Nephrology Department, New Taipei City Hospital, New Taipei City, Taiwan; Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.
Nephrology Department, New Taipei City Hospital, New Taipei City, Taiwan.
Environ Pollut. 2023 Jan 1;316(Pt 2):120606. doi: 10.1016/j.envpol.2022.120606. Epub 2022 Nov 8.
Fine particulate matter (PM) has been reported to be associated with increased risk of chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). However, studies on whether long-term exposure to PM negatively impacts the survival of patients with ESRD are very limited. To conduct this study, we linked Taiwan Air Quality-Monitoring Database (TAQMD) and the National Health Insurance Research Database (NHIRD) by zip-code. A retrospective population-based cohort of 34,088 adult patients initiating dialysis over six months was formed. Cox proportional regression models were used to estimate the risk of mortality in dialysis patients per 10-μg/m increase of PM and by PM levels divided into quintiles. Restricted cubic spline analysis was performed to delineate the concentration-response relationship between PM and mortality. The adjusted hazard ratio (aHR) per 10-μg/m increase of PM for mortality was 1.11 (95% confidence interval [CI] = 1.08-1.13). When analyzing PM exposure divided into quintiles, patients with mean PM exposure over 29.33 μg/m, including level III (aHR 1.00, 95% CI = 0.94-1.07), level IV (aHR 1.09; 95% CI = 1.03-1.16), and level V (HR 1.11; 95% CI = 1.05-1.19), were at stepwise higher risks of mortality compared with level I. Spline analysis showed a non-linear concentration-response function between PM and mortality, with the lowest mortality aHR identified at a mean PM of 26 μg/m, followed by a concentration interval with a gradual increase of aHR, and finally a steep rise of mortality risk when mean PM exceeded 37 μg/m. Individuals with older age, those were male, with selected comorbidities, and with low socioeconomic status (SES) were at higher mortality risk. Male and non-diabetics participants were more sensitive to the effect of a 10-μg/m of PM increase on mortality than their counterparts. In conclusion, long-term exposure to PM exceeding a threshold was observed to be associated with increased risk of mortality among dialysis patients.
细颗粒物（PM）已被报道与慢性肾脏病（CKD）风险增加和进展至终末期肾病（ESRD）有关。然而，关于长期暴露于 PM 是否会对 ESRD 患者的生存产生负面影响的研究非常有限。为了进行这项研究，我们通过邮政编码将台湾空气质量监测数据库（TAQMD）和国家健康保险研究数据库（NHIRD）进行了链接。建立了一个由 34088 名接受透析治疗超过六个月的成年患者组成的回顾性基于人群的队列。使用 Cox 比例风险回归模型来估计每增加 10μg/m3 PM 时透析患者的死亡率风险，并按 PM 水平分为五分位数。进行限制立方样条分析以描绘 PM 与死亡率之间的浓度-反应关系。PM 每增加 10μg/m3 死亡率的调整后的危害比（aHR）为 1.11（95%置信区间[CI] = 1.08-1.13）。当分析分为五分位数的 PM 暴露时，PM 暴露均值超过 29.33μg/m3 的患者，包括水平 III（aHR 1.00，95%CI = 0.94-1.07）、水平 IV（aHR 1.09；95%CI = 1.03-1.16）和水平 V（HR 1.11；95%CI = 1.05-1.19），与水平 I 相比，死亡率的风险逐渐升高。样条分析显示 PM 与死亡率之间存在非线性浓度-反应关系，最低死亡率 aHR 出现在 PM 均值为 26μg/m3 时，随后是 aHR 逐渐增加的浓度间隔，最后当 PM 均值超过 37μg/m3 时死亡率风险急剧上升。年龄较大、男性、患有某些合并症和社会经济地位（SES）较低的个体死亡率风险较高。男性和非糖尿病患者对 PM 每增加 10μg/m3 对死亡率影响的敏感性高于其对应者。总之，观察到长期暴露于超过阈值的 PM 与透析患者的死亡率风险增加有关。
