Kidney Week

Abstract: FR-PO693

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

Session Information

• Glomerular Diseases: From Inflammation to Fibrosis - II
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1401 Glomerular Diseases: From Inflammation to Fibrosis

Authors

• Trachtman, Howard, University of Michigan, Ann Arbor, Michigan, United States

Howard Trachtman,

• Troost, Jonathan P., University of Michigan, Ann Arbor, Michigan, United States

Jonathan P. Troost,

• D'Souza, Jennifer, University of Michigan, Ann Arbor, Michigan, United States

Jennifer D'Souza,

• Adar, Sara, University of Michigan, Ann Arbor, Michigan, United States

Sara Adar,

• Buxton, Miatta, University of Michigan, Ann Arbor, Michigan, United States

Miatta Buxton,

• Kshirsagar, Abhijit V., University of North Carolina Research Opportunities Initiative, Chapel Hill, North Carolina, United States

Abhijit V. Kshirsagar,

• Engel, Lawrence S., University of North Carolina Research Opportunities Initiative, Chapel Hill, North Carolina, United States

Lawrence S. Engel,

• O'Lenick, Cassandra R., University of North Carolina Research Opportunities Initiative, Chapel Hill, North Carolina, United States

Cassandra R. O'Lenick,

• Smoyer, William E., Nationwide Children's Hospital, Columbus, Ohio, United States

William E. Smoyer,

• Klein, Jon B., University of Louisville, Louisville, Kentucky, United States

Jon B. Klein,

• Ju, Wenjun, University of Michigan, Ann Arbor, Michigan, United States

Wenjun Ju,

• Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States

Laura H. Mariani,

• Kretzler, Matthias, University of Michigan, Ann Arbor, Michigan, United States

Matthias Kretzler,

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) PM_2.5; (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

PM_2.5, 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, PM_2.5, 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 PM_2.5 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