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Abstract: FR-PO432

Elevated PM2.5 Increases Daily Hospital Admission and Readmission Risk in Chronic Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Wyatt, Lauren, ORISE at the Environmental Protection Agency, Chapel Hill, North Carolina, United States
  • Xi, Yuzhi, University of North Carolina, Chapel Hill, North Carolina, United States
  • Kshirsagar, Abhijit V., University of North Carolina, Chapel Hill, North Carolina, United States
  • Wade, Timothy J., US EPA, RTP, North Carolina, United States
  • Rappold, Ana G., US EPA, RTP, North Carolina, United States

Fine particulate matter (diameter < 2.5 um, PM2.5) increases the risk of hospitalization through acute exacerbations of underlying conditions. We examine the role of PM2.5 on all-cause and cause-specific admissions and readmissions among hemodialysis patients, a population with elevated hospital and 30-day readmission rates.


Health data from the United States Renal Data System included individual-level inpatient hospitalizations and events classified as rehospitalizations between 2008 and 2012 in 552 US counties. Admission rates were calculated for 1,799,928 inpatient hospitalizations. We evaluated immediate (same day) and delayed effects of a 10μg/m3 increase in PM2.5 on all-cause and cause-specific (cardiovascular, respiratory, and cerebrovascular) health associations. Daily county admission risk was measured with admission counts and expressed as a risk ratio (RR) using Conditional Poisson models stratified by county-day. This time stratified case crossover approach adjusted for changes in population size and risk characteristics by design, where each population served as its own control. Patient readmission risk was expressed as a RR and evaluated using Cox proportional hazard models with time-dependent environmental covariates controlling for meteorology, patient-specific, and event-specific variables.


Same day elevated PM2.5 was associated with a 0.4% (95%CI: 0.05-0.7%) increase in the RR of all-cause daily county admissions and even greater risk for increased 30-day readmission. Daily RRs associated with same day PM2.5 were increased by 1.1% (0.6-1.6%) for all-cause and 4.9% (2.3-7.7%) for cerebrovascular readmissions. At delayed exposure times cardiovascular and respiratory readmission risks were also observed but are not shown due to space constraints.


Our results show increased risk of hospital admission and 30-day readmission associated with elevated PM2.5 for patients receiving chronic hemodialysis. These findings suggest that daily ambient air quality may impact morbidity and healthcare costs for patients with End Stage Renal Disease. This abstract does not reflect EPA policy.


  • Other U.S. Government Support