School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China.
Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02912, USA.
Chemosphere. 2020 May;247:125913. doi: 10.1016/j.chemosphere.2020.125913. Epub 2020 Jan 13.
Emerging epidemiologic studies suggested that particulate matter (PM) was a risk factor for the incidence of chronic kidney disease (CKD). However, few studies were conducted to examine whether PM was associated with cause-specific deaths in the CKD progression. This study aimed to estimate the association between fine particulate matter (PM) and a spectrum of deaths among CKD patients. We took leverage of the Elderly Health Service cohort (n = 66,820), a large Hong Kong elderly cohort followed up till 2010. A total of 902 CKD incident patients in the cohort were identified during the follow-up period. We estimated yearly PM at the residential address for each CKD patient based on a satellite-based spatiotemporal model. We used Cox proportional hazards models with attained age as the underlying timescale to assess the association between long-term exposure to PM and cause-specific mortality among CKD patients. A total of 496 patients died during the follow-up, where 147 died from cardiovascular disease, 61 from respiratory disease and 154 from renal failure. The mortality hazard ratio (HR) per interquartile-range increase in PM (4.0 μg/m) was 1.97 (95% confidence interval (CI): 1.34 to 2.91) for ischemic heart disease (IHD) among CKD patients, and was 1.42 (95%CI: 1.05 to 1.93) for CKD among those patients concomitantly with hypertension. Associations were not of statistical significance between PM and mortality hazard ratios of all-cause, stroke, and pneumonia among CKD patients. Our findings suggest that long-term exposure to PM may contribute to the CKD progression into ischemic heart diseases.
新兴的流行病学研究表明，颗粒物（PM）是慢性肾脏病（CKD）发病的一个危险因素。然而，很少有研究调查 PM 是否与 CKD 进展过程中的特定原因死亡有关。本研究旨在评估细颗粒物（PM）与 CKD 患者各种死亡原因之间的关联。我们利用老年服务队列（n=66820），这是一个对香港老年人进行随访至 2010 年的大型队列。在随访期间，队列中共有 902 名 CKD 新发病例。我们根据基于卫星的时空模型，为每位 CKD 患者在居住地址估算每年的 PM 值。我们使用 Cox 比例风险模型，以达到的年龄为基础时间尺度，评估 CKD 患者长期暴露于 PM 与特定原因死亡率之间的关联。在随访期间，共有 496 名患者死亡，其中 147 人死于心血管疾病，61 人死于呼吸疾病，154 人死于肾衰竭。PM（每增加 4.0μg/m）每四分位间距的死亡率风险比（HR）为 1.97（95%置信区间：1.34 至 2.91），用于 CKD 患者的缺血性心脏病（IHD），而对于同时患有高血压的患者，HR 为 1.42（95%CI：1.05 至 1.93）。PM 与 CKD 患者全因、中风和肺炎的死亡率风险比之间没有统计学意义的关联。我们的研究结果表明，长期暴露于 PM 可能导致 CKD 进展为缺血性心脏病。
