Long-Term Exposure to Ambient PM_2.5 and Increased Risk of CKD Prevalence in China

Background Fine particulate matter (PM_2.5) is an important environmental risk factor for cardiopulmonary diseases. However, the association between PM_2.5 and risk of CKD remains under-recognized, especially in regions with high levels of PM_2.5, such as China.

Methods To explore the association between long-term exposure to ambient PM_2.5 and CKD prevalence in China, we used data from the China National Survey of CKD, which included a representative sample of 47,204 adults. We estimated annual exposure to PM_2.5 before the survey date at each participant’s address, using a validated, satellite-based, spatiotemporal model with a 10 km×10 km resolution. Participants with eGFR <60 ml/min per 1.73 m² or albuminuria were defined as having CKD. We used a logistic regression model to estimate the association and analyzed the influence of potential modifiers.

Results The 2-year mean PM_2.5 concentration was 57.4 μg/m³, with a range from 31.3 to 87.5 μg/m³. An increase of 10 μg/m³ in PM_2.5 was positively associated with CKD prevalence (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.22 to 1.35) and albuminuria (OR, 1.39; 95% CI, 1.32 to 1.47). Effect modification indicated these associations were significantly stronger in urban areas compared with rural areas, in males compared with females, in participants aged <65 years compared with participants aged ≥65 years, and in participants without comorbid diseases compared with those with comorbidities.

Conclusions These findings regarding the relationship between long-term exposure to high ambient PM_2.5 levels and CKD in the general Chinese population provide important evidence for policy makers and public health practices to reduce the CKD risk posed by this pollutant.