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The association between fine particulate matter (PM2.5) and chronic kidney disease using electronic health record
Lama Ghazi1, Paul E Drawz2, Jesse D Berman3
1Clinical and Translational Research Accelerator, Department of Medicine, Section of Nephrology, Yale University, New Haven, CT, USA. lamaghazi@gmail.com.
Background:
Recent evidence has shown that fine particulate matter (PM2.5) may be an important environmental risk factor for chronic kidney disease (CKD), but few studies have examined this association for individual patients using fine spatial data.
Objective:
To investigate the association between PM2.5 and CKD (estimated glomerular filtration rate [eGFR]<45 ml/min/1.73 m2) in the Twin-Cities area in Minnesota using a large electronic health care database (2012-2019).
Methods:
We estimated the previous 1-year average PM2.5 from the first eGFR (measured with the CKD Epidemiology Collaboration equation using the first available creatinine measure during the baseline period [2012-2014]) using Environmental Protection Agency downscaler modeling data at the census tract level. We evaluated the spatial relative risk and clustering of CKD prevalence using a K-function test statistic. We assessed the prevalence ratio of the PM2.5 association with CKD incidence using a mixed effect Cox model, respectively.
Results:
Patients (n = 20,289) in the fourth (PM2.5 > 10.4), third (10.3 < PM2.5 < 10.8) and second quartile (9.9 < PM2.5 < 10.3) vs. the first quartile (<9.9 μg/m3) had a 2.52[2.21, 2.87], 2.18[1.95, 2.45], and 1.72[1.52, 1.97] hazard rate of developing CKD in the fully adjusted models, respectively. We identified spatial heterogeneities and evidence of CKD clustering across our study region, but this spatial variation was accounted for by air pollution and individual covariates.
Significance:
Exposure to higher PM2.5 is associated with a greater risk for incident CKD. Improvements in air quality, specifically at hotspots, may reduce CKD.
Insights
Exposure to fine particulate matter (PM2.5) is linked to an increased risk of developing chronic kidney disease (CKD). Reducing air pollution, especially in high-exposure areas, could help prevent CKD incidence.
Area of Science:
- Environmental Health
- Nephrology
- Epidemiology
Background:
- Growing evidence suggests fine particulate matter (PM2.5) as a risk factor for chronic kidney disease (CKD).
- Limited research has explored this association using granular spatial data for individual patients.
Purpose of the Study:
- To investigate the link between PM2.5 exposure and CKD incidence.
- Utilized a large electronic health record database in the Twin Cities area, Minnesota (2012-2019).
Main Methods:
- Estimated annual average PM2.5 exposure at the census tract level using EPA downscaler data.
- Assessed CKD prevalence and incidence using eGFR and mixed-effects Cox models.
- Evaluated spatial patterns and clustering of CKD using K-function statistics.
Main Results:
- Patients in higher PM2.5 quartiles (vs. the lowest) faced significantly increased hazard rates for developing CKD.
- The hazard ratio for CKD increased with higher PM2.5 levels, with the highest quartile showing a 2.52-fold increased risk.
- Identified spatial CKD clustering, which was explained by air pollution and individual factors.
Conclusions:
- Higher PM2.5 exposure is significantly associated with a greater risk of incident CKD.
- Air quality improvements, particularly in pollution hotspots, may play a role in CKD prevention.
- This study highlights the environmental burden of air pollution on kidney health.
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