consequently a reduction of this fleet is desirable for pollution mitigation purposes. Conversely, in Rome, Genoa and Bari, Euro 3 and 4 car fleets emit a total PM10 mass which is 3-6 times the one emitted by Euro 6 vehicles, which calls for a reduction of these fleets. Thus, the extension to the entire national territory of the results obtained in a specific metropolitan city may be strongly misleading and produce limited effects in terms of pollution mitigation.
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Affiliation(s)
- Fabrizio Pini
- Interdepartmental Centre for Landscape, Building, Conservation, Environment (CITERA), Sapienza University of Rome, Via A. Gramsci, 53, 00197 Rome, Italy.
| | - Giuseppe Piras
- Department of Astronautics, Electrical and Energy Engineering (DIAEE), Sapienza University of Rome, Via Eudossiana, 18, 00184 Rome, Italy.
| | - Davide Astiaso Garcia
- Department of Astronautics, Electrical and Energy Engineering (DIAEE), Sapienza University of Rome, Via Eudossiana, 18, 00184 Rome, Italy; Department of Planning, Design, and Technology of Architecture (PDTA), Sapienza University of Rome, Via Flaminia 72, 00196, Rome, Italy.
| | - Paolo Di Girolamo
- Scuola di Ingegneria, Università degli Studi della Basilicata, Viale dell'Ateneo Lucano, 10, 85100 Potenza, Italy.
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Tsai HJ, Hung CH, Wang CW, Tu HP, Li CH, Tsai CC, Lin WY, Chen SC, Kuo CH. Associations among Heavy Metals and Proteinuria and Chronic Kidney Disease. Diagnostics (Basel) 2021; 11:diagnostics11020282. [PMID: 33670331 PMCID: PMC7918558 DOI: 10.3390/diagnostics11020282] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The prevalence of chronic kidney disease (CKD) is increasing annually in Taiwan. In addition to traditional risk factors, heavy metals contribute to the development of CKD. The aim of this study was to investigate associations among heavy metals and proteinuria and CKD in the general population in Southern Taiwan. We also explored the interaction and synergetic effects among heavy metals on proteinuria. Methods: We conducted a health survey in the general population living in Southern Taiwan between June 2016 and September 2018. Seven heavy metals were measured: blood lead (Pb) and urine nickel (Ni), chromium (Cr), manganese (Mn), arsenic (As), copper (Cu), and cadmium (Cd). Proteinuria was measured using reagent strips. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Results: The mean age of the 2447 participants was 55.1 ± 13.2 years and included 977 males and 1470 females. Participants with high blood Pb and high urine Ni, Mn, Cu, and Cd were significantly associated with proteinuria. Interactions between blood Pb and urine Cr, and between urine Cd and Cu, had significant effects on proteinuria. The participants with high blood Pb and high urine Cu were significantly associated with an eGFR of <60 mL/min/1.73 m2. Conclusion: High blood Pb and high urine Cu may be associated with proteinuria and an eGFR of <60 mL/min/1.73 m2. High urine Ni, Mn, and Cd were significantly associated with proteinuria. Co-exposure to Cd and Cu, and Pb and Cr, may have synergistic effects on proteinuria.
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Affiliation(s)
- Hui-Ju Tsai
- Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 801, Taiwan;
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-H.H.); (W.-Y.L.)
| | - Chih-Hsing Hung
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-H.H.); (W.-Y.L.)
- 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
| | - Chih-Wen Wang
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (C.-W.W.); (C.-H.K.)
- Department of Internal Medicine, Division of Hepatobiliary, 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;
| | - Chiu-Hui Li
- Health Management and Occupational Safety Health Center, Kaohsiung Municipal Siaogang Hospital; Kaohsiung 812, Taiwan; (C.-H.L.); (C.-C.T.)
| | - Chun-Chi Tsai
- Health Management and Occupational Safety Health Center, Kaohsiung Municipal Siaogang Hospital; Kaohsiung 812, Taiwan; (C.-H.L.); (C.-C.T.)
| | - Wen-Yi Lin
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-H.H.); (W.-Y.L.)
- Department of Internal Medicine, Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Health Management and Occupational Safety Health Center, Kaohsiung Municipal Siaogang Hospital; Kaohsiung 812, Taiwan; (C.-H.L.); (C.-C.T.)
| | - Szu-Chia Chen
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-H.H.); (W.-Y.L.)
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (C.-W.W.); (C.-H.K.)
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-8036783 (ext. 3440); Fax: +886-7-8063346
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (C.-W.W.); (C.-H.K.)
- Department of Internal Medicine, Division of Gastroenterology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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12
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Wang Y, Shi L, Chen D, Tan X. Spatial-Temporal Analysis and Driving Factors Decomposition of (De)Coupling Condition of SO 2 Emissions in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186725. [PMID: 32942742 PMCID: PMC7560182 DOI: 10.3390/ijerph17186725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/02/2023]
Abstract
China has a fast-growing economy and is one of the top three sulfur dioxide (SO2) emitters in the world. This paper is committed to finding efficient ways for China to reduce SO2 emissions with little impact on its socio-economic development. Data of 30 provinces in China from 2000 to 2017 were collected to assess the decoupling relationship between economic growth and SO2 emissions. The Tapio method was used. Then, the temporal trend of decoupling was analyzed and the Moran Index was introduced to test spatial autocorrelation of the provinces. To concentrate resources and improve the reduction efficiency, a generalized logarithmic mean Divisia index improved by the Cobb-Douglas function was applied to decompose drivers of SO2 emissions and to identify the main drivers. Results showed that the overall relationship between SO2 emissions and economic growth had strong decoupling (SD) since 2012; provinces, except for Liaoning and Guizhou, have reached SD since 2015. The decoupling indexes of neighboring provinces had spatial dependence at more than 95% certainty. The main positive driver was the proportion of the secondary sector of the economy and the main negative drivers were related to energy consumption and investment in waste gas treatment. Then, corresponding suggestions for government and enterprises were made.
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Affiliation(s)
- Yue Wang
- School of Environment and Natural Resources, Renmin University of China, Beijing 100872, China; (Y.W.); (D.C.)
| | - Lei Shi
- School of Environment and Natural Resources, Renmin University of China, Beijing 100872, China; (Y.W.); (D.C.)
- Correspondence:
| | - Di Chen
- School of Environment and Natural Resources, Renmin University of China, Beijing 100872, China; (Y.W.); (D.C.)
- Division of the Social Science, The University of Chicago, Chicago, IL 60615, USA
| | - Xue Tan
- State Grid Energy Research Institute Co., LTD, Beijing 102209, China;
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