Exposure to Particulate Air Pollution and the Risk of Progression to End-Stage Renal Disease: An Advanced Chronic Kidney Disease Registry-Based Cohort Study in Taiwan

Abstract

Background: Limited evidence concerns fine particulate matter (PM2.5) exposure and the risk of end-stage renal disease (ESRD). This study assessed whether PM2.5 exposure was associated with progression of chronic kidney disease (CKD) to ESRD. Methods: We conducted a prospective cohort study of 6,628 patients with CKD to assess the effect of long-term exposure to PM2.5 on the risk of progression to ESRD and all-cause mortality. Satellite-based spatiotemporal models were used to calculate each individual’s one-year PM2.5 exposure prior to the date of enrollment into the Advanced CKD Program. Multivariable proportional hazard regression analysis was used to estimate the association of PM2.5 with ESRD and all-cause mortality, Restricted cubic splines were used to explore dose-response relationships. Results: A total of 941 events of ESRD and 1,653 deaths occurred during follow-up. The adjusted hazard ratio (HR) for progression to ESRD was 1.19 (95% CI, 1.08 to 1.31) per 7.8 µg/m3 increase in PM2.5, an increase spanning the interquartile range. There was evidence of a dose-response relationship (adjusted HR, 1.16 [95% CI, 0.90 to 1.51] in low PM2.5 level; 1.19 [95% CI, 0.94 to 1.52] in medium PM2.5 level; 1.42 [95% CI, 1.12 to 1.80] in high PM2.5 level). There was no significant association between PM2.5 and all-cause mortality (adjusted HR, 1.01 [95% CI, 0.95 to 1.08]). Conclusions: Our findings suggest that long-term exposure to PM2.5 is associated with an increased risk of progression to ESRD in patients with CKD.