The impact of sunlight exposure on mortality of patients with end stage renal disease

Una Amelia Yoon,Ho Kim,Yon Su Kim,Jung Pyo Lee,Chun Soo Lim,Jung Nam An,Soie Kwon,Hyewon Lee,Dong Ki Kim,Yong Chul Kim

doi:10.1038/s41598-019-38522-w

Abstract

Recent data suggest that reduced sunlight exposure is associated with increased mortality in the general population. To date, the association between sunlight exposure and mortality in dialysis patients has not been examined. Among 134,478 dialysis patients in the Korean end-stage renal disease (ESRD) cohort from 2001 to 2014, 31,291 patients were enrolled from seven metropolitan cities, and data were analyzed using bi-directional case-crossover design. We examined the association between short-term sunlight exposure and mortality in ESRD patients. We adjusted for temperature, humidity, and daily concentrations of nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), carbon monoxide (CO), and particle matter (PM10) as confounders. The characteristics of the study population included age (65.6 ± 12.26 (mean ± standard deviation [SD]) years), sex (male, 59.96%; female, 41.04%), comorbidity (diabetes, 53.58%; hypertension, 40.5%), and kidney dialysis type (hemodialysis, 73.02%; peritoneal dialysis, 26.98%). The mean ± SD follow-up time was 4.68 ± 4.37 years. The daily sunlight exposure was significantly decreased in the case group compared with the control group (P = 0.004). Sunlight exposure was associated with all-cause death overall (ORs [95% CI]: 0.99 [0.98–0.99], P = 0.042) in a fully adjusted model. Patients with diabetes (ORs [95% CI]: 0.98 [0.97–0.99], P = 0.016) or aged higher than 75 years (ORs [95% CI]; 0.97 [0.96–0.99], P = 0.020) had higher risks of mortality than patients without diabetes or aged below 75 years, respectively. These findings suggest that sunlight exposure is inversely correlated with all-cause mortality in dialysis patients.

Highlights

There is a lively debate regarding the avoidance of sunlight and how this is a major risk factor for public health
Low circulating 25(OH)D concentration leads to mineral bone disease (MBD) such as secondary hyperparathyroidism, which is critically correlated with increased risks of coronary arterial calcification[16], atherosclerosis, and endothelial cell dysfunction[17], which result in cardiovascular events and mortality[18,19]
We identified 134,472 patients registered in the Korean Society of Nephrology for kidney dialysis registry

Summary

Introduction

There is a lively debate regarding the avoidance of sunlight and how this is a major risk factor for public health. High-intensity ultraviolet radiation can be a carcinogen to the skin[1], there is growing scientific evidence that avoiding sunlight exposure is a major risk factor for various diseases and death[2,3,4]. There have been few studies on the relationship between sunlight exposure and clinical prognosis in patients with ESRD who undergo renal replacement therapy, such as hemodialysis or peritoneal dialysis. Given this concern, this study was conducted to investigate the relationship of sunlight exposure and death in dialysis patients

Methods

Results

Conclusion