Kidney Week

Abstract: SA-PO1127

Influence of Environmental Factors on the Progression of CKD in São Paulo, Brazil

Session Information

• CKD: Progression, Drugs, Modalities, and Environmental Factors
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Moreira, Tiana Carla Lopes, University of São Paulo School of Medicine, São Paulo, SP, Brazil

Tiana Carla Lopes Moreira, ScD

• Tammaro, Alessandra, Amsterdam UMC Locatie AMC, Amsterdam, NH, Netherlands

Alessandra Tammaro, PhD

• Santos, Itamar de Souza, University of São Paulo School of Medicine, São Paulo, SP, Brazil

Itamar de Souza Santos, PhD

• Bensenor, Isabela M., University of São Paulo School of Medicine, São Paulo, SP, Brazil

Isabela M. Bensenor, PhD

• Lotufo, Paulo, University of São Paulo School of Medicine, São Paulo, SP, Brazil

Paulo Lotufo, MD, PhD

• Andrade, Maria, Institute of Astronomy, Geophysics and Atmospheric Sciences University of Sao Paulo, São Paulo, SP, Brazil

Maria Andrade, PhD

• Mauad, Thais, University of São Paulo School of Medicine, São Paulo, SP, Brazil

Thais Mauad, PhD

• Andrade, Lucia, University of São Paulo School of Medicine, São Paulo, SP, Brazil

Lucia Andrade, MD, PhD

• Kers, Jesper, Amsterdam UMC Locatie AMC, Amsterdam, NH, Netherlands

Jesper Kers, MD, PhD

Background

CKD is an emerging public health concern globally, particularly in urban centers with high environmental stress. Although the adverse effects of air pollution on the cardiovascular and respiratory systems are well established, its relationship with CKD progression remains underexplored. São Paulo, Brazil—one of the world’s largest megacities—faces elevated levels of PM_2.5 and a densely built environment, offering a unique context to study how environmental exposures affect renal function.

Methods

This longitudinal study used data from a large cohort study (ELSA) conducted in the city (n = 3,418), collected in three waves (2008-2010, 2012-2014, and 2017-2019). CKD was defined by an estimated GFR (eGFR) categorized as ≥ stage 3 or an albumin-to-creatinine ratio (ACR) > 30 mg/g (albuminuria). Individual exposure to PM_2.5 was estimated via satellite data and vehicle emission inventories. Land cover, green space, and built environments were assessed through satellite imagery. Socioeconomic data were extracted from a geographically-based index of health studies in Brazil. A linear mixed model was applied to evaluate the longitudinal relationships that environmental exposures and individual risk factors have with CKD progression.

Results

The eGFR declined significantly over time (β = −0.587, p < 0.001). Female sex was associated with higher eGFRs (β = 4.49, p < 0.001), whereas higher BMI and age were associated with lower renal function. Increased built environment coverage was significantly associated with eGFR decline (β < 0, p = 0.04). Although the socioeconomic index showed a marginal association with the eGFR (β < 0, p = 0.09), its interaction with age was not significant. Albuminuria increased significantly over time (β = 12.99, p < 0.001), and BMI was positively associated with the ACR (β = 1.72, p = 0.01). Renal function trajectories varied among individuals.

Conclusion

Environmental exposures, such as to densely built urban areas, were associated with declining renal function over time in São Paulo. These findings underscore the need to incorporate environmental and urban planning perspectives into kidney disease prevention strategies, especially in contexts of high urbanization, social inequality, or both. (Supported by FAPESP)

Funding

• Government Support – Non-U.S.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025hjknw8x3