Particulate Air Pollution and Progression to Kidney Failure With Replacement Therapy: An Advanced CKD Registry-Based...

Limited evidence concerns fine particulate matter (with aerodynamic diameter ≤ 2.5μm [PM_2.5]) exposure and the risk for kidney failure with replacement therapy (KFRT). This study assessed whether PM_2.5 exposure was associated with progression of chronic kidney disease (CKD) to KFRT.

Prospective cohort study.

6,628 adult patients with CKD were recruited from the Advanced CKD Program in Taiwan between 2003 and 2015.

Satellite-based spatiotemporal models were used to calculate each individual's 1-year PM_2.5 exposure before the date of enrollment into the Advanced CKD Program.

Time to KFRT (defined as initiation of maintenance hemodialysis, peritoneal dialysis, or kidney transplantation) and time to all-cause mortality.

Multivariable proportional hazard regression analyses were used to estimate the association of PM_2.5 with KFRT and all-cause mortality. Restricted cubic splines were used to explore dose-response relationships.

The study population included 6,628 adult patients with CKD who were aged 20 to 90 years. 941 KFRT events and 1,653 deaths occurred during follow-up. The adjusted HR for progression to KFRT was 1.19 (95% CI, 1.08-1.31) per 7.8μg/m³ greater PM_2.5, an amount spanning the interquartile range. There was evidence of a dose-response relationship (adjusted HRs of 1.16 [95% CI, 0.90-1.51], 1.19 [95% CI, 0.94-1.52], and 1.42 [95% CI, 1.12-1.80] for low, medium, and high PM_2.5 levels). There was no significant association between PM_2.5 and all-cause mortality (adjusted HR, 1.01 [95% CI, 0.95-1.08]).

Misclassification of PM_2.5 exposure assessment and the potential for residual confounding.

Our findings suggest that long-term exposure to PM_2.5 is associated with increased risk for progression to KFRT in patients with CKD.