期刊
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
卷 15, 期 3, 页码 311-319出版社
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.08350719
关键词
chronic kidney disease; albuminuria; glomerular filtration rate; epidemiology and outcomes; ARIC; particulate matter; air pollution; humans; cross-sectional studies; creatinine; linear models; geographic information systems; International Classification of Diseases; follow-up studies; confidence intervals; chronic renal insufficiency; chronic kidney failure; kidney function tests; cohort studies; atherosclerosis; demography; hospitalization; social class; albumin
资金
- National Heart, Lung, and Blood Institute
- National Institutes of Health (NIH)
- US Department of Health andHuman Services [HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I]
- NIDDK [R01DK089174, 5R01DK115534]
- NIH [R01ES020836-02]
Background and objectivesExposure to particulate matter (PM) <2.5 ?m in aerodynamic diameter (PM2.5) has been linked to detrimental health effects. This study aimed to describe the relationship between long-term PM2.5 exposure and kidney disease, including eGFR, level of albuminuria, and incident CKD.Design, setting, participants, & measurementsThe study included 10,997 participants from the Atherosclerosis Risk in Communities cohort who were followed from 1996?1998 through 2016. Monthly mean PM2.5 concentrations (?g/m(3)) were estimated at geocoded participant addresses using geographic information system?based, spatiotemporal generalized additive mixed models?including geospatial covariates such as land use?and then averaged over the 12-month period preceding participant examination. Covariate-adjusted, cross-sectional associations of PM2.5, baseline eGFR, and urinary albumin-creatinine ratio (UACR) were estimated using linear regression. PM2.5 and incident CKD (defined as follow-up eGFR <60 ml/min per 1.73 m(2) with ?25% eGFR decline relative to baseline, CKD-related hospitalization or death based on International Classification of Diseases 9/10 codes, or development of ESKD) associations were estimated using Cox proportional hazards regression. Modeling was stratified by study site, and stratum-specific estimates were combined using random-effects meta-analyses.ResultsBaseline mean participant age was 63 (?6) years and eGFR was 86 (?16) ml/min per 1.73 m(2). There was no significant PM2.5-eGFR association at baseline. Each 1-?g/m(3) higher annual average PM2.5 was associated with higher UACR after adjusting for demographics, socioeconomic status, and clinical covariates (percentage difference, 6.6%; 95% confidence interval [95% CI], 2.6% to 10.7%). Each 1-?g/m(3) higher annual average PM2.5 was associated with a significantly higher risk of incident CKD (hazard ratio, 1.05; 95% CI, 1.01 to 1.10).ConclusionsExposure to higher annual average PM2.5 concentrations was associated with a higher level of albuminuria and higher risk for incident CKD in a community-based cohort.
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