Does Fine Particulate Matter Exacerbate Cardiovascular Events Among Patients with Chronic Kidney Disease?

Abstract

Background: Compared with the general population, cardiovascular disease (CVD) is more frequent and well recognised among patients suffering from chronic kidney disease (CKD). With the rising global air pollution, both CVD and CKD events were notably elevated, and innovative studies targeting non-traditional cardio-renal risk factors were needed for patients with existed CKD. This study compared excess mortality of total and cause-specific CVDs with particulate matter air pollution between patients with and without CKD. Methods: A total of 66,820 participants aged 65 years old and above were recruited in the Elderly Health Service Cohort between 1998 and 2000, and then followed up till the end of 2010. Yearly fine particulate matter (PM2.5) was estimated based on a satellite-based spatiotemporal model. Cox regression models were used to assess the association between all- and specific- CVD mortality risks and annual exposure to PM2.5 among patients with and without CKD. Findings: Among 1204 CKD patients 215 of whom were died from cardiovascular diseases during the follow-up period, including 102 from ischemic heart disease (IHD), followed by 42 from stroke and 38 from hypertensive disease. An interquartile-range (IQR) increase of 3.22 µg/m3 in PM2.5 concentrations was associated with increased risks of mortality from total CVD and IHD among patients with and without CKD. The PM2.5-IHD mortality association was more pronounced among patients with CKD (HR, 1.77; 95%CI, 1.29 to 2.42) than those without CKD (1.18; 1.08 to 1.29). Interpretation: Our findings suggest that long-term exposure to PM air pollution may exacerbate cardiovascular attacks among CKD patients. Funding Statement: The authors have not received direct or indirect funding. Declaration of Interests: The authors declare no competing interests. Ethical Approval Statement: Ethical approval was obtained from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster.