Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina.
Oak Ridge Institute for Science and Education at the United States Environmental Protection Agency, National Health and Environmental Effects Research Laboratory, Environmental Public Health Division, Research Triangle Park, North Carolina.
Kidney360. 2023 Jan 1;4(1):63-68. doi: 10.34067/KID.0003822022.
Ambient particles with a median aerodynamic diameter of <2.5 µm (PM2.5) is a ubiquitous air pollutant with established adverse health consequences. While postulated to promote a systemic inflammatory response, limited studies have demonstrated changes in serum biomarkers related to PM2.5 exposure. We aim to examine associations between short-term PM2.5 exposure and commonly measured biomarkers known to be affected by inflammation among patients receiving maintenance in-center hemodialysis.
We conducted a retrospective open cohort study from January 1, 2008, to December 31, 2014. Adult hemodialysis patients were identified from the United States Renal Data System and linked at the patient level to laboratory data from a large dialysis organization. Daily ambient PM2.5 was estimated on a 1-km grid and assigned to cohort patients based on the ZIP codes of dialysis clinics. Serum albumin, serum ferritin, transferrin saturation (TSAT), and serum hemoglobin were ascertained from the dialysis provider organization database. Mixed-effect models were used to assess the changes in biomarker levels associated with PM2.5 exposure.
The final cohort included 173,697 hemodialysis patients. Overall, the daily ZIP-level ambient PM2.5 averages were 8.4-8.5 µg/m3. A 10-µg/m3 increase in same-day ambient PM2.5 exposure was associated with higher relative risks of lower albumin (relative risk [RR], 1.01; 95% confidence interval [95% CI], 1.01 to 1.02) and lower hemoglobin (RR, 1.02; 95% CI, 1.01 to 1.03). Associations of same-day ambient PM2.5 exposure and higher ferritin and lower TSAT did not reach statistical significance.
Short-term PM2.5 exposure was associated with lower serum hemoglobin and albumin among patients receiving in-center hemodialysis. These findings lend support to the role of inflammation in PM2.5 exposure-outcome associations.
中位空气动力学直径小于 2.5 µm（PM2.5）的环境颗粒是一种普遍存在的空气污染物，其对健康有不良影响。虽然推测 PM2.5 暴露会导致全身炎症反应，但有限的研究表明，与 PM2.5 暴露相关的血清生物标志物发生了变化。我们旨在研究短期 PM2.5 暴露与炎症相关的常见血清生物标志物之间的关联，这些生物标志物在接受中心维持性血液透析的患者中受到影响。
我们进行了一项回顾性开放队列研究，时间为 2008 年 1 月 1 日至 2014 年 12 月 31 日。从美国肾脏数据系统中确定成年血液透析患者，并在患者层面上与大型透析组织的实验室数据相关联。每天在 1 公里的网格上估计环境 PM2.5，并根据透析诊所的邮政编码将其分配给队列患者。从透析提供者组织数据库中确定血清白蛋白、血清铁蛋白、转铁蛋白饱和度（TSAT）和血清血红蛋白。混合效应模型用于评估与 PM2.5 暴露相关的生物标志物水平变化。
最终队列包括 173697 名血液透析患者。总体而言，每日 ZIP 级环境 PM2.5 平均值为 8.4-8.5 µg/m3。当日环境 PM2.5 暴露增加 10 µg/m3，与白蛋白降低的相对风险增加相关（相对风险 [RR]，1.01；95%置信区间 [95%CI]，1.01 至 1.02）和血红蛋白降低（RR，1.02；95%CI，1.01 至 1.03）。当日环境 PM2.5 暴露与铁蛋白升高和 TSAT 降低之间的关联未达到统计学意义。
短期 PM2.5 暴露与中心血液透析患者的血清血红蛋白和白蛋白降低有关。这些发现支持炎症在 PM2.5 暴露-结局关联中的作用。
