Lin Jui-Hsiang, Yen Tzung-Hai, Weng Cheng-Hao, Huang Wen-Hung
From the Department of Nephrology and Division of Clinical Toxicology (J-HL, T-HY, C-HW, W-HH), Chang Gung Memorial Hospital, Linkou Medical Center; Chang Gung University College of Medicine (T-HY, C-HW, W-HH); and Division of Nephrology (J-HL), Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, R.O.C.
Medicine (Baltimore). 2015 Jan;94(1):e368. doi: 10.1097/MD.0000000000000368.
An ongoing issue related to global urbanization is the association of air pollution with increased incidences of morbidity and mortality. However, no in-depth study has investigated this issue focusing on peritoneal dialysis (PD) patients. Therefore, this study assessed the effects of traffic-related air pollutants and other important mortality-associated factors on 2-year mortality in PD patients.A total of 160 PD patients were recruited in this 2-year retrospective observational study. Differences in air quality were analyzed with respect to the patients' living areas. The PD patients were categorized into 2 groups according to high (n = 65) and low (n = 95) nitrogen dioxide (NO2) exposure. Demographic, hematological, nutritional, inflammatory, biochemical, air pollutants, and dialysis-related data were analyzed. Univariate and multivariate Cox regression analyses were used for 2-year mortality analysis.A total of 160 PD patients (38 men and 122 women) were enrolled. Fourteen patients (8.8%) died within 2 years; among them, the causes of death were infection (n = 10), malignancy (n = 1), and cardiovascular events (n = 3). Among the 10 patients who died from infection, 5, 4, and 1 died from pneumonia, PD-related peritonitis, and sepsis of unknown origin, respectively. All patients who died from pneumonia were living in high environmental NO2 exposure areas. Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.073, 95% confidence interval [CI] [1.013-1.137]; P = 0.017), white blood cell count (HR 1.41, 95% CI [1.116-1.781]; P = 0.004), log normalized protein nitrogen appearance (HR 0.0001, 95% CI [0-0.073]; P = 0.005), high cardiothoracic ratio (HR 14.28, 95% CI [1.778-114.706]; P = 0.012), and high environmental NO2 exposure (HR 3.776, 95% CI [1.143-12.47]; P = 0.029) were significantly associated with 2-year mortality.PD patients with high environmental NO2 exposure had a higher 2-year mortality rate than those with low exposure. Therefore, air pollution may be associated with 2-year mortality in such patients.
与全球城市化相关的一个持续存在的问题是空气污染与发病率和死亡率上升之间的关联。然而，尚无深入研究聚焦于腹膜透析（PD）患者来调查这一问题。因此，本研究评估了与交通相关的空气污染物及其他重要的死亡相关因素对PD患者2年死亡率的影响。
在这项为期2年的回顾性观察研究中，共招募了160例PD患者。根据患者居住地区分析空气质量差异。PD患者根据二氧化氮（NO₂）高暴露（n = 65）和低暴露（n = 95）分为2组。分析了人口统计学、血液学、营养、炎症、生化、空气污染物及透析相关数据。采用单因素和多因素Cox回归分析进行2年死亡率分析。
共纳入160例PD患者（38例男性和122例女性）。14例患者（8.8%）在2年内死亡；其中，死亡原因分别为感染（n = 10）、恶性肿瘤（n = 1）和心血管事件（n = 3）。在10例死于感染的患者中，分别有5例、4例和1例死于肺炎、PD相关腹膜炎和不明来源的败血症。所有死于肺炎的患者均生活在高环境NO₂暴露地区。多因素Cox回归分析显示，年龄（风险比[HR] 1.073，95%置信区间[CI] [1.013 - 1.137]；P = 0.017）、白细胞计数（HR 1.41，95% CI [1.116 - 1.781]；P = 0.004）、对数标准化蛋白氮呈现率（HR 0.0001，95% CI [0 - 0.073]；P = 0.005）、高心胸比（HR 14.28，95% CI [1.778 - 114.706]；P = 0.012）和高环境NO₂暴露（HR 3.776，95% CI [1.143 - 12.47]；P = 0.029）与2年死亡率显著相关。
环境NO₂高暴露的PD患者2年死亡率高于低暴露患者。因此，空气污染可能与这类患者的2年死亡率相关。
