ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: FR-OR051

Association Between Ambient Fine Particulate Matter Air Pollution and Death due to CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Bowe, Benjamin Charles, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
  • Xie, Yan, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
  • Xian, Hong, Saint Louis University College for Public Health & Social Justice, St. Louis, Missouri, United States
  • Yan, Yan, Washington University Medical School, Saint Louis, Missouri, United States
  • Al-Aly, Ziyad, VA Saint Louis Health Care System, Saint Louis, Missouri, United States

Group or Team Name

  • Clinical Epidemiology Center, VA Saint Louis Health Care System

Experimental and epidemiologic evidence suggest that ambient fine particulate matter (PM2.5) is a risk factor for chronic kidney disease (CKD). However, no studies have investigated whether PM2.5 is associated with mortality due to CKD, nor quantified the burden in the US.


Data from the Environmental Protection Agency, Department of Veterans Affairs, and National Death Index were linked. Non-linear exposure response functions were built using an ensemble survival modeling approach, and CKD death rates associated with PM2.5 exposure were estimated.


A cohort of 4,522,160 US veterans was followed for a median of 10 years. There were 29,016 deaths due to CKD during follow-up. The median PM2.5 exposure at baseline was 11.8 (µg/m3) (IQR: 10.0-13.8). As PM2.5 levels increased, an increase in risk of death due to CKD was observed. In the contiguous US in 2017, it was estimated that 7,175.2 (Uncertainty Interval (UI): 5910.2-8371.9) CKD deaths were associated with PM2.5 exposure, corresponding to an age-standardized rate of 1.9 (UI: 1.5-2.2) deaths due to CKD per 100,000 persons. Geographic heterogeneity in age-standardized rates of CKD deaths associated with PM2.5 was observed (Figure), where states with the highest rates (per 100,000 persons) included Mississippi (3.14), Georgia (2.9), and Indiana (2.9), while states with the lowest rates included Vermont (0.31), Wyoming (0.46), and Washington (0.56). In those of black or African American race, the age-standardized CKD death rate associated with PM2.5 was estimated to be 2.1 per 100,000 persons, 16.4% higher than the estimate in those not of black or African American race (1.8 per 100,000 persons).


Elevated levels of PM2.5 is associated with increased risk of death due to CKD. The burden is disproportionately borne by those of black or African American race.

Age-standardized rates of death due to CKD associated with PM2.5 in the contiguous US


  • Veterans Affairs Support