Kidney Week

Abstract: SA-PO1060

Association of Ambient PM2.5 Exposure with ESRD Prevalence and Mortality in the United States Using US Renal Data System and CDC Public Databases, 2003-2011

Session Information

• Hemodialysis: Risk Factors, Epidemiology, and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Bakhshi, Tanvir, AdventHealth Sebring, Sebring, Florida, United States

Tanvir Bakhshi, MD, MBBS

• Asghar, Muhammad Sohaib, AdventHealth Sebring, Sebring, Florida, United States

Muhammad Sohaib Asghar, MD, MBBS

• Bano, Shehar, AdventHealth Sebring, Sebring, Florida, United States

Shehar Bano, MD

• Noor, Ali, AdventHealth Sebring, Sebring, Florida, United States

Ali Noor, MBBS

• Tandon, Rishabh, AdventHealth Sebring, Sebring, Florida, United States

Rishabh Tandon, MD

• Quadri, Afreen, AdventHealth Sebring, Sebring, Florida, United States

Afreen Quadri, MD, MBBS

• Babu, Poorvika, AdventHealth Sebring, Sebring, Florida, United States

Poorvika Babu, MD

• Jauhar, Prakriti, Prakriti Hospital, Jalandhar, Punjab, India

Prakriti Jauhar, MBBS

• Abanilla, Fernando M., AdventHealth Sebring, Sebring, Florida, United States

Fernando M. Abanilla, MD, FASN

• Sabucedo, Alberto J., AdventHealth Sebring, Sebring, Florida, United States

Alberto J. Sabucedo, MD, PhD, FASN

Background

End-stage renal disease (ESRD) contributes to substantial morbidity, frailty, and mortality. Environmental exposures, particularly fine particulate matter (PM2.5), may accelerate kidney function decline and increase mortality risk. This study evaluates the relationship between ambient PM2.5 concentrations and ESRD prevalence and mortality rates across the United States (US).

Methods

We conducted a retrospective ecological analysis of U.S. state- and county level ESRD prevalence and mortality from 2003-2011 using publicly available databases. Age-adjusted ESRD mortality rates (ICD-10 code: N18.0) were extracted from CDC WONDER, point prevalence data for the same period was obtained from US renal data system and annual mean PM2.5 concentrations were obtained from EPA Air Quality System and satellite-based exposure models. Additional daily air temperature and heat indices were obtained from North America Land Data Assimilation System (NLDAS) as effect modifiers. Spearman's correlations were used to estimate associations between PM2.5 levels and ESRD prevalence and mortality estimates.

Results

Data from 3,111 U.S. counties were available through the CDC portal, excluding Alaska, Hawaii, and Miami-Dade County. The mean PM2.5 concentration during the study period was 11.18 (range: 7.96-14.95 µg/m) and showed a stronger correlation with ESRD mortality (rho: +0.669, p<0.001) than all-cause mortality, as well as a significant association of ESRD prevalence with PM2.5 exposure during that period of time (rho: +0.625, p<0.001). Other environmental exposures assessed were average daily maximum and minimum air temperatures and maximum heat index, showing strong correlation, while average daily sunlight (KJ/m²) and precipitation (mm) had weak correlations.

Conclusion

Reducing PM2.5 exposure may offer a population-level opportunity to decrease preventable end-stage renal disease-related prevalence and mortality.