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Abstract: FR-PO693

The Impact of Exposure to Air Pollution on the Progression of Primary Glomerular Disease

Session Information

Category: Glomerular Diseases

  • 1401 Glomerular Diseases: From Inflammation to Fibrosis

Authors

  • Trachtman, Howard, University of Michigan, Ann Arbor, Michigan, United States
  • Troost, Jonathan P., University of Michigan, Ann Arbor, Michigan, United States
  • D'Souza, Jennifer, University of Michigan, Ann Arbor, Michigan, United States
  • Adar, Sara, University of Michigan, Ann Arbor, Michigan, United States
  • Buxton, Miatta, University of Michigan, Ann Arbor, Michigan, United States
  • Kshirsagar, Abhijit V., University of North Carolina Research Opportunities Initiative, Chapel Hill, North Carolina, United States
  • Engel, Lawrence S., University of North Carolina Research Opportunities Initiative, Chapel Hill, North Carolina, United States
  • O'Lenick, Cassandra R., University of North Carolina Research Opportunities Initiative, Chapel Hill, North Carolina, United States
  • Smoyer, William E., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Klein, Jon B., University of Louisville, Louisville, Kentucky, United States
  • Ju, Wenjun, University of Michigan, Ann Arbor, Michigan, United States
  • Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
  • Kretzler, Matthias, University of Michigan, Ann Arbor, Michigan, United States
Background

Exposure to air pollution is linked to chronic disease. Air pollution stimulates injury pathways that contribute to organ damage. However, there is limited information about its impact on the course of kidney disease or the molecular pathways involved.

Methods

Patients enrolled in the Nephrotic Syndrome Study Network (n=228) and Cure Glomerulonephropathy (n=697) studies with residential census tract data and ≥2 yr of follow-up were included. Three indices of air pollution exposure were assessed: (1) PM2.5; (2) Black carbon; and (3) Sulfates. The primary outcome was the hazard ratio for >40% decline in eGFR or end-stage kidney disease (eGFR<15 ml/min/1.73 m2, initiation of dialysis, or kidney transplantation). Air quality was categorized by census tract and assessed using modeled concentrations.

Results

PM2.5, black carbon, and sulfate exposure were comparable in the two cohorts but higher in Black participants (p<0.005). Baseline eGFR was lower and proteinuria higher in those with exposure above the median for all three pollutants. Among patients with disease duration ≥1 year, in an adjusted analysis, PM2.5, HR 1.23 [95% CI:1.02, 1.49], p=0.029, and black carbon, HR 1.42 [95% CI:1.18, 1.71], p=0.0002, were associated with increased likelihood of worsening kidney disease. Sulfate exposure was associated with increased urinary MCP-1 excretion (p=0.018) and increased serum TNF levels (p=0.003), while PM2.5 exposure was associated with increased serum IL-1β levels (p=0.025) (Figure 1).

Conclusion

In patients with primary glomerulopathies, exposure to air pollution is associated with an elevated risk for disease progression and increases in systemic biomarkers of inflammation.

Funding

  • NIDDK Support