Kidney Week

Abstract: FR-PO396

Particulate Matter Air Pollution and the Risk of Incident CKD and Progression to ESRD

Session Information

• CKD: Risk Factors for Incidence and Progression - I
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 301 CKD: Risk Factors for Incidence and Progression

Authors

• Bowe, Benjamin Charles, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States

Benjamin Charles Bowe,

• Xie, Yan, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States

Yan Xie,

• Li, Tingting, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States

Tingting Li,

• Yan, Yan, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States

Yan Yan,

• Xian, Hong, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States

Hong Xian,

• Al-Aly, Ziyad, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States

Ziyad Al-Aly,

Background

Elevated levels of fine particulate matter of <2.5 µm in aerodynamic diameter (PM_2.5) are associated with increased risk of cardiovascular outcomes and death. However, whether higher concentrations of PM_2.5 are associated with increased risk of incident chronic kidney disease (CKD), CKD progression, and end stage renal disease (ESRD) is unknown.

Methods

We linked the Environmental Protection Agency and the Department of Veterans Affairs databases to build an observational cohort of 2,482,737 United States veterans, and used survival models to evaluate the association of PM_2.5 concentrations and risk of incident eGFR <60 ml/min/1.73m², incident CKD, eGFR decline ≥30%, and ESRD. County-level exposure was defined at baseline as the annual average PM_2.5 concentrations in 2004, and separately as time-varying where it was updated annually and as cohort participants moved.

Results

Over a median follow-up of 8.52 years (IQR:8.04-8.80); where exposure was defined at baseline (median 11.8 µg/m³; IQR:10.1-13.7), a 10 µg/m³ increase in PM_2.5 concentration was associated with increased risk of eGFR <60 ml/min/1.73m² (Hazard Ratio (HR)=1.21; 95% Confidence Interval (CI)=1.14-1.29); CKD (HR=1.27;CI=1.17-1.38); eGFR decline≥30% (HR=1.28;CI=1.18-1.39); and ESRD (HR=1.26;CI=1.17-1.35). In time-varying analyses, a 10 µg/m³ increase in PM_2.5 concentration was associated with increased risk of eGFR <60 ml/min/1.73m² (HR=1.25;CI=1.17-1.34); CKD (HR=1.37;CI=1.26-1.48); eGFR decline≥30% (HR=1.36;CI=1.26-1.46); and ESRD (HR=1.31;CI=1.21-1.43). Spline analyses showed a linear relationship between PM_2.5 concentrations and risk of kidney outcomes. Exposure estimates derived from NASA’s satellite data yielded consistent results.

Conclusion

Our findings demonstrate a significant association between exposure to ambient fine particulate matter and risk of incident CKD, eGFR decline, and ESRD.

Funding

• Veterans Affairs Support