SUN-258 ASSOCIATION BETWEEN AIR POLLUANTS AND GLOBAL BURDEN OF DISEASE IN CHRONIC KIDNEY DISEASE: A SYSTEMIC REVIEW AND META-ANALYSIS

Abstract

Chronic kidney disease (CKD) is a prevalent disease conferring high burden worldwide, with a plethora of known risk factors. CKD of uncertain etiology (CKDu) denotes CKD which cannot be attributable to traditional risk factors. It is well recognized that the identification of modifiable risk factors for CKD is crucial for reducing its heavy global burden of disease (GBD), but our effort in uncovering non-traditional risk factors is still far from adequacy. To assess the association between air pollution and the risk of CKD, including incident case and renal function decline. Systematic review, random-effects meta-analysis, and population attributable fraction (PAF) was utilized to evaluate the proportion of disease burden that could be prevented. Electronic literature search of Cochrane Library, PubMed, Medline, and Embase for studies published up to March 2018 without language restriction. Studies investigating the association between the increases in gaseous (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) or particulate [diameter < 2·5 μm (PM2·5) or <10 μm (PM10)] air pollutants and CKD, end-stage renal disease or renal dysfunction. We used a random-effects model to derive overall risk estimates per pollutant. Of 3,989 identified articles, 18 met inclusion criteria after screening and 10 were included in the meta-analysis. Pooled effect estimates showed that summary risk ratio (RR) for CKD per 10 μg/m3 increase in PM2.5 was 1.12 (95% confidence interval [CI] 0.97 - 1.29) and 1.16 (95% CI 1.05 - 1.29) for PM10; per 10 ppm increase in CO was 1.31 (95% CI 0.86 - 2.00); and per 10 ppb increase in NO2 was 1.11 (95% CI 1.09 - 1.14). For the pooled effect on estimated glomerular filtration rate (eGFR), an increase in PM10 (per 10 μg/m3) was significantly associated with lower eGFR by -0.83 (95% CI -1.54 - -0.12) mL/min/1.73 m2, while an increase in PM2.5 showed a trend toward faster eGFR decline. Also, an estimated 67.3 million excess prevalent CKD cases globally were attributable to PM2.5 exposure (population attributable fraction=24.6%; 95% uncertainty interval -1.9% - 43.2%). Air pollution is closely associated with CKD and renal function decline. Although more cross-national studies are required, air pollution can be pervasive for kidney health and should remain a prime focus among global health policy.