Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan.
Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Environ Health Perspect. 2018 Oct;126(10):107002. doi: 10.1289/EHP3304.
Chronic kidney disease (CKD) is a serious global public health challenge, but there is limited information on the connection between air pollution and risk of CKD.
The aim of this study was to investigate the association between long-term exposure to particulate matter (PM) with an aerodynamic diameter of less than [Formula: see text] ([Formula: see text]) and the development of CKD in a large cohort.
A total of 100,629 nonCKD Taiwanese residents age 20 y or above were included in this study between 2001 and 2014. Ambient [Formula: see text] concentration was estimated at each participant's address using a satellite-based spatiotemporal model. Incident CKD cases were identified by an estimated glomerular filtration rate (eGFR) of less than [Formula: see text]. We collected information on a wide range of potential confounders/modifiers during the medical examinations. Cox proportional hazard regression was applied to calculate hazard ratios (HRs).
During the follow-up, 4,046 incident CKD cases were identified, and the incidence rate was 6.24 per 1,000 person-years. In contrast with participants with the first quintile exposure of [Formula: see text], participants with the fourth and fifth quintiles exposure of [Formula: see text] had increased risk of CKD development, adjusting for age, sex, educational level, smoking, drinking, body mass index, systolic blood pressure, fasting glucose, total cholesterol, and self-reported heart disease or stroke, with an HR [95% confidence interval (CI)] of 1.11 (1.02, 1.22) and 1.15 (1.05, 1.26), respectively. A significant concentration-response trend was observed ([Formula: see text]). Every [Formula: see text] increment in the [Formula: see text] concentration was associated with a 6% higher risk of developing CKD (HR: 1.06, 95% CI: 1.02, 1.10). Sensitivity and stratified analyses yielded similar results.
Long-term exposure to ambient [Formula: see text] was associated with an increased risk of CKD development. Our findings reinforce the urgency to develop global strategies of air pollution reduction to prevent CKD. https://doi.org/10.1289/EHP3304.
慢性肾脏病（CKD）是一个严重的全球公共卫生挑战，但有关空气污染与 CKD 风险之间的关系的信息有限。
本研究旨在调查长期暴露于空气动力学直径小于[Formula: see text]（[Formula: see text]）的颗粒物（PM）与大型队列中 CKD 发展之间的关联。
本研究共纳入了 2001 年至 2014 年期间年龄在 20 岁及以上的 100629 名非 CKD 台湾居民。使用基于卫星的时空模型在每个参与者的地址处估算环境[Formula: see text]浓度。通过估计肾小球滤过率（eGFR）<[Formula: see text]确定 CKD 病例。我们在体检期间收集了广泛的潜在混杂因素/修饰因素的信息。应用 Cox 比例风险回归计算危险比（HRs）。
在随访期间，确定了 4046 例 CKD 病例，发病率为每 1000 人年 6.24 例。与[Formula: see text]暴露的第一五分位数的参与者相比，[Formula: see text]暴露的第四和五分位数的参与者发展 CKD 的风险增加，调整年龄、性别、教育水平、吸烟、饮酒、体重指数、收缩压、空腹血糖、总胆固醇和自我报告的心脏病或中风后，HR[95%置信区间（CI）]分别为 1.11（1.02，1.22）和 1.15（1.05，1.26）。观察到显著的浓度反应趋势（[Formula: see text]）。[Formula: see text]浓度每增加[Formula: see text]，发生 CKD 的风险增加 6%（HR：1.06，95%CI：1.02，1.10）。敏感性和分层分析得出了类似的结果。
长期暴露于环境[Formula: see text]与 CKD 发展风险增加有关。我们的研究结果强化了制定全球减少空气污染战略以预防 CKD 的紧迫性。
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