Journal
AMERICAN JOURNAL OF KIDNEY DISEASES
Volume 76, Issue 5, Pages 645-+Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2020.02.447
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Funding
- Ministry of Science and Technology [MOST 106-2314-B-039-041-MY3]
- China Medical University Hospital, Taichung, Taiwan [CRS-106-018, DMR-109-200]
- China Medical University, Taichung, Taiwan [CMU-108-S-19]
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Rationale & Objective: Limited evidence concerns fine particulate matter (with aerodynamic diameter <= 2.5 mu m [PM2.5]) exposure and the risk for kidney failure with replacement therapy (KFRT). This study assessed whether PM2.5 exposure was associated with progression of chronic kidney disease (CKD) to KFRT. Study Design: Prospective cohort study. Setting & Participants: 6,628 adult patients with CKD were recruited from the Advanced CKD Program in Taiwan between 2003 and 2015. Exposure: Satellite-based spatiotemporal models were used to calculate each individual's 1-year PM2.5 exposure before the date of enrollment into the Advanced CKD Program. Outcomes: Time to KFRT (defined as initiation of maintenance hemodialysis, peritoneal dialysis, or kidney transplantation) and time to all-cause mortality. Analytical Approach: Multivariable proportional hazard regression analyses were used to estimate the association of PM2.5 with KFRT and all-cause mortality. Restricted cubic splines were used to explore dose-response relationships. Results: The study population included 6,628 adult patients with CKD who were aged 20 to 90 years. 941 KFRT events and 1,653 deaths occurred during follow-up. The adjusted HR for progression to KFRT was 1.19 (95% CI, 1.08-1.31) per 7.8 mu g/m(3) greater PM2.5, an amount spanning the interquartile range. There was evidence of a dose-response relationship (adjusted HRs of 1.16 [95% CI, 0.90-1.51], 1.19 [95% CI, 0.94-1.52], and 1.42 [95% CI, 1.12-1.80] for low, medium, and high PM2.5 levels). There was no significant association between PM2.5 and all-cause mortality (adjusted HR, 1.01 [95% CI, 0.95-1.08]). Limitations: Misclassification of PM2.5 exposure assessment and the potential for residual confounding. Conclusions: Our findings suggest that long-term exposure to PM2.5 is associated with increased risk for progression to KFRT in patients with CKD.
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