Short-Term Exposure to Fine Particulate Air Pollution and Emergency Department Visits for Renal Diseases in the Atlanta Metropolitan Area

Abstract

Background: Emerging toxicological evidence has shown that inhaled fine particulate matter (PM2.5) may directly or indirectly affect distant organs including kidneys. However, there is limited epidemiologic evidence about the impacts of short-term exposure to PM2.5 on kidneys.Objectives: We investigated the associations between short-term exposure to PM2.5, major PM2.5 components, and criteria gases and emergency department (ED) visits for renal disease outcomes during 2002-2008 in Atlanta, Georgia.Methods: Poisson time-series models with unconstrained distributed lags were run to estimate the acute effects of air pollutants on counts of ED visits for renal disease outcomes (all renal diseases and acute renal failure [ARF]), controlling for meteorology (air temperature and dew-point temperature) and time (season, day of week, holidays, and long term trend).Results: For all renal diseases, significant associations were observed for 8-day (lag 0-7) exposure to CO (rate ratio [RR] = 1.025, [95% CI: 1.009, 1.042]), NO2 (1.021, [1.002, 1.040]), NOx (1.019, [1.002, 1.035]), organic carbon (OC) (1.019, [1.006, 1.033]), and elemental carbon (EC) (1.014, [1.000, 1.029]) per interquartile-range (IQR) increase. For ARF, significant associations were shown for 8-day exposure to O3 (1.081, [1.012, 1.156]), PM2.5 (1.035 [1.007, 1.063]), nitrate (1.039, [1.006, 1.074]), OC (1.035, [1.009, 1.063]), and EC (1.032, [1.004, 1.061]) per IQR increase. The estimated associations were stronger for ARF than all renal diseases. Single-day exposures showed a specific lag pattern, where lags 2 and 3 had the strongest associations for all renal diseases and lag 7 was an additional peak for ARF.Conclusions: Robust associations between short-term exposure to fine particulate air pollution and renal disease outcomes, particularly ARF, were observed. This study adds to the growing epidemiologic evidence that fine particles may impact distant organs. In particular, the air pollution-related impacts on renal disease may be experienced over the short term.