Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China.
Department of Surveying and Remote Sensing Science, School of Geosciences and Info-physics, Central South University, Changsha, China.
Am J Kidney Dis. 2022 Nov;80(5):638-647.e1. doi: 10.1053/j.ajkd.2022.03.009. Epub 2022 Apr 22.
RATIONALE & OBJECTIVE: Increasing evidence has linked ambient fine particulate matter (ie, particulate matter no larger than 2.5 μm [PM]) to chronic kidney disease (CKD), but their association has not been fully elucidated, especially in regions with high levels of PM pollution. This study aimed to investigate the long-term association of high PM exposure with incident CKD in mainland China.
Prospective cohort study.
SETTING & PARTICIPANTS: 72,425 participants (age ≥18 years) without CKD were recruited from 121 counties in Hunan Province, China.
Annual mean PM concentration at the residence of each participant derived from a long-term, full-coverage, high-resolution (1 × 1 km), high-quality dataset of ground-level air pollutants in China.
Incident CKD during the interval between the baseline examination of each participant (2005-2017) and the end of follow-up through 2018.
Cox proportional hazards models were used to estimate the independent association of PM with incident CKD and the joint association of PM with temperature or humidity on the development of PM-related CKD. Restricted cubic splines were used to model exposure-response relationships.
Over a median follow-up of 3.79 (IQR, 2.03-5.48) years, a total of 2,188 participants with incident CKD were identified. PM exposure was associated with incident CKD with an adjusted hazard ratio of 1.71 (95% CI, 1.58-1.85) per 10-μg/m greater long-term exposure. Multiplicative interactions between PM and humidity or temperature on incident CKD were detected (all P < 0.001 for interaction), whereas an additive interaction was detected only for humidity (relative risk due to interaction, 3.59 [95% CI, 0.97-6.21]).
Lack of information on participants' activity patterns such as time spent outdoors.
Greater long-term ambient PM pollution is associated with incident CKD in environments with high PM exposure. Ambient humidity has a potentially synergetic effect on the association of PM with the development of CKD.
PLAIN-LANGUAGE SUMMARY: Exposure to a form of air pollution known as fine particulate matter (ie, particulate matter ≤2.5 μm [PM]) has been linked to an increased risk of chronic kidney disease (CKD), but little is known about how PM affects CKD in regions with extremely high levels of PM pollution. This longitudinal cohort study in China investigates the effect of PM on the incidence of CKD and whether temperature or humidity interact with PM. Our findings suggest that long-term exposure to high levels of ambient PM significantly increased the risk of CKD in mainland China, especially in terms of cumulative average PM. The associations of PM and incident CKD were greater in high-humidity environments. These findings support the recommendation that reducing PM pollution should be a priority to decrease the burden of associated health risks, including CKD.
越来越多的证据表明，环境细颗粒物（即直径不超过 2.5μm 的颗粒物）与慢性肾脏病（CKD）有关，但它们之间的关联尚未完全阐明，尤其是在细颗粒物污染水平较高的地区。本研究旨在探讨中国内地长期高 PM 暴露与 CKD 发病的关系。
前瞻性队列研究。
本研究纳入了来自中国湖南省 121 个县的 72425 名无 CKD 的参与者（年龄≥18 岁）。
根据中国地面空气污染物的长期、全覆盖、高分辨率（1×1km）、高质量数据集，得出每位参与者居住地的年平均 PM 浓度。
在每位参与者的基线检查（2005-2017 年）至 2018 年底随访结束期间，发生 CKD。
采用 Cox 比例风险模型估计 PM 与 CKD 发病的独立关联，以及 PM 与温度或湿度对 PM 相关 CKD 发病的联合关联。采用限制性立方样条模型来建立暴露-反应关系。
在中位随访时间为 3.79 年（IQR，2.03-5.48 年）期间，共发现 2188 例 CKD 发病患者。PM 暴露与 CKD 发病有关，长期每增加 10μg/m，调整后的风险比为 1.71（95%CI，1.58-1.85）。PM 与湿度或温度之间的交互作用存在多效性（所有 P 值均<0.001），但仅在湿度方面存在相加性交互作用（交互作用的相对危险度为 3.59[95%CI，0.97-6.21]）。
缺乏参与者户外活动时间等活动模式的信息。
在 PM 暴露水平较高的环境中，长期接触大气细颗粒物与 CKD 发病有关。环境湿度可能对 PM 与 CKD 发病之间的关系产生协同作用。
