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Kidney Week

Abstract: FR-PO319

Residential Greenness Improves Clinical Outcomes of Patients with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Park, Jae Yoon, Dongguk University Ilsan Hospital, Gyeonggido, Korea (the Republic of)
  • Jung, Jiyun, Seoul National University, Seoul, Korea (the Republic of)
  • Kim, Yong Chul, SNUH, Seoul, Korea (the Republic of)
  • Kim, Kyung Soo, Dongguk University Hospital, Goyang City, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Kim, Ho, Seoul National University, Seoul, Korea (the Republic of)
  • Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)

As industrialization has progressed, green areas have been decreasing. The association between the distribution of green spaces and health outcomes is becoming global issues, especially regarding cardiovascular and respiratory diseases. However, little is known for relationship between residential greenness and survival of patients with chronic kidney disease (CKD).


64,780 patients who visited 3 medical centers (Seoul National University Hospital, Seoul National University Bundang Hospital, Seoul National University Boramae Medical Center) from January 2001 to December 2016 were enrolled in the cohort study. Cox proportional hazard models were used to identify the association between long-term exposure of green space and mortality of patients with CKD, occurrence of end-stage renal disease (ESRD) and major adverse cardiovascular events (MACE) which were adjusted by age, sex, estimated glomerular filtration rate, hemoglobin albumin, hypertension, diabetes and mean particulate matter < 10 μm in aerodynamic diameter (PM10). Green space was defined as average normalized difference vegetation index (NDVI) in summer (Jun-Aug) around patients’ residence within 250m and 1250m area measured by MODIS satellite.


The mean age of patients was 54 years, and 49 % of them were male. During the mean 6.75 follow-up years, 8,557 deaths (13%) occurred. Higher levels of residential greenness within 250m area (0.1 increases in residential NDVI) had lower HRs for all-cause mortality (HR 0.91, CI 0.89-0.94), MACE (HR 0.94, CI 0.90-0.97) and progression to ESRD (HR 0.88, CI 0.83-0.93), which were adjusted by PM10 of observation stations within 5km around the residence. Those who were highly educated, non-smokers and non-drinkers were more affected by residential greenness. These results were consistent for the 1,250m area which were adjusted by mean PM10 within 3km and 5km around residence.


CKD patients who lived in areas with higher levels of greenness had reduced risks of all-cause mortality, MACE and progression to ESRD.