Long-Term Exposure to Ambient PM2.5 and Increased Risk of CKD Prevalence in China

Guoxing Li; Jing Huang; Jinwei Wang; Minghui Zhao; Yang Liu; Xinbiao Guo; Shaowei Wu; Luxia Zhang

doi:10.1681/ASN.2020040517

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Visual Abstract

Significance Statement

Exposure to an air pollutant, fine particulate matter (PM_2.5), is an important environmental risk factor for cardiopulmonary disease. However, minimal data exist on how exposure to high PM_2.5 levels, such as in areas of mainland China, may affect CKD risk. In their analysis of data from a large survey of Chinese adults, the authors demonstrate significant associations between long-term exposure to high ambient levels of PM_2.5 and an increased risk of CKD prevalence and albuminuria. These associations were significantly stronger in urban areas, among males, among individuals <65 years, and among those with comorbidities. The study’s findings offer insight for target population protection and provide evidence for policy makers and public health practices to reduce the CKD risk associated with ambient PM_2.5 pollution.

Abstract

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.

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