Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Am J Kidney Dis. 2020 Nov;76(5):645-657.e1. doi: 10.1053/j.ajkd.2020.02.447. Epub 2020 May 30.
RATIONALE & OBJECTIVE: Limited evidence concerns fine particulate matter (with aerodynamic diameter ≤ 2.5μm [PM]) exposure and the risk for kidney failure with replacement therapy (KFRT). This study assessed whether PM exposure was associated with progression of chronic kidney disease (CKD) to KFRT.
Prospective cohort study.
SETTING & PARTICIPANTS: 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 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 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/m greater PM, 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 levels). There was no significant association between PM and all-cause mortality (adjusted HR, 1.01 [95% CI, 0.95-1.08]).
Misclassification of PM exposure assessment and the potential for residual confounding.
Our findings suggest that long-term exposure to PM is associated with increased risk for progression to KFRT in patients with CKD.
关于细颗粒物（空气动力学直径≤2.5μm[PM]）暴露与接受替代治疗的肾衰竭（KFRT）风险的证据有限。本研究评估了 PM 暴露是否与慢性肾脏病（CKD）进展至 KFRT 相关。
前瞻性队列研究。
2003 年至 2015 年期间，从台湾的 ADVANCED CKD 项目中招募了 6628 名患有 CKD 的成年患者。
使用基于卫星的时空模型来计算每位患者在入组 ADVANCED CKD 项目之前 1 年内的 PM 暴露量。
KFRT（定义为开始维持性血液透析、腹膜透析或肾移植）和全因死亡率的时间。
使用多变量比例风险回归分析来估计 PM 与 KFRT 和全因死亡率的关联。使用限制立方样条来探索剂量-反应关系。
该研究人群包括 6628 名年龄在 20 至 90 岁之间的患有 CKD 的成年患者。在随访期间发生了 941 例 KFRT 事件和 1653 例死亡。每增加 7.8μg/m 的 PM，进展为 KFRT 的调整后 HR 为 1.19（95%CI，1.08-1.31），这一数值跨越了四分位间距。存在剂量-反应关系的证据（调整后的 HRs 为 1.16[95%CI，0.90-1.51]、1.19[95%CI，0.94-1.52]和 1.42[95%CI，1.12-1.80]，对应于低、中、高 PM 水平）。PM 与全因死亡率之间无显著关联（调整后的 HR，1.01[95%CI，0.95-1.08]）。
PM 暴露评估的分类错误和潜在的残余混杂因素。
我们的研究结果表明，长期暴露于 PM 与 CKD 患者进展为 KFRT 的风险增加相关。
